Role Of Induction Chemotherapy Research Articles

Role of induction chemotherapy in advanced-stage olfactory neuroblastoma.

To evaluate the treatment outcomes in patients with advanced-stage olfactory neuroblastoma (ONB) who received induction chemotherapy (IC). The clinical data of 38 patients with advanced-stage ONB who received initial IC were retrospectively analyzed. The response was defined using the Response Evaluation Criteria in Solid Tumors version 1.1. Patients with complete remission or partial remission were defined as responders. Seventeen (44.7%) patients responded to IC. The response rate was higher in patients with high Hyams grade tumor (III/IV) compared to those with low-grade tumors (I/II) (60% vs. 22.2%, p=0.038). Overall, the 5-year cancer-specific survival (CSS) rate was 76.0%. Among nonresponders to IC, a significant difference in 5-year CSS rates was observed between surgery with adjuvant radiotherapy (RT) (100%) versus definitive RT or chemoradiotherapy (CRT) (68.6%) (log-rank p=0.006). However, for responders, there was no significant difference in 5-year CSS rates between surgery with adjuvant therapy (75%) and definitive RT or CRT (51.1%) (log-rank p=0.536). When only high-grade tumors were considered among responders, the 5-year CSS rate was significantly higher in patients who received RT or CRT (51.4%) compared to those who underwent surgery with adjuvant therapy (0%) (log-rank p=0.008). In advanced-stage ONB, RT or CRT may be preferable for high-grade tumor responding to IC. Higher response rate and a potential role for induction IC in determining the optimal definitive treatment modality suggest a positive role for advanced-stage high-grade ONB.

NMR-Based Metabolomics of Blood Serum in Predicting Response to Induction Chemotherapy in Head and Neck Cancer-A Preliminary Approach.

The role of induction chemotherapy (iCHT) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC) is still to be established due to high toxicity and variable response rates. The aim of this retrospective study is to use NMR-based serum metabolomics to predict the response rates to iCHT from the pretreatment samples. The studied group consisted of 46 LA-HNSCC patients treated with iCHT. The response to the treatment was evaluated by the clinical, fiberoptic, and radiological examinations made before and after iCHT. The proton nuclear magnetic resonance (1H NMR) serum spectra of the samples collected before iCHT were acquired with a 400 MHz spectrometer and were analyzed using multivariate and univariate statistical methods. A significant multivariate model was obtained only for the male patients. The treatment-responsive men with >75% primary tumor regression after iCHT showed pretreatment elevated levels of isoleucine, alanine, glycine, tyrosine, N-acetylcysteine, and the lipid compounds, as well as decreased levels of acetate, glutamate, formate, and ketone bodies compared to those who did not respond (regression of the primary tumor <75%). The results indicate that the nutritional status, capacity of the immune system, and the efficiency of metabolism related to protein synthesis may be prognostic factors for the response to induction chemotherapy in male HNSCC patients. However, larger studies are required that would validate the findings and could contribute to the development of more personalized treatment protocols for HNSCC patients.

Clinical prognostic factors to guide treatment strategy for HPV‑positive oropharyngeal cancer using treatment outcomes of induction chemotherapy: A real‑world experience.

