Induction followed with concurrent chemo radiotherapy in advanced head & neck cancer

Background: The need for effective, well tolerated, and convenient therapies for inoperable Head and Neck cancer has led researchers to continually refine chemotherapeutic regimens with radiotherapy to balance efficacy with safety and tolerability in order to maintain or improve quality of life and chemotherapy either induction or concurrent with radiation have emerged as a viable alternative.
Aim: This study was performed to analyze the efficacy and safety of induction chemotherapy with radiotherapy and con-current radiotherapy on survival, functional and quality of life outcomes.
Material and Method: From Dec. 2001 to July 2003, hundred inoperable Head & Neck cancer patients were planned to be treated with methotrexate, Bleocin and cis-platin. On Completion of 3 cycles at 21 days interval, after 2 weeks of last cycles, fifty patients were planned to receive only radiotherapy (Group A) and rest 50 patients (Group B) were given cisplatin 50 mg weekly before Rt. on every Monday. All 100 patients received radiotherapy (66-70 cGy) to the locoregional sites by cobalt 60 units.
Result: After completion of therapy in group A complete response was observed in 56% patients which was 68% in group B. After 2 years of follow up only 54% patient alive and 34% patients were disease free in group A where as in group B. 60% patient alive in which 42% were disease free. The survived patient enjoyed good quality of life.
Conclusion: Patients responded better with induction chemotherapy can be treated with radiotherapy and those who failed to show satisfactory response may be treated with concurrent chemo radiotherapy to get additional benefit in term of survival with good organ preservation along with acceptable and manageable occurrence of schedule & dose related adverse events.

Keywords
Inoperatble Head and Neck cancer, induction chemotherapy, concurrent chemo radiotherapy, prolong infusions