Induction Chemotherapy as a Predictor for Definitive Treatment in Bulky Locally Advanced Squamous Cell Carcinoma of the Head and Neck: A Schedule More Suited to Sub Himalayan Region

Purpose: Use of induction chemotherapy (IC) as a predictor for definitive treatment in bulky locally advanced head and neck cancer (LA HNSCC) patients, who are not feasible for any upfront radical treatment in sub-Himalayan population.

Materials and Methods: 33 patients (stage IVA and IVB, T4, N3) LA HNSCC were treated with induction chemotherapy (TP) from April 2013 to August 2015. All patients were considered inoperable or not feasible for upfront radical treatment and Eastern Cooperative Oncology Group (ECOG) Performance status was ≤ 2.

All patients were reviewed at multidisciplinary tumor board and considered for initial 3 cycles of induction chemotherapy in view of bulky stage IV LAHNSCC. Subsequent Radical (CTRT or Sx → CT RT) or palliative treatment was decided by tumor board after response assessment of NACT. The Statistical Package for the Social Sciences software (SPSS version 16.0) was used for analysis. The response rate, toxicity (accordance with CTCAE vs. 4.02), completion rate of radical treatment post NACT and overall survival was reported.

Results: Median follow up was 22 months (18-26 months). After 3 cycles of IC, 20 patients (60.66%) underwent radical treatment and remaining 13 patients (39.33%) were treated with palliative treatment. Overall grade 2-3 toxicity was seen in 12 patients. No toxicity related mortality was noted. The completion rate of radical treatment post IC was 93.5%. The median OS was 18 month ((95% CI 9.00 to 31.00). Total 16 Patients are alive, in which 11 is disease free. Twelve patients expired and 5 patients were lost to follow up.

Conclusion: Our present experience suggests that neoadjuvant chemotherapy with doublet regime is reasonably well tolerated and feasible in limited resource setting of patients with locally advanced disease who are not fit for upfront radical treatment.