The role of induction chemotherapy (IC) in locally advanced oropharyngeal cancer (OPC) remains debatable, and suitable candidates for de-escalation treatment in these patients have not been fully identified. Therefore, the present study aimed to identify high-risk candidates for human papillomavirus (HPV)-positive OPC by analyzing patients who underwent IC followed by chemoradiotherapy (CRT) to guide optimal treatment strategies. Patients diagnosed with stage III-IVA OPC and treated with a minimum of two cycles of IC followed by CRT, between 2004 and 2020, were retrospectively reviewed. All the patients were restaged according to the American Joint Committee on Cancer, 8th edition. The overall response rate and survival outcomes associated with clinical factors based on HPV status were analyzed using univariate and multivariate analyses. The present study analyzed 105 patients with a median age of 60 years (range, 40-76 years). Among 105 patients, 40 (38.1%) were HPV-negative and 65 (61.9%) HPV-positive. In all patients, survival outcomes were notably poorer in patients aged ≥60 years (P=0.006) and those who did not achieve complete response post-CRT (P<0.001), irrespective of the HPV status. The median relative dose intensity of IC was ≥80%, indicating adequate treatment, regardless of age. In contrast to patients with HPV-negative OPC, age ≥60 years (P=0.011) and T4 stage (P=0.019) emerged as substantial poor prognostic factors for survival outcomes in patients with HPV-positive OPC. Patients with HPV-positive OPC were categorized into three groups based on the number of clinical factors at diagnosis (such as age and T4 stage). The progression-free and overall survival showed significant stratification across each group as the number of high-risk factors increased despite IC and CRT. The findings indicated that patients with these high-risk factors require a cautious therapeutic strategy even when they are diagnosed with HPV-positive OPC, and the role of combined modality, including IC, will need to be investigated in a randomized trial to be routinely incorporated into clinical practice.

Clinical prognostic factors to guide treatment strategy for HPV-positive oropharyngeal cancer from treatment outcomes of induction chemotherapy: A real-world experience.

e18014 Background: The role of induction chemotherapy (IC) in locally advanced oropharyngeal cancer (OPC) remains a topic of debate and suitable candidates for de-escalation treatment in these patients have not been fully identified. This study aimed to identify high-risk groups for HPV-positive OPC by analyzing patients who underwent IC followed by chemoradiotherapy (CRT) to guide optimal treatment strategies. Methods: Between 2004 and 2020, we reviewed patients with OPC diagnosed with stage III-IVA who underwent a treatment regimen comprising a minimum of two cycles of IC followed by CRT.In this study, all patients were re-staged according to the American Joint Committee on Cancer (AJCC) 8th edition, and we analyzed the overall response rate and survival outcomes associated with clinical factors based on HPV status by utilizing univariate and multivariate analyses. Results: This study analyzed 105 patients with a median age of 60 years (range: 40–76 years). Among 105 patients, 40 (38.1%) were HPV-negative, and 65 (61.9%) were HPV-positive. Through a median follow-up of 60.0 months (range, 5–60 months), no significant differences in progression-free survival (PFS) (p = 0.172) and overall survival (OS) (p = 0.064) were observed based on HPV status, regardless of no differences in relative dose intensity of IC and cumulative dose of radiation and cisplatin in CRT. In all patients, survival outcomes were notably poorer in patients aged ≥ 60 years ( p = 0.006) and those who did not achieve complete response (non-CR) post-CRT ( p &lt; 0.001), irrespective of HPV status. All have received sufficient IC with a median RDI of 80% or more in both age &lt; 60 years and age ≥ 60 years. Unlike HPV-negative OPC, where age and T stage showed no significant correlation, in HPV-positive OPC, age ≥ 60 years ( p = 0.011) and T4 stage ( p = 0.019) emerged as substantial poor prognostic factors for survival outcomes despite IC and CRT. Utilizing these results, we categorized HPV-positive OPC patients into three groups based on the number of clinical risk factors at diagnosis (age, T4 stage), the PFS and OS showed significant stratification across each group as the number of clinical risk factors increased. Conclusions: This study revealed that age and T stage significantly influenced on prognosis in HPV-positive OPC but not in HPV-negative OPC. Considering our result, HPV-positive OPC exhibiting these risk factors requires a careful treatment strategy, and combined treatments, including immunotherapy, may be considered to enhance treatment outcomes for these patients.

Phase II prospective trial of induction chemotherapy for advanced sinonasal squamous cell or poorly differentiated carcinoma.

