Treatment Outcome with Weekly Cisplatin Concurrent with Radiation Therapy in Locally Advanced Head and Neck Squamous Cell Carcinoma.

. It comprises 5% of all malignancies worldwide 2 . More than 500,000 new cases are projected annually, globally 3 . Loco regionally advanced stage III or IV cancers comprise > 60% of these tumors for which cure rates have been < 30%, with notably high morbidity for surgical as well non-surgical treatment and therefore prognosis has remained poor in this group of patients and this has remained unchanged over the past 30 years. The treatment of patients with locally advanced unresectable head and neck cancer remains a challenge with poor locoregional tumor control and limited survival when surgery, radiotherapy or both are used. Although radiation and surgery have been the standard of care, the addition of chemotherapy has demonstrated superior locoregional tumor control while showing promise to improve patient survival. In patients with advanced inoperable or unresectable disease, Paccagnella et al demonstrated improved survival after treatment with induction chemotherapy and definitive radiotherapy compared with controls treated with radiation alone. Concurrent chemoradiation has been investigated to take advantage of the radiosensitive capability of many drugs for patients with head and neck cancers to attain an increase in the locoregional control, which would translate into increased survival. The mechanism for enhanced cell kill with concurrent chemoradiation is due to interference with repair process after sub lethal and potentially lethal damage caused by drugs and tumor cell synchronization may also prevent or decrease the emergence of resistant clonogenes 4 . There are many drugs, which have been investigated as radiosensitising agents such as bleomycin, methotrexate, mitomycin, 5-fluorouracil, cisplatin and paclitaxel. Cisplatin is one of the favored drugs because of its proved radiosensitising effect and its different toxicity profile. This drug has been most extensively studied in the management of HNSCC which can be used alone or in combined with variety of other drugs and has shown improved overall response rate ranging from 23% to 71% with a cumulative rate of 28%. This study was conducted to assess the role of concurrent cisplatin with conventional external beam radiotherapy in patients with locally advanced inoperable head and neck cancers. The objective of this study was to evaluate the response rate, locoregional control, disease free survival and overall survival in previously untreated, inoperable head and neck cancer patients. The Institute ethical committee reviewed the study design and allowed to carry out the study.