Induction chemotherapy followed by chemoradiation versus upfront chemoradiation in locally advanced head and neck cancers A prospective randomized study

Background: Upfront concurrent chemoradiotherapy remains the standard of care for treating locally advanced squamous cell carcinoma of the head and neck (LA SCCHN), however, defining the role of induction chemotherapy in these patients yet to be determined. Methods: The current prospective randomized study divided 144 patients with LA SCCHN to receive concurrent chemoradiation (CRT) or induction chemotherapy followed by concomitant chemoradiotherapy (IC+CRT) to investigate its effect on RR, DFS, PFS and OS. This work conducted between January 2015 and December 2016 at Sohag University hospital and Sohag Cancer Center. Results: With a median follow up of 23 months, the initial response rate was 92.9% for the CRT arm and 80% for the IC+CRT arm with a significant difference in the median time to reach initial response (3 months and 2 months for CRT and IC+CRT respectively; p= 0.0008). However, no significant difference between the study groups in ORR (66.67% and 52.78% for CRT and IC+CRT, respectively; p= 0.23). There was no statistically significant difference as regards acute toxicity profile; however, late toxicity was significantly higher in CRT; p-value =0.04. No significant differences found in the cumulative DFS, PFS for different subgroups, (p= 0.8; p= 0.26, respectively), however, larger tumors in stage III/IV were associated with worse OS (p= 0.03). Conclusion: Induction chemotherapy followed by chemoradiation may be not inferior to standard treatment of LA SCCHN tumors with significant early-onset response and less frequent late toxicity. This might hold promise for these patients especially with larger tumor size; however, confirmation mandates larger prospective studies.