Three therapeutic regimens based on induction chemotherapy in locally advanced squamous cell carcinoma of the head and neck: a single center experience

BACKGROUND: This study aimed to compare three different therapeutic models based on regional control and the outcome of locally advanced squamous cell carcinoma of the head and neck (SCCHN) after induction chemotherapy (ICT). METHODS: One hundred and twenty patients with locally advanced SCCHN were retrospectively reviewed and divided into three groups. Patients in Group A received induction chemotherapy + concurrent chemoradiotherapy (ICT + CCRT). Patients in Group B received induction chemotherapy + radical surgery + adjuvant radiotherapy with or without chemotherapy (ICT + Surgery + RT/CRT). Patients in Group C received induction chemotherapy + planned neck dissection + concurrent chemoradiotherapy (ICT + PND + CCRT). The clinicopathological characteristics, locoregional recurrence (LR), distant metastasis (DM), and overall survival (OS) were compared among them. RESULTS: The median follow-up time was 20 months. In Group A, Group B and Group C, the 3-year OS was 69.7%, 72.9%, and 65.5% respectively. The LR rate was 35.1%, 26.2%, and 42.9%, respectively. The DM rate was 10.5%, 31.0%, and 9.5%, respectively. There were no significant differences in OS and LR among three groups. The DM in Group B was significantly higher than that in Group A (P<0.05), and was probably higher than that in Group C (P=0.06). CONCLUSIONS: Locally advanced SCCHN has a poor prognosis, and the first treatment is critical. Individualized therapeutic regimen based on the response of ICT could be an ideal solution. As cervical metastatic lymph nodes are less sensitive to ICT than primary tumors, PND before radiation therapy might improve the regional control and throat function preservation. A multidisciplinary team (MDT) collaboration is important throughout the treatment process.