Journal
JOURNAL OF CANCER RESEARCH AND THERAPEUTICS
Volume 19, Issue 2, Pages 420-425Publisher
WOLTERS KLUWER MEDKNOW PUBLICATIONS
DOI: 10.4103/jcrt.jcrt_839_22
Keywords
Concurrent chemoradiotherapy; induction chemotherapy; locally advanced head and neck cancer; RECIST; treatment-related toxicity
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This study evaluated the response to induction chemotherapy in inoperable locally advanced head and neck cancer patients. The results showed a complete response rate of 57.7% with induction chemotherapy, with younger patients having a better response. However, a higher grade of radiation-induced mucositis was observed in patients receiving three cycles of induction chemotherapy (ICT) and aged over 50 years.
Introduction: Although concurrent chemoradiotherapy is the standard of care for inoperable locally advanced head and neck cancer, induction chemotherapy is considered an alternative approach by head and neck oncologists worldwide. Aims: To evaluate the response to induction chemotherapy in terms of loco-regional control and treatment-related toxicity in inoperable locally advanced head and neck cancer patients. Materials and Methods: This prospective study was conducted on patients who received two to three cycles of induction chemotherapy. Following this, response assessment was performed clinically. Grading of radiation-induced oral mucositis and any interruptions in treatment were noted. At 8 weeks following treatment, magnetic resonance imaging-based radiological response assessment was performed using RECIST criteria version 1.1. Results: Our data revealed 57.7% complete response rate with induction chemotherapy, followed by chemoradiation therapy. We observed that post induction, 67.5% and 47.5% patients had reduction in T-stage (<0.001) and N-stage of disease (<0.001), respectively, with complete response more achieved in younger patients (<= 50 years). Chemotherapy-induced bone marrow suppression and febrile neutropenia occurred in 7.5% patients. We demonstrated that a higher grade of radiation-induced mucositis was noticed among those receiving three cycles of induction chemotherapy (ICT) and aged >50 years. Conclusion: We conclude that induction chemotherapy could still be a viable option for down-staging unresectable locally advanced disease, especially for younger patients in terms of better treatment response and tolerability. The number of cycles of ICT seems to influence radiation-induced mucositis. This study underscores the need for further studies to determine the exact role of ICT in locally advanced head and neck cancer.
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