학술논문
Outcome of Concurrent Chemoradiation after Induction Chemotherapy in Locally Advanced Head and Neck Squamous Cell Carcinoma--A Prospective Study among Patients Attending a Tertiary Care Center in Kerala, India
Original Research Article
Original Research Article
Document Type
Report
Source
Journal of Evolution of Medical and Dental Sciences. January 2023, Vol. 12 Issue 1, p19, 7 p.
Subject
Language
English
ISSN
2278-4748
Abstract
BACKGROUND Head and neck cancers (HNC) are the sixth common cancer worldwide CDIn India, HNCs constitutes 30-40% of all cancers, of which 90% are squamous cell carcinoma. [1] More than [...]
BACKGROUND Concurrent chemoradiation (CCRT) is the standard of care for locally advanced head and neck squamous cell carcinoma (LAHNSCC). In settings with considerable waiting period for radiation, institutional protocols advocate induction chemotherapy before CCRT. This study aimed to assess the outcome of concurrent chemoradiation after induction of chemotherapy among patients with LAHNSCC attending a tertiary care radiotherapy center in Kerala, India. METHODS Patients with non-metastatic LAHNSCC (stage 111 and 1V) with good performance score of 0-1 who received induction chemotherapy (with docetaxel 75mg/[m.sup.2] and cisplatin 75 mg/[m.sup.2], day 1 and 5-fluorouracil 750 mg/[m.sup.2], day 1 and 2 as infusion every 3 weeks for 3 cycles) followed by CCRT (with concurrent cisplatin 40 mg/[m.sup.2] weekly) were selected for the study. CCRT was administered only to those patients who showed more than 30% response to induction chemotherapy. They were followed up for 24 months. The primary end point was the clinical response assessed by ENT evaluation 8 weeks after the completion of CCRT. RESULTS 117 patients with LAHNSCC were enrolled. Four patients (3.4%) dropped out after induction therapy. Out of 113 patients who initiated concurrent chemo radiation, two patients (1.7%) dropped out while on CCRT, two patients (1.7%) were intolerant to CCRT and two patients (1.7%) left soon after CCRT. 107 patients were available for follow up after treatment completion. Acute toxicities were noticed in 9 (7.7%) while on induction treatment. Mucositis occurred in 1 (0.9%), haematological toxicities in 4 (3.4%), gastrointestinal toxicities in 2 (1.7%) and fatigue and malaise in 2 (1.7%). In patients who underwent concurrent chemo radiation, 53 (49.03%) had acute mucosal, skin, GIT and haematological toxicities. On treatment completion, 82 patients (70.1%) had complete response, 24 (20.5%) had partial response and one (0.9%) had stable disease. During the follow up period of 24 months, locoregional failure (relapse) was noted in 15 patients (12.8 %) while 61 patients (52.1%) remained disease free. Organ preservation rate was 53.4% for laryngeal primaries. 4 patients (3.4%) developed distant metastases during the follow up. CONCLUSIONS Induction chemotherapy with docetaxel containing regime followed by concurrent chemoradiation was associated with good clinical response and acceptable toxicity profile. KEY WORDS Concurrent Chemoradiation, Head and Neck Cancer, Induction Chemotherapy.
BACKGROUND Concurrent chemoradiation (CCRT) is the standard of care for locally advanced head and neck squamous cell carcinoma (LAHNSCC). In settings with considerable waiting period for radiation, institutional protocols advocate induction chemotherapy before CCRT. This study aimed to assess the outcome of concurrent chemoradiation after induction of chemotherapy among patients with LAHNSCC attending a tertiary care radiotherapy center in Kerala, India. METHODS Patients with non-metastatic LAHNSCC (stage 111 and 1V) with good performance score of 0-1 who received induction chemotherapy (with docetaxel 75mg/[m.sup.2] and cisplatin 75 mg/[m.sup.2], day 1 and 5-fluorouracil 750 mg/[m.sup.2], day 1 and 2 as infusion every 3 weeks for 3 cycles) followed by CCRT (with concurrent cisplatin 40 mg/[m.sup.2] weekly) were selected for the study. CCRT was administered only to those patients who showed more than 30% response to induction chemotherapy. They were followed up for 24 months. The primary end point was the clinical response assessed by ENT evaluation 8 weeks after the completion of CCRT. RESULTS 117 patients with LAHNSCC were enrolled. Four patients (3.4%) dropped out after induction therapy. Out of 113 patients who initiated concurrent chemo radiation, two patients (1.7%) dropped out while on CCRT, two patients (1.7%) were intolerant to CCRT and two patients (1.7%) left soon after CCRT. 107 patients were available for follow up after treatment completion. Acute toxicities were noticed in 9 (7.7%) while on induction treatment. Mucositis occurred in 1 (0.9%), haematological toxicities in 4 (3.4%), gastrointestinal toxicities in 2 (1.7%) and fatigue and malaise in 2 (1.7%). In patients who underwent concurrent chemo radiation, 53 (49.03%) had acute mucosal, skin, GIT and haematological toxicities. On treatment completion, 82 patients (70.1%) had complete response, 24 (20.5%) had partial response and one (0.9%) had stable disease. During the follow up period of 24 months, locoregional failure (relapse) was noted in 15 patients (12.8 %) while 61 patients (52.1%) remained disease free. Organ preservation rate was 53.4% for laryngeal primaries. 4 patients (3.4%) developed distant metastases during the follow up. CONCLUSIONS Induction chemotherapy with docetaxel containing regime followed by concurrent chemoradiation was associated with good clinical response and acceptable toxicity profile. KEY WORDS Concurrent Chemoradiation, Head and Neck Cancer, Induction Chemotherapy.