Head and Neck Cancer
PV QA 2 - Poster Viewing Q&A 2
Purpose/Objective(s): Induction chemotherapy (IC) in locally advanced head and neck cancer (HNC) has not shown any survival benefit in spite of higher response rates. We tested relatively less toxic IC using gemcitabine and cisplatin (GC) in these patients having two things in mind . Firstly, reduction in IC treatment duration leading to less chance of resistant clonogens to repopulate and secondly reduce the burden of indoor patients in overloaded department by outpatient treament. Hypofractionated radiotherapy (HRT) was used to reduce the overall treatment time.
Materials/Methods: A total of 105 patients with biopsy proven HNC were included. Patients having primary tumor in oropharynx (29), larynx (35) and hypopharynx (41) with TNM stage III to IVB were selected. The patients were planned for three cycles of GC every three weeks in a dose of 1000 mg/m² and 50 mg/m² on D1 and D8 of each cycle respectively. After three cycles of chemotherapy, patients were planned for HRT. A total of 55 Gray (Gy) was planned with 2.75 Gy per fraction and five fractions a week. Spinal cord dose was limited to 33 Gy. Necessary treatment interruptions were allowed depending upon IC and HRT related toxicity. Primary end point was to assess disease free survival (DFS) while overall survival (OS) was also assessed as a secondary end point.
Results: 94 patients (90%) were available for evaluation while rest of the patients were unable to complete the planned treatment protocol. Eight patients (8%) showed disease recurrence during treatment and were offered some other treatment. DFS and OS were calculated for 86 patients. Four year DFS and OS were 37% and 46% respectively. Mean and median DFS (year) were 3.12±0.11 (95% confidence interval [CI] 2.89-3.34) and 3.24±0.39 (CI 2.46-4.02) respectively. Mean and median OS (year) were 3.99±0.099 (CI 3.79-4.18) and 4.01±0.21 (CI 3.59-4.43) respectively.
Conclusion: Induction CC followed by HRT is a reasonable in locally advanced HNC. A larger phase III randomized trial is warranted to define its role before routinely recommending in these patients.
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