A comparative evaluation of acute toxicity and locoregional control by concomitant chemoradiation therapy with or without neoadjuvant chemotherapy in locally advanced head and neck squamous cell carcinoma

Introduction: Head and neck cancer is the commonest malignancy in India. Most of the cases present at a locally advanced stage. Concurrent chemoradiotherapy with or without neo-adjuvant chemotherapy are both viable treatment options in locally advanced cases. Materials & Methods: 30 biopsy proven cases of locally advanced head and neck cancer attending the Out Patient Department of Radiotherapy from August 2016 to May 2018, meeting specified Inclusion and Exclusion Criteria, willing to participate in the study were included. Patients were treated with neo-adjuvant chemotherapy followed by concurrent chemoradiation and followed for a minimum of 9 months. The toxicity and loco-regional control data were assessed. Results: At last follow-up Complete Response, Partial Response, Stable Disease and Progressive Disease was observed in 76.66%, 3.33%, 10% and 3.33% of cases respectively. Haematological toxicities like neutropenia (13.3%), thrombocytopenia (10%) and anaemia (20%) were seen. Acute toxicities like oral mucositis and skin reaction were observed in 33.3% and 30% cases respectively and late toxicity like xerostomia was observed in 40% of the cases. Hoarseness and dysphagia were observed in 30% and 56.66% respectively. Conclusions: Neo-adjuvant chemotherapy followed by concurrent chemoradiation gives good locoregional response, but increasing toxicity which is manageable. Thus, neo-adjuvant chemotherapy followed by concurrent chemoradiation is a good option in locally advanced head and neck cancer.