Impact Of Induction Chemotherapy Research Articles

Impact of induction chemotherapy on Resectability in Locally advanced oral cavity Carcinomas

Purpose: We aim to assess resectability in patients with locally advanced oral cavity squamous cell carcinomas with induction chemotherapy (ICT). Methods: All stage III-IVB oral squamous cell carcinoma patients with borderline resectable (suspected R1) or unresectable disease (stage IVB, except internal carotid artery encasement or pterygoid plate or skull base involvement) recruited between January 2020 and August 2021 at a tertiary care hospital received 2-3 cycles of ICT (standard TPF regimen) followed by a surgical assessment. The primary aim was to evaluate the proportion of patients that became resectable by ICT. Results: Out of 40 patients, 21 were unresectable (stage IVB disease), and 19 were borderline resectable (stage IVA disease) with doubtful resection margins as per the multi-disciplinary discussion. After chemotherapy, 21 patients became resectable (13 out of 19; and 8 out of 21). Thus, resectability was achieved in 52.5% of patients (32.5% for stage IVA and 20% for stage IVB). The median overall survival (OS) in patients who underwent surgery was 20.5 months (95% CI: 16.95-28.25 months) versus 8.0 months (95% CI: 5.74-13.46 months) in patients who remained unresectable after induction chemotherapy (p=0.0001). Conclusions: In our study, induction chemotherapy leads to improved surgical resection rates with acceptable toxicities in a significant proportion of unresectable locally advanced oral cancers, with improved overall survival significantly.

Impact of induction chemotherapy with concurrent chemoradiotherapy on nasopharyngeal carcinoma: A meta-analysis of randomized controlled trials.

PurposeInduction chemotherapy followed by concurrent chemoradiotherapy (IC-CCRT) may be beneficial for nasopharyngeal carcinoma. However, the evidence on medium- and long-term effects of IC-CCRT is limited, and new randomized controlled trials (RCTs) have been published after 2018. Therefore, this systematic review and meta-analysis compared survival rates between patients with nasopharyngeal carcinoma receiving IC-CCRT or concurrent chemoradiotherapy (CCRT).MethodsFour databases were searched for RCTs on this topic. Two authors independently selected studies, assessed evidence, and extracted data on progression-free survival, overall survival, metastasis-free survival, and local recurrence-free survival. Available data were pooled in a random-effects model and mainly presented in hazard ratio (HR). Heterogeneity and small study effects were also evaluated.ResultsEleven RCTs (n = 3345) were deemed eligible. Pooled results revealed that patients receiving IC-CCRT had significantly improved progression-free survival (HR = 0.66, P < 0.05), overall survival (HR = 0.64, P < 0.05), metastasis-free survival (HR = 0.58, P < 0.05), and local recurrence-free survival (HR = 0.69, P < 0.05) at 3 years, but no significant difference in 5-year overall survival was noted between IC-CCRT and CCRT (HR = 0.84, P > 0.05). Most findings had low heterogeneity.ConclusionIC-CCRT may benefit patients with nasopharyngeal carcinoma in the medium term, although no significant difference was observed in 5-year survival compared with CCRT. All outcomes had decreased survival rate from the 3-years to 5-year follow-up. Differences in patient ethnicities and regimens of IC-CCRT may be sources of heterogeneity.

The impact of induction chemotherapy on long-term quality of life in patients with locoregionally advanced nasopharyngeal carcinoma: Outcomes from a randomised phase 3 trial

