Induction chemotherapy using gemcitabine and cisplatin followed by hypofractionated radiotherapy in advanced head and neck squamous cell carcinoma.

Abstract

e18010 Background: The mainstay of treatment for locally advanced head and neck squamous cell carcinoma (HNSCC) is definitive concurrent chemoradiation (CRT). Since, most of these patients present in advanced stage, induction chemotherapy (IC) may provide a tool to downstage the disease and provide an opportunity for organ preservation. Furthermore, IC bridges the time gap till the definitive chemoradiation as there is long waiting list for radiation therapy in oncology sections. The objective of this study was to assess the disease-free survival (DFS) and overall survival (OS) of induction chemotherapy using gemcitabine and cisplatin followed by hypo-fractionated radiation therapy (HRT) in locally advanced HNSCC. Methods: A total of 127 patients, with biopsy proven locally advanced HNSCC were included. Patients with primary tumor in oral cavity (n=22), oropharynx (n=29), larynx (35) and hypopharynx (n=41) having TNM stage between III to IVB were selected. The patients were planned for three cycles of IC using gemcitabine and cisplatin (GC) every three weeks in a dose of 1000 mg/m 2 and 50 mg/m 2 on D1 and D8 of each cycle respectively. After three cycles of chemotherapy, patients were planned for HRT. A total of 55 Gray (Gy) was planned with 2.75 Gy per fraction and five fractions a week. Spinal cord dose was limited to 33 Gy in 12 fractions. Treatment interruptions were allowed for grade 3 or 4 toxicity. The response was assessed after 6 weeks of completion of treatment using CT scan. Primary end point was to assess DFS while OS was also assessed as a secondary end point. Results: A total of 118 patients (89%) were available for assessment as remaining patients were unable to complete the planned treatment. Eleven patients (9%) showed disease progression during treatment and were shifted to other treatment. DFS and OS were calculated for 107 patients. Five-year DFS and OS were 34% and 42% respectively. Mean and median DFS (years) were 3.21±0.13 (95% confidence interval [CI] 2.95 to 3.47) and 3.41±0.28 (CI 2.85 to 3.97) respectively. Mean and median OS (years) were 3.91±0.11 (CI 3.69 to 4.13) and 3.98±0.23 (CI 3.52 to 4.44) respectively. Conclusions: Induction chemotherapy using GC followed by HRT is a reasonable option in locally advanced HNSCC. A larger randomized phase III trial is required to recommend this treatment in practice.