Comparison of sequential chemoradiation with radiation alone in the treatment of advanced head and neck cancers.

Objectives: To compare locoregional control with alternating chemo radiation and radiation alone in patients with locally advanced head and neck carcinoma.
Study Design: A prospective randomized study.
Setting: Tertiary academic referral center.
Patients: 50 patients of biopsy proven locally-advanced carcinoma of head and neck.
Intervention: 25 patients were kept in Group I or study group (i.e. alternating chemo-radiation) and 25 patients in Group II or control group (i.e. radiation alone). In the study group, patients were given 3 cycles of chemotherapy (Cisplatin 20 mg/m([2]) and Inj. 5-FU 200mg/m([2]) from day 1-5 of each week) during weeks 1,5 and 9 alternated with radiation dose of 10Gy/week was given during weeks 2,3,4 and 6,7,8. In the control group, patients were given a total dose of 60Gy in 6 weeks.
Outcome Measures: The response rate at the primary site and nodal site was better in study group as compared to control group.
Results: On comparing the response at the primary and nodal site together, 72% (18/25) patients of group I and 44% (11/25) patients of group II showed CR. PR was seen in 28% (7/25) and 36% (9/25) patients in group I and II respectively. No response was seen in 5/25 (20%) of patients in Group II.
Conclusion: Our study has revealed that alternating/ sequential chemoradiation is a promising and feasible approach for patients in advanced head and neck cancer.