BackgroundOur previous trial confirmed that induction chemotherapy (IC) improved long-term survival outcomes in patients with locoregionally advanced nasopharyngeal carcinoma (NPC). In this study, we investigated the impact of IC on long-term quality of life (QoL) in this cohort. MethodsOur trial was a randomised, open-label phase 3 trial comparing IC followed by concurrent chemoradiotherapy (CCRT) versus CCRT alone in patients with stage III-IVB (except T3N0-1) NPC. All participants completed two self-administered questionnaires, the European Organization for Research and Treatment of Cancer (EORTC) Quality of Life Questionnaire C30 (QLQ-C30) and the EORTC QLQ Head and Neck Cancer–Specific Module (H&N35). As per protocol, the questionnaires had to be completed before knowledge of treatment allocation by the patient (baseline). Patients were then approached to enroll at the time of the present study period. ResultsUltimately, QoL data from 228 patients were included in the analysis. Most scales were both statistically and clinically decreased in both groups between baseline and the latest follow-up. The IC followed by CCRT group had significantly better outcome in role functioning, cognitive functioning, social functioning, fatigue, pain, and constipation in QLQ-C30 scales at the last follow-up. Similarly, in H&N35 scales, a significantly better result was observed in pain, sexuality, sticky saliva, pain killers use, nutritional supplements, and weight loss, but a poorer result in senses problems, for those treated by IC followed by CCRT. ConclusionIC followed by CCRT seemed to have better long-term QoL outcomes compared with CCRT alone in patients with locoregionally advanced NPC.

Impact of induction chemotherapy with intermediate-dosed cytarabine and subsequent allogeneic stem cell transplantation on the outcome of high-risk acute myeloid leukemia

BackgroundAcute myeloid leukemia (AML) with antecedent hematological disease (s-AML) and treatment-related AML (t-AML) predicts poor prognosis. Intensive treatment protocols of those high-risk patients should consider allogeneic stem cell transplantation (allo-HSCT) in first complete remission (CR). Despite allo-HSCT, relapse rate remains high. Induction chemotherapy with liposomal cytarabine and daunorubicin (CPX-351) has been approved for patients with AML with myeloid-related changes (AML-MRC) or t-AML based on improved survival and remission rates compared to standard 7 + 3 induction.Patients and methods110 patients with newly diagnosed s-AML or t-AML at a university hospital were analyzed retrospectively. Median age was 62 years (24–77 years). A total of 65 patients with s-AML after MDS (59%) and 23 patients (20.9%) with t-AML were included. Induction chemotherapy consisted of intermediate-dosed cytarabine (ID-AraC) in combination with idarubicin (patients up to 60 years) or mitoxantrone (patients over 60 years). In patients subsequently undergoing allo-HSCT, reduced conditioning regimens (RIC) were applied prior to transplantation in 47 of 62 patients (76%).ResultsInduction chemotherapy with ID-AraC resulted in an overall response rate of 83% including complete remission (CR/CRi) in 69 patients (63%) with a low rate of early death (2.7%). Most relevant non-hematologic toxicity consisted of infectious complications including sepsis with need of intensive care treatment in five patients (4.5%) and proven or probable invasive fungal disease in eight patients (7.2%). Relapse-free survival (RFS), event-free survival (EFS) and overall survival (OS) of the whole cohort were 19 months (0–167), 10 months (0–234) and 15 months (0–234), respectively (p < 0.0001). A significant improvement of OS was observed in patients who underwent allo-HSCT compared to those without subsequent allo-HSCT: 9 vs. 46 months, p < 0.0001. Rate of transplantation-related mortality (TRM) in the early phase post allo-HSCT was low (0.9% at day 30 and 1.8% at day 90, respectively). RIC conditioning results in OS rate of 60% after 60 months post allo-HSCT (median OS not reached).ConclusionS-AML and t-AML patients receiving induction chemotherapy with intermediate-dosed cytarabine showed satisfactory response rate and consolidation therapy with allo-HSCT after full or reduced-intensity conditioning further improved survival in these patients with similar outcome as reported for CPX-351.

Impact of induction chemotherapy and socioeconomics on sinonasal undifferentiated carcinoma survival.

