A prospective comparision of sequential chemoradiation vs concurrent chemoradiation in locally advanced oropharyngeal carcinomas

Abstract

Purpose: Induction chemotherapy has shown to provide consistent benefit for local control in primary treatment of advanced oropharyngeal cancer. The beneficial role of chemoradiation following induction chemotherapy over concurrent chemora-diation has not been evaluated. Present study evaluates the same prospectively. Results: The response rate and acute toxicity (primary end points) in both the arms were found to be similar (p > 0.05) The points disease free survival and overall survival (secondary end points) were significantly (p < 0.05) better in treatment arm as compared to control arm. Method: Out of 135 patients of locally advanced oropharyngeal carcinoma, 105 patients were found eligible and randomized to treat either with induction chemotherapy consisting of 2-3 cycles of cisplatin and 5-Florouracil followed by low dose weekly cisplatin based chemoradiotherapy (treatment arm: n = 48) or chemora-diotherapy only (control arm: n = 57). The primary tumor and regional lymph drainage areas received 66-70 Gy in 6.5 to 7 weeks by fractionated dose schedule. Conclusion: Patients receiving chemoradiation following induction chemotherapy showed better response rates both in terms of complete response and disease free survival at 2 years than those receiving only concurrent chemoradiation but at the cost of manageable increase in toxicity. © 2009 Landes Bioscience.