Optimizing a Convenient Protocol in Induction Treatment Of Locally Advanced Head And Neck Cancers: Taxotere- Cisplatin- 5 Fluorouracil versus Cisplatin-5 Fluorouracil

Background: Induction docetaxel cisplatin and 5-fluorourcil (TPF) followed by 
concomitant chemoradiotherapy (CT/RT) in locally advanced squamous cell 
carcinoma of the head and neck (LASCCHN) is the most efficacious strategy 
but on the other hand it lowers the compliance of the patients due to its high 
toxicity. We preferred to use the cisplatin 5-fluorouracil (PF) as induction due to 
better compliance and lower toxicity.
Materials and methods: A total of 52 patients received either TPF of PF as 
induction before chemoradiation were studied retrospectively. Treatment 
compliance, febrile neutropenia and response rates (RR) were analyzed as well 
as progression free survival (PFS) 
Results: Treatment delays during chemotherapy were much lower in the PF arm 
compared to TPF 1/25 (4%) versus7/27 (25.9%) respectively with significant P 
value (P=0.051). Neutropenia G3-4 with PF was significantly lower than the 
TPF regimen 8% (2/25) versus 40.7% (11/27) (P=0.06). RR (CR+PR) after 
concomitant CT/RT was almost the same in both arms 88% in the PF versus 
85.2% in the TPF with non-significant P value. Comparison of progression-free 
survival (PFS) between PF group and TPF group showed no significant 
difference (p=0.305).at 18 months follow up, the PFS at PF arm was 75.4 % vs 
92.1% in the TPF arm.
Conclusion: Induction PF protocol suits better our population as it yielded 
better compliance, lesser toxicity with maintaining the same efficacy.