Sinonasal undifferentiated carcinoma (SNUC) is an uncommon malignancy of the nasal cavity and accessory sinuses with limited available studies evaluating role of induction chemotherapy (IC), demographics, and socioeconomic factors on overall survival (OS). The 2004-2015 National Cancer Database was queried for patients with histologically confirmed SNUC. IC was defined as chemotherapy administered 6 months to 2 weeks before surgery or ≥45 days before radiotherapy. Of 440 identified patients, 70 (16%) underwent treatments involving IC. This consisted of 52 (12%), 15 (3%), and 3 (1%) patients receiving IC before definitive radiation therapy, surgery and adjuvant radiotherapy, or surgery only, respectively. On univariate analysis, IC (p = 0.34) did not affect OS, whereas having government insurance (hazard ratio [HR], 1.79; 95% confidence interval [CI], 1.37-2.34; p < 0.001) and living in regions with ≥13% of the population without a high school diploma (HR, 1.38; 95% CI, 1.06-1.79; p = 0.02) were associated with worse OS. On log-rank test, patients with advanced stage had similar OS regardless of whether or not they received IC (p = 0.96). Patients who received IC lived closer to their treatment site (p = 0.02) and had worse overall health, with more comorbidities (p = 0.02). The timing of IC before definitive surgery or radiation did not affect OS (p = 0.69). In this SNUC population-based analysis, IC did not appear to provide additional OS benefit regardless of disease stage or timing before definitive treatment. Distance to treatment and level of comorbidities may be associated with receiving IC, whereas type of insurance and residence education level may impact SNUC OS, regardless of treatment.

Impact of induction chemotherapy on nodal positivity and recurrence in stage 4 buccal cancer patients

Impact of induction chemotherapy on nodal positivity and recurrence in stage 4 buccal cancer patients

Impact of Induction Chemotherapy and Primary CNS Prophylaxis on Outcomes in High-Grade B-Cell Lymphoma with MYC and BCL2 and/or BCL6 Rearrangements (HGBL-DH/TH) or HGBL-NOS: An International Multi-Center Retrospective Analysis

IntroductionHigh-grade B-cell lymphomas are a subgroup of lymphomas characterized by high-grade morphological appearances and the presence of rearrangements in MYC in addition to BCL2 and/or BCL6 (HGBL-DH/TH) or in the absence of cytogenetic changes, HGBL-NOS, previously described as B-cell lymphoma unclassifiable with features intermediate between diffuse large B-cell lymphoma and classical Burkitt's lymphoma (BCLU). These entities have been shown to have poorer outcomes from conventional treatment compared with diffuse large B cell lymphomas (DLBCL) not otherwise specified. One feature contributing to the poor prognosis of DHL is increased risk of central nervous system (CNS) involvement. Intensive chemotherapy regimens which include CNS prophylaxis may improve PFS in HGBL compared with R-CHOP-like therapy.MethodsWe conducted an international, multi-center retrospective analysis of HGBL-DH/TH/NOS and BCLU. The association between baseline clinical and histopathological characteristics and clinical outcome was assessed by Cox proportional hazards model, and variables with P<0.10 by univariate analysis were included in multivariate Cox regression.Results57 patients were included - 20 patients with MYC/BCL2 rearrangements, 6 patients with MYC/BCL6 rearrangements, 13 with MYC/BCL2/BCL6 rearrangements, 16 with the WHO 2008 BCLU classification and 2 with HGBL-NOS classification. 16 (28%) patients had evidence of transformation from antecedent or synchronously diagnosed indolent lymphoma.The median age at diagnosis was 63 years (range 39-86), with 30 (53%) male and median year of diagnosis was 2015 (range 2011 - 2017). The majority of patients were Stage III/IV [n=42, 74%] and ECOG ≤ 1 [n=44, 77%]. 40 patients (70%) had raised LDH at diagnosis; in 15 (26%) LDH was ≥3x ULN. Bone marrow involvement with high-grade lymphoma and extranodal involvement (excluding bone marrow) were present in 9 (16%) and 34 (60%) patients respectively. The median number of extranodal sites of involvement was 1 (range 0-10). Of 32 patients (56%) who underwent CNS staging at diagnosis, 2 (6%) had CNS involvement at baseline- one diagnosed with CSF cytology, and the other by combined modalities (CSF flow cytometry, cytology and MRI).R-CHOP was the most common initial (49%) and ongoing (39%) induction chemotherapy regimen, followed by dose-adjusted EPOCH (32%), R-HyperCVAD and R-CODOX-M/IVAC (7% each) and other regimens (9%). A predominance of patients [n=33, 58%] received a form of CNS directed treatment- 8 (14%) as a standard component of the chosen induction regimen, and 25 (44%) as an addition to induction treatment (intrathecal [n=18, 32%], systemic therapy [n=2, 4%] or both [n=5, 9%]).At a median follow-up of 25 months (range 5-67), the 2 year PFS and OS was 68% (95% CI: 50-81%) and 74% (95% CI: 55-85%) respectively for HGBL-DH/TH and 67% (95% CI: 40-83%) and 72% (95% CI: 46-87%) for BCLU/HGBL-NOS (Figure 1). Outcomes between the R-CHOP and intensive chemotherapy regimens were similar. At 2 years PFS was 70% (95% CI: 44-86%) vs 73% (95% CI: 52-86%), and OS was 79% (95% CI: 52-92%) vs 76% (95% CI: 56-89%). Two patients experienced CNS progression- one in a patient with BCLU and documented CNS disease at diagnosis, and another as a presentation of CNS relapse in a patient with HGBL-TH without evidence of CNS disease at diagnosis who did not receive specific CNS prophylaxis. Raised LDH was adversely prognostic for PFS in entire cohort and ECOG >2 was adversely prognostic for OS in the BCLU/HGBL-NOS group. Among patients who achieved a complete response at end of treatment, the 2 year PFS and OS was 96% (95% CI: 75-99%). In patients who had non-complete response (PD, SD, PR) the 2 year PFS and OS was 29% (95% CI: 13-48%) and 42% (95% CI: 22-62%) respectively. Among 23 patients (40%) with Deauville scores reported, those with Deauville score of 1-3 had a 2 year PFS and OS of 100%, with no events amongst 17 patients.ConclusionWithin the limits of a retrospective analysis, outcomes of HGBL-DH/TH and HGBL-NOS/BCLU were similar. Rates of CNS involvement at diagnosis and on relapse were comparable with other retrospective series. Negative end of treatment PET-CT (DS 1-3) identifies a subset of patients with favorable prognosis. [Display omitted] DisclosuresJeyasekharan:AstraZeneca: Other: Collaboration; Merck Sharp & Dohme: Honoraria; Janssen: Research Funding; PerkinElmer: Other: Collaboration. Bishton:Gilead: Research Funding; Abbvie: Research Funding; Roche: Research Funding; Takeda: Other: travel support to ASH.

