Toxicity profile and clinical outcomes in locally advanced head and             neck cancer patients treated with induction chemotherapy prior to concurrent chemoradiation.
The use of induction chemotherapy prior to chemoradiation for locally advanced             head and neck squamous cell carcinoma (LA-HNSCC) remains controversial. We explored             whether toxicity from induction chemotherapy influenced the delivery of concurrent             chemoradiation. Among 171 consecutive previously unirradiated patients with HNSCC             treated with combined chemotherapy and radiation, we identified 66 patients with             stage III-IVB head and neck carcinoma who were treated with induction chemotherapy             prior to planned chemoradiation. The most common induction regimen was docetaxel,             cisplatin and 5-FU (TPF; 80%) for 2 to 3 cycles. Mean radiation dose was 72 Gy             (range, 36-75 Gy). Concurrent chemotherapy regimens included cisplatin (26%),             cetuximab (5%) and 5-fluorouracil/hydroxyurea (65%)-based regimens. At a median             follow-up of 27 months (range, 9-56 months), the 2-year locoregional control and             distant control rates were 85 and 86%, respectively. The 2-year disease-free survival             and overall survival rates were 74 and 80%, respectively. Although there were             no grade 5 toxicities during induction chemotherapy, 26% of patients required             hospitalization for adverse events, including 5% needing intensive care. The most             common high grade adverse events were grade 4 neutropenia (21%) and neutropenic             fever (17%). Six percent of patients were unable to tolerate concurrent chemotherapy.             The 2-year disease-free survival was significantly higher in patients able to             complete induction and concurrent chemoradiation as planned (83 vs. 27%, p<0.001).             Induction chemotherapy followed by concurrent chemoradiation results in promising             survival rates in our cohort of advanced head and neck carcinoma patients. Due             to severe toxicities in a subset of patients, this strategy is only recommended             in selected high-risk patients who are carefully followed by an experienced multidisciplinary             team.
Department of Radiation Oncology, Mount Sinai Medical Center,                     New York, NY, USA.
Eric C
EC
Ko
Eric M
EM
Genden
Krzysztof
K
Misiukiewicz
Peter M
PM
Som
Lale
L
Kostakoglu
Chien-Ting
CT
Chen
Stuart
S
Packer
Johnny
J
Kao
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D005260:Female; D006258:Head and Neck Neoplasms / Q000188:drug therapy / Q000532:radiotherapy / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy / Q000009:adverse effects*; D008297:Male; D055118:Medication Adherence; D008875:Middle Aged; D009367:Neoplasm Staging; D050397:Radiotherapy, Intensity-Modulated / Q000009:adverse effects*; D012307:Risk Factors; D000077195:Squamous Cell Carcinoma of Head and Neck; D016019:Survival Analysis; D016896:Treatment Outcome; D055815:Young Adult