6090 Background: The standard treatment for resectable advanced sinonasal carcinoma is surgery followed by adjuvant therapy. Despite aggressive therapy, disease control and survival have historically remained poor. The role of induction chemotherapy (IC) has not been fully assessed. The objective of this study is to prospectively evaluate IC for local disease control, organ preservation, and response-based local treatment selection. Methods: This is a phase II, open-label, single-center trial of patients with previously untreated, resectable and nonresectable, locally advanced squamous cell or poorly differentiated carcinoma of the nasal cavity or paranasal sinuses. Eligible patients were &gt; 16 years of age, had an ECOG Performance Status of 0-1, and stage II-IV, M0 disease . Patients were treated with an IC regimen of docetaxel, cisplatin, and fluorouracil (TPF) for 2 cycles, then evaluated for response using clinical (symptoms and nasal endoscopy) and radiographic (RECIST 1.1 and PET) assessments. Those who achieved an objective response received a third cycle followed by chemoradiotherapy (CRT); non-responders underwent surgery with adjuvant radiotherapy. The primary endpoints were overall response rate (ORR) and 2-year local disease control. Secondary endpoints included disease-specific survival (DSS), overall survival (OS), disease-free survival (DFS), organ preservation, patterns of failure, and treatment toxicity. Results: 31 patients were enrolled between 2008 and 2020, of which 28 were evaluable for efficacy. Disease was T4a (57%) or T4b (21%), N+ (38%), and would have required maxillectomy (89%), craniotomy (54%), or orbital exenteration (29%). After IC, the ORR was 82.1% (7.1% complete response, 75.0% partial response), and the non-response rate was 17.9% (17.9% stable disease, 0% progressive disease). Patients then underwent CRT (79%) or surgery (21%). Following CRT, salvage surgery was performed for 41% of patients. Grade 3 or 4 adverse events occurred in 18% of patients. The 2-year local control rate was 53.6%. The 2-year DSS rate was 75% (median DSS not reached). For patients alive at 2 years, 63% had organ preservation (avoiding maxillectomy 38%, craniotomy 13%, orbital exenteration 38%). The median DFS and OS were 19.2 and 47.4 months, respectively. Factors associated with worse OS were nonwhite race ( P = .035), T4 category ( P = .037), overall stage IV ( P = .038), and paranasal sinus subsite ( P = .002). Surgery did not have significantly different OS than CRT ( P = .86). Conclusions: This phase II study demonstrates the validity of induction chemotherapy as a guide for local treatment selection in patients with advanced sinonasal carcinoma. A majority of patients achieved disease control and organ preservation. The median survival was 4 years in a cohort with very advanced locoregional disease, with no survival difference between CRT and surgery. NCT03493425. Clinical trial information: NCT00707473 .

The SINTART 1 study. A phase II non-randomised controlled trial of induction chemotherapy, surgery, photon-, proton- and carbon ion-based radiotherapy integration in patients with locally advanced resectable sinonasal tumours

