Induction chemotherapy followed by concomitant chemoradiotherapy in the treatment of locoregionally advanced oropharyngeal cancer

PURPOSE Locoregionally advanced oropharyngeal cancer has been conventionall y treated with either surgery and adjuvant radiotherapy or radiotherapy alo ne, and clinical and functional outcomes have been pear. Chemoradiotherapy has been demonstrated to improve functional outcome and disease control ove r conventional treatment in recent randomized head and neck trials. Herein, we report overall survival, progression-free survival, and patterns of fai lure in locoregionally advanced oropharyngeal cancer treated with induction chemotherapy with or without conservative surgery followed by concomitant chemoradiation. MATERIALS AND METHODS Three cycles of induction chemotherapy consisting of cisplatin, 5-fluorouracil, leucovorin, and interferon alpha -2b (PFL-IFN) w ere followed by conservative, organ-sparing surgery for residual disease. A ll patients then proceeded to concomitant chemoradiation consisting of seve n or eight cycles of 5-fluorouracil, hydroxyurea, and a total radiotherapy dose of roughly 7000 cGy. RESULTS Sixty-one patients with predominantly stage IV disease were treated . Clinical complete response was observed in 65% of patients after inductio n therapy. The median follow-up was 68.0 months for survivors and 39.0 mont hs for all patients. At 5 years, overall survival is 51%, progression-free survival is 64%, locoregional control is 70%, and distant control is 89%. L ocoregional recurrence accounted far 80% of all initial failures. Only five radical surgeries (none were total glossectomy) were performed for initial disease control. Treatment-related toxicity accounted for four deaths. CONCLUSION PR-IFN given with 5-fluorouracil, hydroxyurea, and radiotherapy produces a high rate of cures with organ preservation in a disease group th at has traditionally fared poorly. Local and distant disease control and su rvival rates exceed those observed with more standard treatment approaches involving surgery and radiotherapy. Further investigation into chemoradioth erapy as a curative modality for this disease is warranted.