TPF INDUCTION CHEMOTHERAPY FOLLOWED BY CISPLATIN-BASED CONCURRENT CHEMORADIOTHERAPY IN PATIENTS WITH STAGE IV HEAD AND NECK CANCER DEMONSTRATED NO BENEFIT

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Abstract

Background

Docetaxel, cisplatin, and 5-fluorouracil (TPF) is considered to be the mosteffective induction chemotherapy combination for locally advanced unresectable head and neck cancer. However, it remains unclear that induction chemotherapy added to concurrent chemoradiotherapy (sequential therapy) has a positive effect on survival when compared with concurrent chemoradiotherapy (CCRT) alone. The purpose of this study was to compare the sequential therapy with CCRT alone.

Methods

We analyzed newly diagnosed stage IV head and neck cancer patients who received CCRT (cisplatin 80 mg/m2 on day 1, 22, and 43 plus RT) with or without three cycles of TPF induction chemotherapy (docetaxel 75 mg m2 day 1, cisplatin 75 mg/m2 day 1, and 5-fluorouracil 750 mg/ m2/day by continuous infusion on days 1–4) at The Cancer Institute Hospital of JFCR between May 2006 and August 2010 retrospectively.

Results

There were 82 patients who received cisplatin-based CCRT, of which 15 patients (18.3%) received TPF induction before CCRT. Complete response (CR) after completion of TPF induction chemotherapy were 1/15 (6.7%) and subsequently, 11/15 (73.3%) patients achieved CR after CCRT, while 50/67 (74.6%) patients achieved CR in CCRT alone with no significant difference (P = 0.58). With a median follow-up of 27 months, progression-free survival and overall survival had no significant benefit with TPF + CCRT compared with CCRT alone (hazard ratio 1.28: CI 0.56–3.53); 2-year PFS were 46.7 versus 71.6% and 2-year OS were 86.7 versus 79.6%, respectively. The poor prognostic factor were age over 65, nasopharyngeal cancer, and CR achievement after CCRT.

Conclusion

TPF induction chemotherapy is a feasible option before concurrent chemoradiotherapy. However, there is no significant benefit in this small retrospective study. Further prospective study is needed to assess the role of induction chemotherapy.

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