Induction Chemotherapy Followed by Concomitant Chemoradiation in Head and Neck Squamous Cell Carcinoma: A Single Institution Experience

Objective: Phase 3 studies are underway to compare induction chemotherapy (IC) followed by concomitant chemoradiation (CRT) with CRT alone in advanced head and neck cancer. The purpose is to report the outcome of patients with advanced head and neck cancer treated at Centre Hospitalier de l’Universite de Montreal (CHUM) with IC followed by CRT. Methods: From March 1998 to December 2007, 56 consecutive patients were treated for advanced squamous cell carcinoma of the head and neck with high-dose IC followed by CRT. Sixteen patients with carcinoma of the nasopharynx, paranasal sinuses or nasal cavity were excluded. Patients presented with either T4 (60%) or N3 (60%) disease. Outcomes were computed using Kaplan-Meier curves. The number of IC cycles were compared with logrank tests. Results: The 2 year estimates of OS, DFS, LRC and DMFS rates were 58%, 46%, 78% and 75% respectively. At last follow-up, we observed 17 patients with relapse of which 10 were at a distant site. When stratified by the number of IC cycles, a DMFS rate of 87% was observed for 1-2 cycles vs 49% for 3 cycles, p=0.05. Conclusions: Despite intensive treatment with platinum based IC and CRT, prognosis for this highly advanced population of T4 or N3 cancers is poor. The number of IC cycles seem to influence the rate of DM. Further trials are needed to answer the question regarding IC followed by CRT vs CRT alone. Targeted therapies might also yield more promising results.