Till now, the role of induction chemotherapy has remained a subject of controversy. Our study was to directly compare survival in patients receiving induction chemotherapy docetaxel or platinum given before concomitant chemoradiotherapy with upfront chemoradiotherapy alone.
The National Health Insurance claims database and cancer registry databases in Taiwan were linked for the analysis. Head and neck cancer patients from January 1, 2002 to December 31, 2011 were included in the study. The inclusion criteria were having a head and neck cancers, being aged > 20 years, American Joint Committee on Cancer clinical cancer stage III ∼ IV and having undergone induction chemotherapy or concurrent platinum based chemoradiotherapy (CCRT). Exclusion criteria were having been diagnosed with cancer before the head and neck cancer was confirmed, having distant metastasis, platinum and docetaxel combined use before RT, docetaxel use during/after RT, induction chemotherapy beyond 8 weeks before RT, cetuximab use, adjuvant chemotherapy within 90 days after completion of RT, < 7,000 cGy dose of RT, curative surgery before RT, nasopharyngeal cancer, carcinoma in situ, sarcoma, head and neck cancer recurrence, or an unknown gender, and being younger than 20 years.
In total, 10,721 stage III ∼ IV head and neck cancer patients without distant metastasis were included in the study. There were 7,968 patients in the CCRT group (arm 1); 503 patients in the induction chemotherapy with docetaxel group of arm 2 and 2,232 patients in the induction chemotherapy with platinum group of arm 3. We used the CCRT arm as the control arm to investigate the risk of death after induction chemotherapy. After adjustments for age, gender, clinical stage, and comorbidities, the aHRs of overall deaths were 1.37 (95% CI, 1.22–1.53) in arm 2 and 1.44 (95% CI, 1.36–1.52) in arm 3. In disease-specific survival rate analysis, after adjustments for age, gender, clinical stage, and comorbidities, the aHRs of head and neck cancers deaths were 1.29 (95% CI, 1.14-1.46) in arm 2 and 1.47 (95% CI, 1.38-1.56) in arm 3.
Our cohort study showed induction chemotherapy with docetaxel or platinum not only did not improve survival but also result in more all death and head and neck cancer death risk compared with CCRT.
Clinical trial identification
not a clinical trial
All authors have declared no conflicts of interest.