P0032 Induction chemotherapy for locally advanced head and neck cancer: Retrospective analysis of a single centre experience

Abstract

Background Head and neck squamous cell carcinomas (HNSCC) have an unsatisfactory prognosis despite intensive local treatment. As tumours without prior surgical or radiotherapy treatment respond better to cytostatic therapy, induction chemotherapy is usually administered prior to local or regional standard therapy. We report here compliance to planned treatment and treatment outcomes in patients with surgically unresectable stage III or IV (A or B) HNSCC after 1 year of induction chemotherapy. Methods We performed a single-institution retrospective analysis of 60 patients with stage III or IV HNSCC, treated with induction chemotherapy between January, 2012, and December, 2012. The treatment for these patients was a non-surgical approach of induction chemotherapy followed by chemoradiotherapy. Patients were scheduled to receive one to three cycles of induction chemotherapy consisting of four regimens. Analysis included treatment and follow-up data at 12 months. Findings Only 38 (63%) patients received all three planned cycles of induction chemotherapy, 15 (25%) patients completed two out of three cycles, and the rest of the patients defaulted during the initial course of treatment. Only 20 (33%) patients received subsequent radiation treatment after induction chemotherapy. The remaining 40 (67%) failed to receive radiation therapy. Among the 20 patients who received subsequent radiation treatment, 17 were treated with radical intent and three with palliative intent. Only 12 of these 17 patients received concurrent chemoradiotherapy following induction chemotherapy, as initially planned. Details of patient characteristics and treatment regimens will be presented. Interpretation Poor compliance of patients to planned final treatment is the most common pitfall in the use of induction chemotherapy in developing countries. Periodic assessment of response to treatment and early initiation of radiation therapy in non-responders should be the cornerstone of future strategies. Despite intensive treatment, prognosis for this highly advanced HNSCC population is poor so there is a need for targeted therapies.