title: Current attitudes of head and neck oncologists in the United Kingdom to induction chemotherapy for locally advanced head and neck cancer: a survey of centres participating in a national randomised controlled trial.
abstract: OBJECTIVE
  Induction chemotherapy (IC) followed by chemoradiation (CRT) for locally advanced squamous cell head and neck cancer (SCCHN) remains controversial in the absence of clear evidence to define its role. As part of a prospective, randomised, multicentre study of CRT for stage III/IV laryngeal/hypopharyngeal cancers (ART DECO, CRUK/10/018), we have examined the attitudes of oncologists in the United Kingdom (UK) to IC.
  
  
  METHODS
  Head and neck oncologists across the UK who expressed an interest in participating in the ART DECO trial were asked to complete a short written questionnaire designed to identify current UK practice of IC for stage III-IVb SCCHN. Completed questionnaires were returned to the clinical trials office prior to patient recruitment.
  
  
  RESULTS
  Clinicians from twenty-five/48 centres (52.1%) responded. Twenty centres (80%) elected to use IC in the trial. For stage III disease, 80% of centres did not prescribe IC for T1N1 disease and 60% did not offer IC for T3N0 disease. Patients with bulky primary tumours or extensive nodal disease were more likely to receive IC. Thirteen prescribing centres (65%) use 3 drugs (docetaxel, cisplatin, and 5-fluorouracil) compared to 7 (35%) using 2 drugs (cisplatin and 5-fluorouracil). Fifteen centres (75%) prescribed 2 cycles of IC, and 5 (25%) prescribed 3 cycles. There was variation in the dosage for both the 2- and 3-drug regimens.
  
  
  CONCLUSIONS
  Results suggest that clinical practice in the UK is currently divided between a 2- versus 3-drug regimen for IC for specific subgroups of patients. A consensus regarding the optimal combinations and dosages is required before further optimization of systemic therapy with other cytotoxics and biological agents is attempted.
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK.
authors.forename: D M
authors.initials: DM
authors.lastname: Gujral
authors.affiliation: Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK.
authors.forename: D
authors.initials: D
authors.lastname: Piercy
authors.affiliation: Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK.
authors.forename: J P
authors.initials: JP
authors.lastname: Morden
authors.affiliation: Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Emson
authors.affiliation: Clinical Trials and Statistics Unit, Institute of Cancer Research, London, UK.
authors.forename: E
authors.initials: E
authors.lastname: Hall
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK.
authors.forename: A B
authors.initials: AB
authors.lastname: Miah
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK.
authors.forename: S A
authors.initials: SA
authors.lastname: Bhide
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK.
authors.forename: K L
authors.initials: KL
authors.lastname: Newbold
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK.
authors.forename: K J
authors.initials: KJ
authors.lastname: Harrington
authors.affiliation: Head and Neck Unit, The Royal Marsden Hospital, London, UK; Division of Radiotherapy and Imaging, Institute of Cancer Research, London, UK. Electronic address: Christopher.Nutting@rmh.nhs.uk.
authors.forename: C M
authors.initials: CM
authors.lastname: Nutting
mesh_terms: D001291:Attitude of Health Personnel; D006801:Humans; D007012:Hypopharyngeal Neoplasms / Q000188:drug therapy*; D060828:Induction Chemotherapy / Q000706:statistics & numerical data*; D007822:Laryngeal Neoplasms / Q000188:drug therapy*; D008495:Medical Oncology / Q000379:methods*; D006113:United Kingdom
keywords: Advanced; Chemoradiation; Chemotherapy; Head-and-neck cancer; Induction