Induction chemotherapy with docetaxel and cisplatin versus docetaxel, cisplatin and fluorouracil followed by concomitant chemoradiation in locally advanced squamous cell carcinoma of the head and neck

Abstract

The administration of chemotherapy in conjunction with radiotherapy in the treatment of patients with locally advanced head and neck carcinoma has been broadly explored. For many years, chemotherapy has been administered in the adjuvant or neoadjuvant settings and, more recently, concurrently with radiotherapy. The concurrent administration of chemotherapy and radiotherapy has been the most promising approach, given that the dominant pattern of failure with radiotherapy is local and regional relapse. Recently, the sequential approach, using induction and concurrent chemoradiation has been investigated. In this study we compared induction by docetaxel / cisplatin versus docetaxel / cisplatin / 5FU, followed by concurrent chemoradiation.

The tested regimen was found effective with manageable acute toxicity when appropriate supportive care was employed. After TP induction, 81% of our patients achieved an overall response versus 85.7% in the TPF arm (P = .598). The occurrence of CR or PR after induction chemotherapy was an indicator of statistically longer overall survival.

As regard the survival analysis, there was no significant difference in median progression free survival. Median overall survival in our study was not reached due to the short follow up period. Survival rate at 1 year for the TP arm and the TPF arm respectively was 71% and 90.5% and the actuarial survival rate at 2 years was 53% and 50% respectively.

When comparing the TP and TPF arms respectively, laryngeal cancer patients had respectively a numerically better median OS (21 months vs 16 months) and median PFS (14 months vs 10 months), but this was not statistically significant. Median PFS in hypopharyngeal cancer patients treated with TP was much lower than in the TPF counterpart (8 months vs 17 months).

When looking at subgroups according to disease stage, the most important factor affecting survival was the T stage. T1 and T2 tumours had a median PFS of 25 months versus 14.5 months in the T3 and T4 tumours, irrespective of the treatment received.