Dosimetric impact of induction chemotherapy on intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma and dosimetric characteristics of replanning

Objective To investigate the benefits of replanning after induction chemotherapy (IC) by analyzing the dosimetric impact of IC on intensity-modulated radiotherapy (IMRT) for locally advanced nasopharyngeal carcinoma (NPC) and the dosimetric characteristics of replanning after IC, and to provide data for the rational design of clinical radiotherapy plans. Methods 16 NPC patients underwent contrast-enhanced CT scan once before and after IC. Target volumes were delineated and the chemotherapy plans were created, defined as Plan-1 and Plan-2, respectively. Then the target structure after IC was copied to Plan-1, generating the third plan, defined as Plan-1-2. The paired t-test was used to compare the dosimetric parameters between Plan-1 and Plan-1-2 and between Plan-2 and Plan-1-2. Results Plan-1 vs. Plan-1-2: Plan-1-2 showed significantly reduced Dmean of target volume compared with Plan-1(P<0.05). Plan-1-2 significantly increased Dmean and Dmax of the spinal cord (P<0.05), although significantly reduced Dmean of the brain stem and Dmax of the temporal lobes compared with Plan-1. Plan-1-2 also had significantly reduced conformity index (CI) and significantly increased homogeneity index (HI) for the target volume compared with Plan-1(P<0.05). Plan-2 vs. Plan-1-2: Compared with Plan-1-2, Plan-2 significantly increased Dmean and Dmin of gross tumor volume (GTV) and primary GTV (P<0.05) and significantly reduced Dmean of the temporal lobes and Dmax and Dmean of the spinal cord (P<0.05), with Dmax decreased to 430.48 cGy; Plan-2 had significantly increased CI and significantly reduced HI for the target volume compared with Plan-1-2(all P<0.05). Conclusions IMRT plan-1 after IC has worse dosimetric distribution, while replanning after IC has more dosimetric benefits. Key words: Nasopharyngeal neoplasms/induction chemotherapy; Nasopharyngeal neoplasms/intensity modulated radiotherapy; Target delineation; Dosimetry

Impact of induction chemotherapy, hyperfractionated accelerated radiotherapy and high‐dose thiotepa on brain volume loss and functional status of children with primitive neuroectodermal tumour

