title: Sequential therapy (triple drug-based induction chemotherapy followed by concurrent chemoradiotherapy) in locally advanced inoperable head and neck cancer patients - Single institute experience.
abstract: BACKGROUND
  India has a high incidence of head and neck squamous cell carcinoma (HNSCC) mostly presenting in advanced stage. In the majority of inoperable patients a combination of chemotherapy and radiotherapy (CRT) is considered as the treatment of choice. Adding induction chemotherapy (ICT) before CRT has shown to decrease systemic relapse. Incorporation of taxanes to the cisplatin and 5-FU-based ICT has shown increase in response rates.
  
  
  OBJECTIVE
  To evaluate the efficacy and toxicity of triple drug-based ICT followed by CCRT in locally advanced, inoperable HNSCC in the Indian context.
  
  
  METHODS
  Prospective, non-controlled, observational study, a single-institute experience.
  
  
  METHODS
  Consecutive, locally advanced inoperable HNSCC patients were put on sequential therapy consisting of docetaxel, 5-FU and cisplatin for three cycles followed by concurrent weekly cisplatin and radiotherapy for responding or stable disease patients.
  
  
  RESULTS
  Forty-four patients were enrolled with male,female ratio of 33/44(75%) and 11/44(25%). Hypopharynx 16/44(36.36%) was the most common site followed by oral cavity 12/44(27.27%) and oropharynx 12/44(27.27%); 38/44(86.36%) patients could complete the planned treatment. Seven patients required dose reduction in ICT. As per the RECIST criteria, 16 patients had Complete Response (CR) and 15 had partial response (PR), 10 had stable disease (SD) and three had progressive disease (PD) after ICT. Thirty-eight patients received concomitant chemo radiotherapy (CCRT); 28/44 (66.63%) patients achieved CR, 10/44 (22.72 %) had PR. The main toxicity was mucositis 18/44 (40.90%) secondary to ICT. Grade III and IV hematological toxicity was seen in 16/44(36.36%), of which 6/44 (13.63%) had febrile neutropenia.
  
  
  CONCLUSIONS
  Triple drug-based sequential therapy is tolerable in our context. In this trial from a single institute the results are very encouraging.
authors.affiliation: Department of Medical Oncology, Bhagwan Mahaveer Cancer Hospital and Research Centre, Jaipur, Rajasthan, India.
authors.forename: Naresh
authors.initials: N
authors.lastname: Somani
authors.forename: S
authors.initials: S
authors.lastname: Goyal
authors.forename: R
authors.initials: R
authors.lastname: Pasricha
authors.forename: N
authors.initials: N
authors.lastname: Khuteta
authors.forename: P
authors.initials: P
authors.lastname: Agarwal
authors.forename: A K
authors.initials: AK
authors.lastname: Garg
authors.forename: H
authors.initials: H
authors.lastname: Singhal