prospective comparative study to compare response and toxicities of concurrent chemoradiation with and without induction chemotherapy (ic) in locally advanced stage iii & iv (m0) head and neck squamous cell cancer (lahnscc)

Introduction: Concurrent chemoradiation is currently the standard of care in LAHNSCC. Most of head and neck cancer patients present initially as locally advanced disease. Induction Chemotherapy (IC) causes tumor down staging, facilitating organ preservation, decreasing possibilities of recurrences and potential to prevent distant metastasis. The purpose of the study was to assess effectiveness in treatment response and various toxicity profile between IC followed by concurrent chemoradiation (CTRT) and only concurrent chemoradiation in patients of locally advanced unresectable head and neck squamous cell cancer. Materials and method: Patients with LAHNSCC of oropharynx, larynx and hypopharynx (AJCC Stage III-IVB) enrolled in study from April 2019 to August 2020 were randomized into two groups -68 subjects in study group and 66 subjects in control group. Study Group A patients received three cycles of induction chemotherapy (IC) Paclitaxel 175mg/m2 and Cisplatin 75mg/m2 at three weekly interval followed by CTRT or CTRT alone in Control Group B. The total dose of radiation was given in both the groups 66 Gray in 33 fractions, five fractions per week for 6.3 weeks on Telecobalt machine Bhabhatron along with concurrent chemotherapy Injection Cisplatin 30mg/m2 weekly. Results: Overall response was 79.4% (54 patients) including CR 23.5% (16 patients) & PR 55.9% (38 patients) after IC. Grade 3 toxicities nausea & vomiting (7.35%), neutropenia (6%), anemia (4.4%) and diarrhoea (4.4%) occurred during IC. Response evaluation was done after 6 months of completion of treatment in both groups showed complete response (CR) 76.5% & 59% in Study group A & Control group B respectively. Overall response rate (OR=CR+PR) was 92.7% in Study group and 90.8% in Control group. CR was better in study arm but not statistically significant. Significant grade ≥ 3 acute toxicities were nausea & vomiting 10.3% patients (p-value 0.038), mucositis 44.1% patients (p-value 0.047) in study group after completion of chemoradiation. Rest acute toxicities like dysphagia, dermatitis, nephrotoxicity and xerostomia were more in study group A but statistically not significant. Conclusion: Our study induction chemotherapy paclitaxel & cisplatin with sequential chemoradiation is more suitable in terms of complete response rate (CRR), compliance with manageable toxicity in LAHNSCC.