PurposeSinonasal tumours are rare diseases with poor prognosis. Multimodal approach including surgery is widely used, although no standard therapy has been established in prospective trials. This study assessed activity and safety of an innovative integration of multimodality treatment—induction chemotherapy (ICT), surgery and radiotherapy (RT)—modulated by histology and response to ICT. MethodsPatients with untreated, operable sinonasal tumours with selected histotypes (squamous cell carcinoma, intestinal-type adenocarcinoma, sinonasal undifferentiated and neuroendocrine carcinoma, olfactory neuroblastoma) were enrolled in a single-arm, phase II, multicenter clinical trial. Patients were treated with up to 5 ICT cycles, whose regimen was selected according to histotype, followed either by curative chemo-RT for pts with ≥80% reduction of initial tumour diameter or surgery and adjuvant (chemo)RT. Photon and/or proton/carbon ion-based RT was employed according to the disease site and stage. Primary end-point was 5-year progression-free survival (PFS), secondary end-points were overall survival (OS), ICT objective response rate (ORR) per RECIST 1.1 and safety. ResultsThirty-five patients were evaluable for primary end-point. Fourteen patients (40%) were treated with definitive (CT)RT and 20 (57%) underwent surgery. Five-year PFS was 38% (95% confidence interval [CI], 21–69), with a median PFS of 26 months. Five-year OS was 46% (95% CI, 28–75), with a median OS of 36 months. Three-year PFS—OS for pts achieving PR/CR versus stable disease (SD)/PD to ICT were 49.8–57% versus 43.2–53%, respectively. Three-year PFS for patients achieving major volumetric partial response (≥80% reduction of initial tumour volume, major partial volumetric response [mPRv]) versus non-mPRv were 82% versus 28% and 3-year OS were 92% versus 36% (p value 0.010 and 0.029, respectively). The ORR to ICT was 54% and 60% across all histotypes and in the sinonasal undifferentiated carcinoma (SNUC) subpopulation, respectively, with 6/15 SNUCs (40%) achieving mPRv. ConclusionTreatment of advanced sinonasal cancer with histology-driven ICT followed by (CT)RT in responsive patients was feasible. Overall, these findings suggest a possible role of ICT as the primary approach in newly diagnosed, resectable sinonasal tumours—especially SNUC—to select patients with favourable prognosis. Histology heterogeneity limits generalisation of trial results.

Response to induction chemotherapy predicts survival outcomes in oropharyngeal cancer.

The role of induction chemotherapy (IC) in oropharyngeal squamous cell carcinoma (OPSCC) remains controversial. Its interpretation can be confounded by heterogeneity in chemosensitivity and human papillomavirus (HPV) status. This study aimed to investigate the prognostic impact of IC response in HPV-positive and -negative OPSCC. Patients with OPSCC who underwent IC and concurrent chemoradiotherapy (CCRT) were retrospectively analyzed. Radiologic response to IC by ≥50% was defined as IC-sensitive (IC-s), while lesser response was deemed as IC-resistant (IC-r). Progression-free survival (PFS) and overall survival (OS) were compared between subgroups. A total of 51 HPV-positive and 57 HPV-negative patients were included. IC-s patients accounted for 55.6%, 62.7%, and 49.1% in the entire cohort, HPV-positive, and HPV-negative subgroup, respectively. Compared with IC-r subgroup, IC-s was associated with better clinical outcomes either in the entire cohort (3y-PFS 91.7%vs.43.7%, P< 0.001; 3y-OS 98.3% vs. 67.4%, P= 0.002), the HPV-positive subgroup (3-year PFS 94.7% vs. 47.9%, P< 0.001; 3-year OS 100% vs. 73.5%, P=0.055) or the HPV-negative subgroup (3-year PFS 88.2% vs. 40.9%, P= 0.001; 3-year OS 96.4% vs. 63.1%, P=0.026). Multivariate analysis demonstrated that response to IC represents an independent prognosticator for 3-year PFS (HR, 0.088; 95% CI, 0.027-0.289; P < 0.001) and 3-year OS (HR, 0.100; 95% CI, 0.021-0.477; P=0.004). Response to IC exerts a critical predictive effect on prognosis of both HPV-positive and -negative OPSCC. Personalized treatment strategy based on IC response is worthy of further exploration in the future.

The Role of Induction Therapy for Sinonasal Cancers.

The role of induction chemotherapy in sinonasal cancers is promising; however, prospective studies with higher grades of evidence are needed. With the currently available literature, the authors would advocate for the use of induction chemotherapy (IC) in locally advanced sinonasal squamous cell carcinoma (T3-T4) for organ preservation and potentially for improved survival outcomes. In sinonasal undifferentiated carcinoma (SNUC), IC should be considered in all patients given its tendency for aggressive invasion and poor outcomes. In SNUC, response to IC may direct the modality of definitive treatment to follow. In responders (partial or complete), chemoradiation therapy should be strongly considered. In non-responders or in those with progression of disease, surgical therapy is favored. For esthesioneuroblastoma, surgical resection with negative margins and adjuvant radiation therapy remains the gold standard. However, IC may be considered for locally advanced disease especially with orbital invasion or in recurrent/distant disease. There is no definite indication for IC in sinonasal adenoid cystic carcinoma or sinonasal adenocarcinoma. Recommendations are summarized in Table 1.

