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

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 chemoradiation 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 chemoradiotherapy 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.