A comparative evaluation of neoadjuvant chemotherapy followed by concomitant chemoradiation versus accelerated radiation therapy versus conventional radiation therapy in a locally advanced head and neck carcinoma

Abstract

Context: Head and neck cancers (HNCs) include malignancies of oral cavity, nasopharynx, oropharynx, hypopharynx, larynx, paranasal sinuses, and major and minor salivary glands. Worldwide incidence of HNC cases is 4.8%, whereas in India, it is 14.3%. Aims: Evaluation and comparison of the efficacy, tolerability, and toxicity of neoadjuvant chemotherapy (NACT) with docetaxel, carboplatin, and 5-fluorouracil (TPF) followed by concomitant chemoradiation in one group, accelerated radiation therapy (RT) in second group, and conventional RT in third group. Subjects and Methods: The present randomized prospective study was conducted on locally advanced head and neck carcinoma patients who were randomly divided into three groups. All patients received NACT with 3-weekly TPF, for 3-courses. Group I-patients received concomitant conventional RT, 64 Gy/32 fractions/6.2-week along with three weekly carboplatin 300 mg/m2 × 3-cycles. Group II-patients received accelerated RT given six fractions per week, total dose 64 Gy/32 fractions/5.2-week. Group III-patients received conventional RT, 64 Gy/32 fractions/6.2-week. Results: The overall response rate to NACT was 100% in all groups. At last follow-up, in Group I – 52% remained alive with no evidence of disease (NED), 39% remained alive with residual disease, and 9% had locoregional recurrence. In Group II – 46% remained alive with NED, 46% remained alive with disease, 8% had locoregional recurrence, whereas in Group III – 40% remained alive with NED, 44% remained alive with disease, and 16% had locoregional recurrence. Conclusions: NACT followed by concomitant chemoradiation is a better treatment protocol as compared to accelerated RT or conventional radiotherapy, in terms of better complete response rates with acceptable toxicity profile.

Keywords

• accelerated radiation
• concomitant chemoradiation
• conventional radiation
• head and neck cancer
• locally advanced head and neck carcinoma