A phase II randomized trial comparing neoadjuvant chemotherapy followed by concurrent chemoradiotherapy versus concurrent chemoradiotherapy alone in advanced squamous cell carcinoma of the pharynx or larynx

• Published in: Biomedical Journal Vol. 41; no. 2; pp. 129 - 136
• Main Authors: Huang, Pei-Wei, Lin, Chien-Yu, Hsieh, Chia-Hsun, Hsu, Cheng-Lung, Fan, Kang-Hsing, Huang, Shiang-Fu, Liao, Chun-Ta, Ng, Shu-Kung, Yen, Tzu-Chen, Chang, Joseph Tung-Chieh, Wang, Hung-Ming
• Format: Journal Article
• Language: English
• Published: United States Elsevier Limited 01.04.2018; Chang Gung University; Elsevier
• Subjects: Adult; Aged; Airway management; Cancer therapies; Chemoradiotherapy; Chemoradiotherapy - adverse effects; Chemotherapy; Cisplatin; Compliance; Female; Head & neck cancer; Head and neck cancer; Humans; Hypopharynx; Induction chemotherapy; Laryngeal Neoplasms - mortality; Laryngeal Neoplasms - therapy; Larynx; Male; Middle Aged; Multivariate analysis; Neoadjuvant Therapy; Original; Ostomy; Patient Compliance; Patients; Pharyngeal Neoplasms - mortality; Pharyngeal Neoplasms - therapy; Pharynx; Radiation therapy; Squamous cell carcinoma; Squamous Cell Carcinoma of Head and Neck - mortality; Squamous Cell Carcinoma of Head and Neck - therapy; Survival; Tegafur; Throat cancer; Tumors; Uracil; Taiwan; Head and neck cancer; Chemoradiotherapy; Induction chemotherapy
• ISSN: 2319-4170; 2320-2890
• DOI: 10.1016/j.bj.2018.04.003

To clarify the effect of induction chemotherapy (ICT) in patients with advanced pharyngeal and laryngeal squamous cell carcinoma (PLSCC) treated with concurrent chemoradiotherapy (CCRT). Patients with treatment-naïve nonmetastatic advanced PLSCC were stratified according to disease stage (III or IV) and resectability before being randomized to either a ICT/CCRT or CCRT arm. A cisplatin/tegafur-uracil/leucovorin regimen was administered during ICT and CCRT. The primary end point was overall survival (OS). We enrolled 151 patients during December 2006 to February 2011. The median follow-up of surviving patients was 54.5 months. The ICT/CCRT arm included more patients with hypopharynx cancer (57.1% vs 40.5%, p = 0.09) and N2 or N3 diseases (85.7% vs 74.4%, p = 0.02). In the ICT/CCRT and CCRT arms, the 5-year OS was 48.1% and 53.2% (p = 0.45); progression-free survival (PFS) was 31.8% and 55.6% (p = 0.015); and locoregional control (LRC) was 37.7% and 56.2% (p = 0.026), respectively. The adverse events and compliance to radiotherapy were similar. However, the proportion of patients receiving a total dose of cisplatin during CCRT <150 mg/m was higher in the ICT/CCRT arm (46.8% vs 16.2%; p = 0.000) and independently predicted poorer PFS and LRC in multivariate analysis. OS did not vary between the ICT/CCRT and CCRT arms. However, poorer compliance to CCRT and inferior LRC and PFS were observed in the ICT/CCRT arm. Optimizing the therapeutic ratio in both ICT and CCRT settings are necessary for developing a sequential strategy for patients with advanced-stage PLSCC.