A RANDOMIZED STUDY ANALYZING CLINICAL AND DOSIMETRIC OUTCOME IN LOCALLY ADVANCED HEAD-AND-NECK CANCER TREATED WITH CONFORMAL CHEMORADIATION WITH OR WITHOUT INDUCTION CHEMOTHERAPY

Abstract

Objective: Squamous cell carcinoma of the head and neck (HNSCC) represents around 10% of new cases in India annually and with a similar trend worldwide. Treatment strategies for stages III and IV HNSCC differ in view of resectability, organ preservation, and medical conditions. Induction chemotherapy (IC) followed by concomitant chemoradiation (CTRT) is widely practiced but Indian data regarding clinical outcomes in the IGRT scenario is still not promising. In this study, we tried to evaluate the dosimetric parameters, response rate, survival, and toxicities as well. Methods: We started our study in August 2019 with Institutional Ethical Committee approval with 42 patients in the CTRT arm and 40 patients in IC+CTRT arm. Patients in the CTRT arm received radiation (66–70 Gy) with 3 weekly cisplatin 80 mg/m2. In the induction arm, 2 cycles of taxane, platinum, 5FU were given followed by concomitant radiotherapy with the same dose and cisplatin. Results: Overall response rates (CR+PR) were 69% versus 72.5% (p=0.06). 2 years overall survival (OS) were 66.7% versus 69.5% (p=0.91). Median disease-free survival were slightly better in the IC+CTRT arm but mean OS was comparable. Mean values of clinical target volume, planning target volume, Spine Dmax, and parotid were lower in the induction arm (p<0.05). Patients with IC experienced more hematological toxicities (p<0.01). Conclusion: IC followed by CTRT offers better dosimetric outcome, slightly better progression-free survival, with more hematological toxicities and no OS benefit.