The introduction of aggressive chemo-radiotherapy regimens has improved overall survival in children with primitive neuroectodermal tumours (PNET). However, these combinations may result in neurotoxicity. Previously reported magnetic resonance imaging abnormalities in children receiving intensive sequential chemotherapy, hyperfractionated accelerated radiotherapy (HART) and high-dose thiotepa prompted us to investigate the degree of brain volume loss and patients' functional status after therapy. We retrospectively reviewed clinico-radiological data of children with PNET treated in this way at our centre. We studied 14 children treated between December 2009 and April 2013. Data were not complete for one child. Performance status was severely restricted in four children, and mildly to moderately impaired in 7 of the 13 children. Eleven of 13 children showed mild-to-severe generalised neuroparenchymal atrophy, in 7 of whom neuroparenchymal volume loss was moderate to severe. Of these seven, six had received high-dose thiotepa. There was no correlation between brain volume loss and Lansky performance status. However, unexpected neurotoxicities, such as symptoms of transverse myelitis, were observed. Measurement of brain volume loss in patients treated with HART and high-dose thiotepa may not be sufficient to predict function. However, correlation of brain volume loss due to late neurotoxicity with performance decline may be more obvious over longer period of follow-up. The combination of HART and myeloablative courses of thiotepa is associated with severe neurotoxicity and subsequent decline in performance status in a significant proportion of patients.

Induction chemotherapy in locally advanced T4b oral cavity squamous cell cancers: A regional cancer center experience.

The present study aimed to investigate the efficacy, toxicity, and impact of induction chemotherapy (IC) in locally advanced T4b oral cavity squamous cell cancers (OSCCs). Patients diagnosed with locally advanced T4b OSCC from January 2013 to October 2016 at our center, who received 2-3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients' profile, response, and toxicity of IC, resectability status, and overall survival (OS) were evaluated. Statistical analyses were performed by SPSS software version 17. A total of 116 patients received IC, and out of them 90 (77.6%) were males. Median age at diagnosis was 43 years (range 31-62 years). Nearly 103 (88.8%) of our patients received doublet chemotherapy and the rest of the patients received triplet regimen. Majority of the patients had buccal mucosa cancers (71.6%), followed by gingivobuccal complex (21.6%) and oral tongue (6.9%) primaries. After IC, partial response was achieved in 20 (17.3%) patients, stable disease in 68 (58.6%) patients, and disease progression was noted in 28 (24.1%) patients. Post-IC, resectability was achieved in 22 (19%) of 116 patients, but 6 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 16) was 19.7 months (95% confidence interval [CI]: 16.0-22.8 months) and for those treated with nonsurgical local therapy (n = 100) was 7.1 months (95% CI: 5.8-8.2 months) (log-rank P = 0.000). IC had a manageable toxicity profile and achieved resectability in 19% of our patients with T4b OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment.

Induction Chemotherapy in Technically Unresectable Locally Advanced T4a Oral Cavity Squamous Cell Cancers: Experience from a Regional Cancer Center of South India.

Objectives:The present study aimed to investigate the efficacy, toxicity, and impact of induction chemotherapy (IC) in technically unresectable T4a oral cavity squamous cell cancers (OSCCs).Materials and Methods:Patients diagnosed with technically unresectable locally advanced T4a OSCC from January 2013 and November 2016 at our center, who received 2–3 cycles of IC and then assessed for resectability, were reviewed retrospectively. Patients' profile, response rates and toxicity of IC, resectability status, and overall survival (OS) were evaluated. Statistical analyses were performed using SPSS version 17.0 for Windows (SPSS Inc., Chicago, IL, USA).Results:Totally 80 patients received IC, and of them 58 (72.5%) were males. Median age at diagnosis was 44 years (range, 34–62 years). All our patients received IC with doublet regimen. Majority of the patients had buccal mucosa cancers (73.8%), followed by gingivobuccal complex (21.2%) and oral tongue (5%) primaries. After IC, partial response was achieved in 17 (21.3%) patients, stable disease in 49 (61.3%) patients and disease progression was noted in 14 (17.4%) patients. Post-IC, resectability was achieved in 19 (23.8%) of 80 patients, but 4 of them did not undergo surgery due to logistic and personal reasons. The median OS of patients who underwent surgery followed by adjuvant local therapy (n = 15) was 16.9 months (95% CI: 15.2–19.8 months) and for those treated with nonsurgical local therapy (n = 65) was 8.8 months (95% CI: 6.8–10.6 months) (log-rank P = 0.000).Conclusions:IC had a manageable toxicity profile and achieved resectability in 23.8% of our patients with technically unresectable T4a OSCC. Patients underwent resection had a significantly better median OS than those who received nonsurgical local treatment.

