Comparative analysis of induction chemotherapy followed by chemoradiotherapy and concurrent chemoradiation therapy efficacy in patients with locally advanced head and neck squamous cell cancer

Treatment strategy of advanced unresectable head and neck squamous cell cancer (HNSCC) is limited to induction chemotherapy (ICT) followed by (chemo) radiotherapy (cRT) and concurrent chemoradiotherapy (CCRT). However, the role of ICT remains controversial considering the lack of overall survival benefit. The aim : to evaluate the role of induction chemotherapy in the treatment of locally advanced HNSCC. Methods : We performed a retrospective clinical study that included patients (pts) with unresectable stage III–IVa cancer of larynx, oropharynx and hypopharynx. Results : A total of 176 pts were enrolled, 84 (48 %) received CCRT with cisplatin or carboplatin and 92 (52 %) — ICT followed by cRT. Groups were well balanced by sex, tumor site, T-stage, while in group of ICT there was a significant prevalence of younger pts (p = 0.004) and pts with stage N2–3 (p = 0,03). The objective response rates (ORR) were 76 % (42 / 55) in CCRT arm (including 53 % (12 / 62) of complete responses) and 72 % (56 / 78) in ICT arm with complete response rate of 15 % (12 / 78). The ORR in ICT arm increased after the completion of CCRT up to 82 % with 53 % (33 / 62) of complete responses. The difference was not statistically significant (p = 0,7). With a median follow-up duration of 8.7 months median progression-free survival (mPFS) was 7.6 and 9.4 months (Hazard ratio (HR) 0.67, 95 % CI 0.43–1.04); 6month OS was 65.7 % and 92.8 % in CCRT and ICT groups, respectively (HR 0.51, 95 % CI 0.30–0.85, р < 0.01). Propensity score matching analysis proved the 6month OS in the ICT + cRT group to be significantly longer than in CCRT group — 97.7 % vs 66.8 %, respectively (HR = 0.28, 95 % CI 0.13–0.62, p < 0.01). Conclusions: ICT + сRT resulted in improvement of PFS and OS compared to CCRT in pts with locally advanced HNSCC.