Soni Mayank, Gupta Sweety, Chakravarty Abhishek, Rastogi Aviral, Kumar Nitin, Bhatia Shrutikant, Joseph Deepa M, Gupta Manoj
Department of Radiation Oncology, AIIMS, Rishikesh, India.
Department of Radiation Oncology, Homi Bhabha Cancer Hospital and Mahamana Pandit Madan Mohan Malaviya Cancer Centre, Varanasi, India.
Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2514-2522. doi: 10.1007/s12070-025-05538-w. Epub 2025 May 20.
Concurrent chemo-radiotherapy is standard of care for locally advanced Head and Neck squamous cell carcinoma. Induction chemotherapy is given to reduce locoregional relapse, distant metastases and tumor shrinkage. Response to induction chemotherapy can predict response to radiotherapy, but impact of IC response to survival benefit after radical treatment is less studied.
We conducted a retrospective study of patients with locally advanced Head and Neck squamous cell carcinoma receiving induction chemotherapy followed by radical chemoradiotherapy. Clinico-radiological response to induction chemotherapy was recorded and further subjected to chemoradiotherapy. Overall, Disease free and distant metastasis free survival were analysed.
116 patients received induction chemotherapy followed by radical chemoradiotherapy. Post induction chemotherapy, response(down-stage) was, 48(41.37%) for T-stage, 46(36.65%) for N-stage and 45(38.79%) for Stage group, respectively. On follow up after chemoradiotherapy, 52(44.8%) had complete response, 61(52.6%) had failure of treatment, and 3(2.6%) died within three months. With median overall survival of 18.89 months, median follow up was of 10.8 months. Univariate analysis indicated significant benefits in Disease free survival for T-stage response ( < 0.04), but not for N-stage ( = 0.25) or stage group ( = 0.11). However, multivariate analysis identified stage group response as statistically significant predictor overall survival (0.04, HR0.538). In subset analysis, younger population (< 50 year), despite being non-responder had significant benefit in distant metastasis free survival status (0.04). For subsite, hypopharyngeal malignancies had significant benefit in overall survival status for N-stage (0.002) and stage group (0.008), and for laryngeal malignancies significant benefit in disease free survival status for T-stage response (0.03).
In locally advanced Head and Neck squamous cell carcinoma, response to induction chemotherapy can be viewed as an indicator of potential survival benefit. Role of induction chemotherapy is recommended for laryngeal and hypopharyngeal malignancies, to preserve organ-function along with enhanced survival rates. In younger patients, even if they are non-responders, induction chemotherapy combined with concurrent chemoradiation is a viable option that may improve locoregional, and distant control of the disease.
同步放化疗是局部晚期头颈部鳞状细胞癌的标准治疗方法。给予诱导化疗以减少局部区域复发、远处转移和肿瘤缩小。诱导化疗的反应可以预测放疗反应，但诱导化疗反应对根治性治疗后生存获益的影响研究较少。
我们对接受诱导化疗后行根治性放化疗的局部晚期头颈部鳞状细胞癌患者进行了一项回顾性研究。记录诱导化疗的临床放射学反应，并进一步进行放化疗。总体上，分析了无病生存期和无远处转移生存期。
116例患者接受了诱导化疗，随后进行了根治性放化疗。诱导化疗后，T分期的反应（降期）为48例（41.37%），N分期为46例（36.65%），分期组为45例（38.79%）。放化疗后的随访中，52例（44.8%）完全缓解，61例（52.6%）治疗失败，3例（2.6%）在三个月内死亡。中位总生存期为18.89个月，中位随访时间为10.8个月。单因素分析表明，T分期反应对无病生存期有显著益处（<0.04），但N分期（=0.25）或分期组（=0.11）无显著益处。然而，多因素分析确定分期组反应是总生存期的统计学显著预测因素（0.04，HR0.538）。在亚组分析中，较年轻人群（<50岁），尽管无反应，但在无远处转移生存状态方面有显著益处（0.04）。对于亚部位，下咽恶性肿瘤在N分期（0.002）和分期组（0.008）的总生存状态方面有显著益处，而喉恶性肿瘤在T分期反应的无病生存状态方面有显著益处（0.03）。
在局部晚期头颈部鳞状细胞癌中，诱导化疗的反应可被视为潜在生存获益的指标。对于喉和下咽恶性肿瘤，推荐诱导化疗的作用，以保留器官功能并提高生存率。在较年轻患者中，即使他们无反应，诱导化疗联合同步放化疗也是一种可行的选择，可能改善疾病的局部区域和远处控制。