Impact of Induction Chemotherapy in Locally Advanced HPV-negative Oropharyngeal Cancer. A Propensity Score-matched analysis.

To estimate the clinical outcomes of induction chemotherapy (IC) followed by standard chemoradiotherapy (CRT) and CRT alone in patients with locally advanced human papilloma virus (HPV)-negative oropharyngeal squamous cell carcinoma. Consecutive patients with histologically-proven HPV-negative squamous cell carcinoma of the oropharynx were included and treated with IC-CRT or CRT alone. In order to compare treatment outcomes and toxicity between groups, patients were matched by primary tumor site and clinical disease stage. Overall survival (OS), disease-free survival (DFS) and metastasis-free survival (MFS) curves were calculated with the Kaplan-Meier method. Nine IC patients and 18 CRT patients were included. All patients completed the programmed treatment. The median follow-up was 38 months. There were no statistically significant differences in OS and DFS between groups. The 5-year MFS was 88.9% and 50.8% in the IC-CRT group, respectively. There was no meaningful difference in toxicity between patients. In HPV-negative patients with locally advanced oropharyngeal cancer, adding IC to standard CRT may increase the MFS rate. However no significant differences in OS and DFS were observed. More studies are needed to better elucidate the role of IC in this setting.

Impact of Induction Chemotherapy Followed by Radiotherapy in Patients of Invasive Cervical Carcinoma with Inadvertent Hysterectomy: A Retrospective Study.

The standard of care for patients who undergo an inadvertent hysterectomy for invasive cervical carcinoma is not well established. The aim of this study was to evaluate the role of induction chemotherapy followed by external beam radiotherapy and brachytherapy in patients who had an inadequate hysterectomy for carcinoma of the cervix. Patients with history of inadequate hysterectomy with no residual disease at presentation to our outpatients department of Radiotherapy and registered between October 2011 to June 2014 were retrospectively analyzed. Most of these patients had received three cycles of induction chemotherapy using Paclitaxel and Carboplatin regime. Thereafter, these patients had received external beam radiotherapy and vaginal brachytherapy. The primary end points were overall survival and disease-free survival. Survival analysis was done using Kaplan-Meier method and the differences in survival rates were compared using log-rank test. A total of 34 patients were eligible for the study. Overall survival and Disease-free survival at 3-years were 70% and 68%. Patients who had Taxane-based chemotherapy had significantly better survival outcomes than their counterparts. Vaginal vault boost with brachytherapy had a significant impact on prognosis of these patients. Induction chemotherapy using Paclitaxel and Carboplatin followed by external beam radiotherapy and brachytherapy is a good treatment option for patients of carcinoma of the cervix who have undergone inadvertent hysterectomy.

Dosimetric Impact of Induction Chemotherapy on Subsequent Radiation Treatment Planning in Patients With Inoperable Non-Small Cell Lung Cancer

Dosimetric Impact of Induction Chemotherapy on Subsequent Radiation Treatment Planning in Patients With Inoperable Non-Small Cell Lung Cancer