Induction chemotherapy in head and neck cancer – Boon or bane?

Although concurrent chemoradiotherapy is the standard of care for inoperable locally advanced head and neck cancer, induction chemotherapy is considered an alternative approach by head and neck oncologists worldwide. To evaluate the response to induction chemotherapy in terms of loco-regional control and treatment-related toxicity in inoperable locally advanced head and neck cancer patients. This prospective study was conducted on patients who received two to three cycles of induction chemotherapy. Following this, response assessment was performed clinically. Grading of radiation-induced oral mucositis and any interruptions in treatment were noted. At 8 weeks following treatment, magnetic resonance imaging-based radiological response assessment was performed using RECIST criteria version 1.1. Our data revealed 57.7% complete response rate with induction chemotherapy, followed by chemoradiation therapy. We observed that post induction, 67.5% and 47.5% patients had reduction in T-stage (<0.001) and N-stage of disease (<0.001), respectively, with complete response more achieved in younger patients (≤50 years). Chemotherapy-induced bone marrow suppression and febrile neutropenia occurred in 7.5% patients. We demonstrated that a higher grade of radiation-induced mucositis was noticed among those receiving three cycles of induction chemotherapy (ICT) and aged >50 years. We conclude that induction chemotherapy could still be a viable option for down-staging unresectable locally advanced disease, especially for younger patients in terms of better treatment response and tolerability. The number of cycles of ICT seems to influence radiation-induced mucositis. This study underscores the need for further studies to determine the exact role of ICT in locally advanced head and neck cancer.

Modified DCF (Docetaxel, Cisplatin and 5-fluorouracil) chemotherapy is effective for the treatment of advanced rectal squamous cell carcinoma.

Advanced rectal squamous cell carcinoma (rSCC) is a very rare and aggressive entity, and the best initial management is crucial for long survival as well as organ preservation and quality of life. Whereas local diseases are treated with chemo-radiotherapy and salvage surgery, data are scarce on how to treat more advanced diseases, and the role of induction chemotherapy is unknown. We retrospectively analyzed all consecutive patients with advanced rSCC and treated with modified DCF (docetaxel, cisplatin, 5-fluorouracil; mDCF) regimen, from January 2014 and December 2021 in two French centers. Exploratory endpoints were efficacy (overall survival, recurrence-free survival, response rate, organ preservation rate) and safety. Nine patients with locally advanced or metastatic diseases received a mDCF regimen and were included for analysis. The median age was 62.0 years, 7 patients (77.8%) were women, and all eight available tumors were positive for HPV, mostly (85.7%) to genotype 16. With a median follow-up of 33.1 months, 77.8% of patients were still alive and disease-free, and the median overall survival was not reached at six years. The objective response rate was 87.5% after mDCF, and the complete response rate was 25.0% after mDCF and was increased to 75.0% after chemoradiotherapy. Only one patient underwent surgery on the primary tumor, with a complete pathological response. The median mDCF cycle was eight over eight scheduled, and all patients received the complete dose of radiotherapy without interruptions. Induction mDCF chemotherapy followed by chemoradiotherapy is safe and highly effective in patients with advanced rSCC, and should be considered as an option in metastatic stage or locally advanced disease with an organ-preservation strategy.

What is the Role of Induction Chemotherapy in the Treatment of Locally Advanced Sinonasal Squamous Cell Carcinoma?

Recently, induction chemotherapy has gained favor for managing locally advanced sinonasal malignancies. In this Trio Best Practices paper, we review the evidence surrounding the application of induction chemotherapy for definitive management of locally advanced sinonasal squamous cell carcinoma.

