COMPARISON BETWEEN INDUCTION CHEMOTHERAPY FALLOWED BY CONCURRENT CHEMOTHERAPY VERSUS CONCURRENT CHEMOTHERAPY ALONE IN HYPOPHARNGEAL CARCINOMA-A PILOT STUDY

Bhaskar Viswanathan, Dr. Deepak and *Swathi Reddy

ABSTRACT

Background: The incidence of distant metastasis is quite high in patients of Hypopharyngeal cancers compared to concurrent chemoradition alone. Aims and objectives: To assess and compare 1) The loco-regional response and patterns of failure in carcinoma hypopharynx patients treated with induction chemotherapy followed by chemoradiation versus chemoradiation alone. 2) The toxicity profile in patients treated in 2 arms. Materials and Methods: 40 patients,(20 prospective for Arm A, 20 retrospective for Arm B presenting with T1N+, T2/T3 any N, M0 stages of Carcinoma Hypopharynx were enrolled. In Arm A, patients received Induction Chemotherapy (2 cycles of 3 weekly Inj.Paclitaxel 175 mg/m2 & Inj.Cisplatin 70mg/m2) followed by concurrent chemoradiation (2cycles of 3 weekly Inj.Cisplatin 70mg/m2. In Arm B, patients received Concurrent Chemoradiation alone (2cycles of 3 weekly Inj.Cisplatin 70mg/m2 .The radiation done was same in both arms at 7000cGy in 35 fractions at 2Gy/fraction. Results: In Arm A, showed more responses compared to Arm B. At 6 months, the complete response rate for Arm A was 88.9% compared to 66.7% in Arm B, though the difference was not statistically significant. None of the patients in Arm A developed progressive disease as opposed to 2 (10%) patients in Arm B. Toxicity profile of mucositis, haematological and dysphagia in both Arms were comparable. Interpretation & Conclusion: Sequential therapy (ICT+CTRT) was well tolerated and showed favorable improvement in tumour response rates and reduced treatment failure compared to patients treated with CTRT alone. Thereby sequential therapy offers a safe and effective means of management in T1N+, T2/T3 any N, M0 stages of Carcinoma Hypopharynx patients.

Keywords: Hypopharynx cancer; Radiotherapy; Sequential therapy; Induction Chemotherapy; Chemoradiation.