OP048: Induction chemotherapy in unresectable oral cavity cancers

To study the safety and impact of induction chemotherapy in unresectable T4b oral cavity cancers. We report a retrospective analysis of patients with T4b oral cavity cancers treated with induction chemotherapy, either 3-drug combination of cisplatin, 5 FU and docetaxel or a 2-drug combination of platinum and taxane. Radiological response and feasibility for resection were reassessed after chemotherapy in a multidisciplinary clinic. Local treatment was surgical excision or radical chemoradiation. The primary objectives were the achievement of resectability and impact of surgery on overall survival. 110 patients with oral cavity tumours received induction chemotherapy. The tumour was staged as T4b due to involvement of masticator space in 102 patients and pterygoid plates in the rest. Twenty-one patients received 3-drug regimen and the rest 2-drug regimen. Docetaxel was used in 40 patients. The radiological response was PR in 28, stable disease in 49 and progression in 23 patients. The primary objective of surgical resectability was achieved in 34 patients. On multivariate analysis, independent predictors of achieving resectability were use of 3 drug regimens and use of docetaxel. Toxicities were manageable with febrile neutropenia in 14 patients (12.72%) and grades 3–4 GI toxicity in 13 patients (11.1%). The patients who were successfully resected after NACT had a statistically significant improvement in overall survival (median survival 7.5 months versus not reached). Induction chemotherapy is safe and can achieve resectability in some patients with T4b tumours. Patients undergoing resection had improved overall survival in our study.

Induction chemotherapy in patients with resectable head and neck squamous cell carcinoma: a meta-analysis

BackgroundInduction chemotherapy has been investigated as a possible strategy to shrink or downstage locally advanced head and neck cancers, providing opportunity to remove the lesions completely after induction chemotherapy, especially in the patients with resectable advanced disease. The aim of this study was to investigate the definitive effect of induction chemotherapy in patients with resectable head and neck squamous cell carcinoma.MethodsA meta-analysis of randomized trials (1965–2011) was performed on the impact of induction chemotherapy on survival, disease control, and toxicity in this population of patients. Kaplan-Meier curves were read by Engauge-Digitizer. Data combining was performed using RevMan.ResultsFourteen trials (2099 patients) were involved in this analysis. There was no significant difference on overall survival, disease free survival, or locoregional recurrence between the patients treated with and without induction chemotherapy (P >0.05). However, the patients treated with induction chemotherapy had a lower rate of distant metastasis by 8% (95% confidence interval 1%–16%, P = 0.02) than those treated without induction chemotherapy. In patients with laryngeal cancer, comparing to radical surgery, the larynx could be preserved in responders to induction chemotherapy without survival decease (P >0.05). Induction chemotherapy-associated death was 0%–5%.ConclusionsBased on the results above, there is a significant benefit of induction chemotherapy on decreasing distant metastasis in patients with resectable head and neck squamous cell carcinoma. In patients with laryngeal cancer, induction chemotherapy provides larynx preservation in responders to induction chemotherapy.

Is there a role of induction chemotherapy followed by resection in T4b oral cavity cancers?

The objective of the following study is to investigate the efficacy and impact of induction chemotherapy in T4b oral cavity cancers. It's a retrospective analysis of prospectively collected data of T4b oral cavity cancer patients who were offered induction chemotherapy and then assessed for resectability at the end of 2 cycles of chemotherapy. Post-induction these patients either underwent surgical or non-surgical local intervention depending upon their response. These patients were then followed-up until either recurrence progression or death whichever was later. Statistical analysis was performed by SPSS version 16. Descriptive analysis was performed. Factors affecting achievement of resectability were sought by univariate and multivariate analysis. The impact of surgery on overall survival (OS) was studied using Kaplan Meier survival analysis with the use of log rank test. A total of 110 patients received chemotherapy. Median age been 41.5 years (range 25-66 years). 21 (20%) of our patient received 3 drug regimen while the rest of our patients received 2 drug regimen. Partial response was achieved in 28 patients, stable disease in 49 patients and progression was noted in 23 patients. Resectability was achieved in 34 (30.9%) of 110 patients. The estimated median OS in patients who underwent surgery was 18.0 months (95% confidence interval [CI]: 13.6-22.46 months) and for those treated with non-surgical treatment was 6.5 months (95% CI: 5.6-7.4 months) (P = 0.0001). Use of induction chemotherapy is safe and can achieve resectability in 30.9% of our T4b patients. In those patients undergoing resection have much better OS then those who underwent non-surgical local treatment.

