Induction Chemotherapy and Sequential Concomitant Chemo-radiation in Locally Advanced Head and Neck Cancers: How Induction-phase Intensity and Treatment Breaks May Impact on Clinical Outcomes.
OBJECTIVE
The purpose of the study was to assess outcomes of locally advanced head and neck (LAHNC) treated with induction chemotherapy (ICT) and subsequent concurrent chemo-radiation.


METHODS
A total of 71 LAHNC patients were treated with 2-3 cycles of docetaxel, cisplatin and 5-fluorouracil as induction chemotherapy and subsequent concurrent chemoradiation with weekly cisplatin or carboplatin. Definitive radiotherapy was delivered with intensity-modulated radiation and a simultaneous integrated boost approach up to a total dose of 70 Gy in 35 fractions to the macroscopic primary and nodal disease.


RESULTS
Actuarial 2-year OS, CSS, DFS, MFS, LC were 55.3% (95%CI=39.3-68.6), 58.6% (95%CI=41.9-72), 60.5% (95%CI=47.3-71.4), 87.3% (95%CI=76.2-93.5) and 74.7% (95%CI=61.5-83.9), respectively. On multivariate analysis undergoing to 3 vs. 2 cycles of TPF (HR=22.31; 95%CI=2.68-185.66; p=0.004) and radiotherapy treatment break >4 days (HR=1.28; 95%CI=1.06-1.55; p=0.01) negatively affected cancer-specific survival (CSS) with statistical significance. Achieving complete remission after ICT had a statistically significant impact on CSS (HR=0.9; 95%CI=0.01-0.54; p=0.009). Patients undergoing ICT with 3 cycles had more frequently treatment breaks compared to those submitted to 2 cycles (HR=1.36; 95%CI=1.06-1.73; p=0.01), and had statistically significant longer treatment break time (5.9+1.8 vs. 3+0.36; p=0.02).


CONCLUSIONS
A shorter ICT phase may be a better option enhancing patients' tolerance during concurrent chemoradiation and affecting clinical outcomes.
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy pierfrancesco.franco@unito.it.
Pierfrancesco
P
Franco
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
Ilenia
I
Potenza
Department of Oncology, 1st Medical Oncology Division, AOU Città della Salute e della Scienza, Turin, Italy.
Marina
M
Schena
Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy.
Giuseppe
G
Riva
Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy.
Giancarlo
G
Pecorari
Department of Surgical Sciences, Maxillofacial Surgery Division, University of Turin, Turin, Italy.
Paolo
P
Garzino Demo
Department of Surgical Sciences, Maxillofacial Surgery Division, University of Turin, Turin, Italy.
Massimo
M
Fasolis
Department of Medical Imaging and Radiotherapy, AOU Città della Salute e della Scienza, Turin, Italy.
Francesco
F
Moretto
Department of Surgical Sciences, 1st ENT Division, University of Turin, Turin, Italy.
Massimiliano
M
Garzaro
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
Jacopo
J
Di Muzio
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
Marco
M
Melano
Department of Oncology, 2nd Medical Oncology Division, AOU Città della Salute e della Scienza, Turin, Italy.
Mario
M
Airoldi
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
Riccardo
R
Ragona
Department of Medical Imaging and Radiotherapy, AOU Città della Salute e della Scienza, Turin, Italy.
Monica
M
Rampino
Department of Oncology, Radiation Oncology, University of Turin, Turin, Italy.
Umberto
U
Ricardi
D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D059248:Chemoradiotherapy; D002945:Cisplatin / Q000008:administration & dosage; D000077143:Docetaxel; D005260:Female; D005472:Fluorouracil / Q000008:administration & dosage; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D006801:Humans; D060828:Induction Chemotherapy; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D009367:Neoplasm Staging; D011379:Prognosis; D050397:Radiotherapy, Intensity-Modulated; D012074:Remission Induction; D012189:Retrospective Studies; D015996:Survival Rate; D043823:Taxoids / Q000008:administration & dosage; D013997:Time Factors
D043823:Taxoids; D000077143:Docetaxel; D002945:Cisplatin; D005472:Fluorouracil
Induction chemotherapy; concomitant chemo-radiation; head and neck cancer; intensity-modulated radiotherapy; treatment breaks