Toxicity Outcome of Induction Chemotherapy Followed by Concurrent Chemoradiotherapy versus Concurrent Chemoradiotherapy Alone for Locally Advanced Hypopharyngeal Cancer

Background: Concurrent chemoradiation has emerged as a mainstay of treatment for locally advanced hypopharyngeal cancer (stage III to IVB). However, induction chemotherapy is still an area of ongoing interest in attempt to decrease the likelihood of emergence of distant metastases, improve loco-regional control and support organ preservation. Method: This quasi-experimental study was carried out among 86 patients of locally advanced hypopharyngeal cancer patients from November 2021 to October 2022 and distributed into two different groups. Group A received induction chemotherapy (IC) with Paclitaxel and Carboplatin followed by concurrent chemoradiotherapy (CCRT) and group B received CCRT alone. Patients were assessed in every 3 weeks during induction chemotherapy after each cycle and weekly during chemoradiotherapy to assess toxicities. Result: Final assessment was done at 12 weeks after completion of treatment. Most commonly observed toxicities were skin toxicity, oral mucositis, dryness of mouth and neurotoxicity. Patients in both groups mainly developed grade 2 skin toxicity and oral mucositis (44.2% vs 34.9% and 45.6% vs 39.5% in group A and B respectively). However, grade 2 dryness of mouth was observed among twenty patients in group A and eighteen patients in group B. Similarly, grade 1 neuropathy was mostly seen in both the group (41.86% vs 25.58% in group A and B respectively), but statistically not significant (p>0.05). 17(39.53%) and 05(11.63%) patients participated in group A developed grade 1 and grade 2 nephrotoxicity respectively, whereas 15(34.88%) and 03(06.98%) patients developed grade 1 and grade 2 nephrotoxicity respectively in group B. Statistically in significant (p>0.05). Hematological toxicity was also seen frequently in both the arms but statistically insignificant. Conclusion: All skin toxicity, oral mucositis, dryness of mouth, neurotoxicity and hematological toxicity were comparable between the two arms. The toxicities were acceptable ....