1040P - The Impact of Induction Chemotherapy on Cisplation Dose Intensity During Chemo-Radiotherapy (CTRT) in Oropharyngeal Squamous Cell Cancer (OPC)

ABSTRACT Background Induction (IC) with TPF (Taxotere, Cisplatin, 5-FU) has been associated with improved outcome in advanced head and neck squamous cell cancer patients (pts). Full dose of cisplatin (300 mg/m2) during CTRT has been demonstrated to impact on patients' outcome. The aim of the current study is to investigate whether the IC could impact on cisplatin dose intensity during CTRT in a homogeneous population of OPC. Materials and methods The study population consisted of 101 pts with stage III-IV OPC treated from 07/2004 to 12/2011 with IC (n = 53) plus CTRT or CTRT alone (n= 48). IC consisted of TPF, while weekly 50 mg/m2 or 3-weekly 100 mg/m2 cisplatin was administered concurrently with RT (planned chemotherapy dose = 300 mg/m2; planned RT dose = 66-70 Gy, 3DRT or IMRT with a conventional or accelerated fractionation). Carboplatin substituted cisplatin in case of creatinine clearance less than 60 mL/min. HPV status, concurrent cisplatin dose intensity and RT overall treatment time (OTT) were analyzed. Results Stage IV pts were 100% in the IC group and 83% in CTRT, while HPV positive OPCs were detected in 58% and 63% of the cases respectively. TPF median number of cycles was 3, with induction cisplatin median dose administered of 200 mg/ m2. RT median total dose administered was 70 Gy in both group. Accelerated fractionated RT was adopted in 65% of CTRT alone group and in 21% of IC group. Two pts (1 in each group) did not complete CTRT because of cardiovascular events. Mean and median dose intensity of cisplatin concurrent to RT in the IC group was 77.7% and 75% (35%-100%) while in CTRT group was 86% and 91.7% (33%-100%), with a p value = 0.014. In 11 pts (21%) treated with IC and only in 1 pts (2%) treated with CTRT alone cisplatin was substituted with carboplatin. No different cisplatin dose intensity was identified in HPV positive versus HPV negative cases. Prolonged OTT (longer than 5 days) was observed in two patients in IC group due to sepsis and severe mucositis as well as in one patient in CTRT group due to machine failure. Conclusions Concurrent cisplatin dose intensity was significantly reduced in pts receiving IC compared to CTRT alone, irrespective of HPV status. Whether this has an impact on the results of IC followed by full dose CT/RT has to be clarified. Disclosure All authors have declared no conflicts of interest.

Impact of Induction Chemotherapy on Estimated Risk of Radiation Pneumonitis in Small Cell Lung Cancer

Induction chemotherapy in patients with bulky small cell lung cancer (SCLC) could lead to decreased tumor burden, smaller radiation fields, and less pulmonary toxicity. This study compared radiation therapy (RT) plans based on pre- and postchemotherapy computed tomography (CT) scans of patients with SCLC to estimate the reduced risk of radiation pneumonitis (RP) after receiving chemotherapy. Between 2003 and 2009, 23 patients with stage IV SCLC were treated with chemotherapy alone (no surgery or RT) and had computed tomography scans pre- and post two cycles of platin-based chemotherapy. Simulated RT plans were created as if to deliver 45 Gy to the thoracic disease. The percent of lung receiving ≥20 Gy (V20), mean lung dose, and normal tissue complication probability (NTCP) was evaluated in patients who had a partial response (≥30% volumetric reduction) in gross tumor volume. One (4.3%) patient had a complete response, 18 (78.3%) had a partial response, and four (17.4%) had stable disease. Among 18 responders, the absolute decrease in V20 was 7.4% (p < 0.01), in mean lung dose was 3.3 Gy (p < 0.01), and in NTCP was 5.5% (p < 0.01). Patients with a prechemotherapy V20 ≥35% versus V20 less than 35% had an average absolute reduction in NTCP of 10% versus 2% (p < 0.01). Patients with limited stage SCLC with a V20 ≥35% may benefit from induction chemotherapy as there is an estimated reduction of RP of 10%. This reduction in risk of RP after induction chemotherapy should be weighed against risks and benefits of delaying upfront RT.

8586 POSTER Impact of Induction Chemotherapy on Local Control for Locally Advanced Nasopharyngeal Cancer

8586 POSTER Impact of Induction Chemotherapy on Local Control for Locally Advanced Nasopharyngeal Cancer