A non-randomized comparison of gemcitabine-based chemoradiation with or without induction chemotherapy for locally advanced squamous cell carcinoma of the head and neck

We compared the outcome of two cohorts of patients (pts) with LA-SCCHN treated at our institution with CRT (n = 27) or ST (n = 31), respectively. CRT consisted of GEM 100 mg/m2 weekly + conventional RT (70 Gy); ST consisted of the same CRT preceded by platinum-based IC.Response to IC: complete 8 (26%), partial 20 (65%), stable 1, progressive 1, not evaluable 1. Median follow up of the surviving pts: for CRT 73 months, for ST 51 months. Median time to distant metastasis (TDM) was for CRT 23.6 months, for ST not reached. Median OS was for CRT 20.2 months, for ST 40.2 months. Cox regression analysis, taking into account age, T and N stage and tumor site, showed a hazard ratio with ST of 1.190 for time to locoregional failure (p = 0.712), 0.162 for TDM (p = 0.002), and 0.441 for overall survival (OS) (p = 0.026).TDM and OS were found significantly longer in the ST cohort without a reduced locoregional control. Notwithstanding the limitations of a non-randomized single-center comparison, the results are in line with very preliminary data of randomized comparisons suggesting an improved outcome with ST.Two thirds of the squamous cell carcinoma of the head and neck (SCCHN) are in a locoregionally advanced disease stage at time of diagnosis. Locoregionally advanced SCCHN is generally treated by a combination of chemotherapy and irradiation with or without surgery [1]. Concurrent chemotherapy and radiotherapy (chemoradiation) is widely adopted as standard of care for locoregionally advanced SCCHN after the publication of a large meta-analysis including individual data on 10.741 patients in 63 randomized trials [2,3]. Concurrent chemoradiation conferred an absolute survival benefit of 8% at 2 and 5 years. In contrast, the meta-analysis failed to demonstrate a survival advantage for induction chemotherapy followed by local treatment compared to local treatment alone. However when the meta-analysis was restricted to trials using the standard cisplatin/infusional 5-fluorouracil