Induction with Taxane/Platinum Based/5-Fu (TPF) Chemotherapy as a Predictor of  Response to Definitive Concurrent Chemo Radiotherapy (CCRT) in Locally Advanced Inoperable Head and Neck Cancers

Objective: To evaluate the effect of induction with Taxane/platinum based/5-FU chemotherapy as a predictor of response to definitive concurrent chemoradiotherapy in inoperable locally advanced squamous cell carcinoma of head and neck. Study Design: Interventional study. Place and Duration of Study: Medical Oncology Department, Jinnah Postgraduate Medical Center Karachi, Pakistan, from Oct 2019 to Oct 2020. Methodology: A total of 71 patients aged 18 years or more with inoperable, locally advanced squamous cell carcinoma of the head and neck were included. Patients were given three cycles of induction therapy with injection Docetaxel 75 mg/m2 day 01, injection Cisplatin 75 mg/m2 intravenously (IV) day 01 and 5-Fluorouracil 1000 mg/m2 IV day one-four every three weeks. CT scan was repeated after the last cycle to check response. All patients irrespective of response to induction received concurrent chemoradiotherapy, which included administration of weekly Carboplatin AUC-2 with radiotherapy 5 days per week. Response was assessed according to revised Response Evaluation Criteria in Solid Tumors (RECIST v1.0) criteria. Results: The mean age of our respondents was 48.46±12.74 years. Of 71 patients, 26(36.6%) had achieved partial response after concurrent chemoradiotherapy, 24(33.8%) had achieved complete response, 10(14.1%) had stable disease and 11(15.5%) had progressive disease. There was a statistically significant association between response to concurrent chemoradiotherapy and response to induction chemotherapy (p=0.001). Conclusion: The response of induction chemotherapy can be used as a guide to select patients for definitive concurrent chemoradiotherapy versus palliative treatment.