Essential news of current guidelines: head and neck squamous cell carcinoma

SummarySquamous cell carcinoma of the head and neck (HNSCC) is the sixth most common cancer and accounts for 890.000 cases 450.000 deaths worldwide annually. HNSCC is a heterogeneous disease affecting mainly elderly patients, who frequently suffer from significant comorbidities. Due to the aggressive tumor biology and high recurrence rates after curative treatment, it is essential to follow the evidence-based treatment recommendations outlined in the international guidelines, although it has to be emphasized that relevant data gaps and controversies exist such as the role of induction chemotherapy, de-intensification strategies or the role of immunotherapy in the locally advanced and recurrent/metastatic setting. These topics will be addressed in this article. Most importantly, interdisciplinary management of HNSCC patients is key for the optimal management at all disease stages.

674P Initial curative management for localized/locally advanced head and neck squamous cell carcinomas (LAHNSCC): Exclusive (chemo)radiation (CRT) or S/IC (surgery or induction chemotherapy) – The EPOCKS study

The initial curative standard therapy for LAHNSCC by exclusive CRT or surgery (+/- CRT) have similar results in term of PFS and OS. Indication depends on several factors including regional expertise and anticipated sequela. The role of induction chemotherapy (IC) remains questionable until today. Previous publications suggested that surgery followed by CRT could be relevant for high-risk relapse tumors. The aim of this retrospective study was to compare as first-intent curative treatment CRT to alternative approach (S/IC: surgery and/or IC +/- CRT).

Induction Chemotherapy in Squamous Cell Carcinoma of Tongue—Still a Slippery Role?

Abstract Background Tongue cancers are more common in the Indian subcontinent and a leading cause of morbidity and mortality among oral cavity cancers. Induction chemotherapy has been considered an intriguing and smart option for many reasons, but even after years of studies and debates, its role has not been fully established in the management of tongue cancers. Materials and Methods In this study, we evaluated 17 patients with oral tongue carcinomas with locally advanced stage, enrolled into a protocol of three drug (docetaxel, cisplatin, 5-fluorouracil) induction chemotherapy for three cycles. After completion of the three cycles, patients were clinically and radiologically re-evaluated and surgery was done if locally operable. Results At the completion of three cycles, five patients were partial responders, four patients were complete responders, and five patients had progressive disease after three cycles. Those patients with response underwent surgery. There were no significant morbid intraoperative or postoperative complications observed in seven out of nine patients. At the end of treatment completion, five out of nine patients had tumor residue/high-risk features and were planned for adjuvant radiotherapy. Conclusion For locally advanced oral tongue carcinomas, the role of induction chemotherapy before surgery has been fruitful and its impact on function preservation with acceptable oncological clearance is an emerging alternative. Spacing chemotherapy and radiotherapy reduce the incidence of adverse effects of combined treatment.

Predictive Biomarkers for Response and Toxicity of Induction Chemotherapy in Head and Neck Cancers.

