NEOADJUVANT CHEMOTHERAPY FOLLOWED BY CONCURRENT CHEMORADIATION FOR LOCALLY ADVANCED HEAD AND NECK CANCERS

Abstract

Background: The administration of chemotherapy with radiotherapy in the treatment of patients with locally advanced head and neck carcinoma has been broadly used. For many years, chemotherapy has been administered in the adjuvant or neoadjuvant settings and concurrently with radiotherapy. Objective: To evaluate the role of neoadjuvant chemotherapy before concurrent chemoradiotherapy in treatment of locally advanced head and neck cancers regarding overall survival, progression free survival, toxicity and organ preservation. Patients and Methods: A 40 patients (all of whom had stage III or IVA disease with no distant metastases and tumors considered to be unresectable or were candidates for organ preservation) received 3 cycles of TPF (docetaxel plus cisplatin and fluorouracil) induction chemotherapy, followed by chemoradiotherapy with weekly carboplatin and radiotherapy (70 Gy over 7 weeks) for 5 days per week. Results: With a minimum of 6 months of follow-up (median follow up period 14.3 months), over all response rate was 95% with complete remission in 30 patients (75%), partial response in 3 patients (7.5%), stationary disease in 5 patients (12.5%) and progressive disease in 2 patients (5%). The median overall survival was not reached and 3 years survival was 62.8%. The toxicity associated with this protocol was controlled and no chemotherapy associated deaths recorded. Conclusion: Induction chemotherapy by TPF is a reasonable approach for unresectable locally advanced head and neck squamous cell carcinoma and organ preservation for laryngeal and hypopharyngeal cancer patients. Also, it is of benefit in large tumor volume to decrease the volume of radiotherapy and subsequently its toxicity.TPF induction must be considered as one of the standards for larynx preservation.