This review focuses on the molecular biology of head and neck squamous cell carcinomas and presents current and emerging biomarkers of the response of patients to induction chemotherapy. The usefulness of genes, proteins, and parameters from diagnostic clinical imaging as well as other clinicopathological parameters is thoroughly discussed. The role of induction chemotherapy before radiotherapy or before chemo-radiotherapy is still debated, as the data on its efficacy are somehow confusing. Despite the constant improvement of treatment protocols and the introduction of new cytostatics, there is still no consensus regarding the use of induction chemotherapy in the treatment of head and neck cancer, with the possible exception of larynx preservation. Such difficulties indicate that potential future treatment strategies should be personalized. Personalized medicine, in which individual tumor genetics drive the selection of targeted therapies and treatment plans for each patient, has recently emerged as the next generation of cancer therapy. Early prediction of treatment outcome or its toxicity may be highly beneficial for those who are at risk of the development of severe toxicities or treatment failure—a different treatment strategy may be applied to these patients, sparing them unnecessary pain. The literature search was carried out in the PubMed and ScienceDirect databases as well as in the selected conference proceedings repositories. Of the 265 articles and abstracts found, only 30 met the following inclusion criteria: human studies, analyzing prediction of induction chemotherapy outcome or toxicity based on the pretreatment (or after the first cycle, if more cycles of induction were administered) data, published after the year 2015. The studies regarding metastatic and recurrent cancers as well as the prognosis of overall survival or the outcome of consecutive treatment were not taken into consideration. As revealed from the systematic inspection of the papers, there are over 100 independent parameters analyzed for their suitability as prognostic markers in HNSCC patients undergoing induction chemotherapy. Some of them are promising, but usually they lack important features such as high specificity and sensitivity, low cost, high positive predictive value, clinical relevance, short turnaround time, etc. Subsequent studies are necessary to confirm the usability of the biomarkers for personal medicine.

Surgical techniques and outcomes in patients with oral cavity cancer after induction chemotherapy

Objective: Locally advanced Oral squamous cell carcinoma OSCC has a poor prognosis, surgery is mainline for treatment. The role of induction chemotherapy is still controversial. Methodology: This is a prospective study that included 25 patients with locally advanced OSCC who received induction chemotherapy with cisplatin, docetaxel &amp; 5-FU (TPF) protocol regimen followed by surgical intervention. The epidemiological, surgical, and oncological outcomes of all the included patients were analyzed. Results: one patient showed no response, 18 patients had a partial response while 6 patients showed pathological complete response (pCR). Five out of the six patients who achieved pCR did not need reconstructive surgery and also five out of those 6 patients were operated on through a less destructive transoral approach. Consequently, those patients had less operative time, blood loss, hospital stay, and significantly less time to start oral feeding. The median disease-free survival was 15 (12-18) months in patients who attained pCR and 13 (5-24) months in the non pCR group. Conclusion: Pathological complete response after induction chemotherapy for locally advanced OSCC is associated with improvement in disease-free survival, less destructive surgery, and less need for flap reconstruction.

The role of induction chemotherapy in patients with locally advanced head and neck squamous cell carcinoma: A nationwide population-based matched study

IntroductionInduction chemotherapy (IC) has a proven role in organ preservation and reducing distant failure. However, its ability to prolong survival remains controversy. Herein, our study aimed to investigate the impact of primary tumor location on survival in patients with locally advanced head and neck squamous cell carcinoma (LA-HNSCC) treated with IC. MethodsPatients who were older than 18 years and diagnosed with LA-HNSCC between 2007 and 2016 were retrospectively identified from Taiwan National Health Insurance Research Database and Taiwan Cancer Registry. Patients were categorized into two group: IC group and CCRT group. In order to reduce the selection bias, IC patients were individually matched with the CCRT patients. The oncologic outcomes were presented with overall survival (OS). ResultsA total of 5547 patients were identified. After matching, 2208 patients were analyzed for outcomes comparison, including 1104 patients in each group. In general, median OS were 27.3 months versus 28.5 months in IC and CCRT group, respectively (p = 0.6151). Patients were stratified by primary tumor location. For patients with oral cavity cancers, the median OS was significantly inferior in IC group than those in CCRT group, while for patients with non-oral cavity cancer, the median OS was superior in IC group than those in CCRT group. ConclusionsPrimary tumor location has a significant impact on survival in patients with LA-HNSCC treated with IC. Our study provides a strong evidence that primary tumor location should be taken into consideration during multidisciplinary approach.

Prognostic impact and potential predictive role of baseline circulating tumor cells in locally advanced head and neck squamous cell carcinoma

ObjectivesThe prognostic impact of circulating tumor cells (CTCs) or circulating tumor microemboli (CTM) in locally advanced head and neck squamous cell carcinoma (LA-HNSCC) is yet to be determined, with conflicting results in previous trials. The role of induction chemotherapy (ICT) in the management of LA-HNSCC is controversial with no predictive biomarkers to guide treatment strategy in this scenario. The aim of this trial is to determine the prognostic impact of CTCs and CTM, their biomarkers expression by immunocytochemistry (ICC), and its potential role as predictors of ICT benefit in LA-HNSCC. Materials and MethodsProspective study, with newly diagnosed stage III/IV non-metastatic LA-HNSCC patients treated with curative intent. Blood samples analyzed for CTCs and CTM before treatment using the ISET method. ResultsA total of 83 patients were included. CTCs counts were an independent prognostic factor for overall survival (OS; HR: 1.17; 95 %CI: 1.05–1.31; p = 0.005) and progression free survival (PFS; HR:1.14; 95 %CI: 1.03–1.26; p = 0.007). Using the Lausen and Schumacher technique, 2.8 CTCs/mL for OS and 3.8 CTCs/mL for PFS were defined as the best cut-offs. CTM were detected in 27.7% of patients, correlating with worse PFS (HR = 2.70; IC95%: 1.30–5.58; p = 0.007). MRP-7 expression in CTM correlated with worse OS (HR = 3.49; 95 %CI: 1.01–12.04; p = 0.047) and PFS (HR = 3.62; 95 %CI: 1.08–12.13; p = 0.037). CTCs counts were predictive of complete response to treatment (OR = 0.74; 95 %CI: 0.58–0.95; p = 0.022) and high counts (cut-off 3.8/mL) and CTM were potential predictors of ICT benefit. ConclusionCTCs/CTM had significant prognostic impact and potential role as predictors of ICT benefit in LA-HNSCC.

Functional Larynx Preservation in Patients With Locally Advanced Squamous Cell Carcinoma of the Larynx and Hypopharynx Treated With Induction Chemotherapy vs. Concurrent Chemoradiation Alone.

ObjectivesChemoradiation therapy (CRT) has been established as a standard treatment for locally advanced hypopharynx/larynx squamous cell carcinoma (SCC) but the role of induction chemotherapy (IC) remains unclear. The primary outcome of this study is to determine whether functional larynx-preservation survival (FLPS) is improved with the addition of IC in these patients. Secondary outcomes were overall survival (OS), progression-free survival (PFS), distant metastasis-free survival (DMFS), and laryngectomy rates.MethodsRecords for patients with AJCC 8th edition clinical stage III-IVB laryngeal and hypopharyngeal SCC treated with CRT +/- IC from 2005-2019 were reviewed. FLPS was defined as time until death, progression, laryngectomy, or non-functional larynx. Kaplan-Meier curves were generated for FLPS, OS, PFS, and DMFS. Outcomes were compared using the stratified log-rank test. Laryngectomy rates were compared using Fisher’s exact test.ResultsWe included 52 patients with laryngeal and 38 with hypopharyngeal SCC (n=90); 19 patients with laryngeal SCC and 19 with hypopharyngeal SCC received IC (median three cycles). There were no differences in the three-year FLPS (61% vs 67.8%; p=0.88), OS (73.9% vs 86.2%; p=0.42), PFS (53.6% vs 62.6%; p=0.44), or DMFS (65.2% vs 71.5%, p= 0.85) between patients who did and did not receive IC all patients. Laryngectomy rates did not differ with and without IC (18.4 % vs 7.7%; p=0.19).ConclusionIn this study of advanced laryngeal and hypopharyngeal SCC, IC did not improve three-year FLPS, OS, PFS, or laryngectomy rates compared to CRT alone. A large prospective series would provide a more robust understanding of the role of IC in this group of patients.

The role of induction chemotherapy in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck

The role of induction chemotherapy in the treatment of patients with locally advanced squamous cell carcinoma of the head and neck