Use of any treatment modality in
cancer depends not only on the effectiveness of the modality, but also on other factors such as local expertise, tolerance of the modality, cost and prevalence of the disease. Oropharyngeal and
laryngeal cancer are the major subsites in which majority of
neoadjuvant chemotherapy (NACT) literature in the head and
neck cancers is available. However,
oral cancers form a major subsite in India.
MATERIALS AND METHODS: This is an analysis of a prospectively maintained data on NACT in the head and
neck cancers from 2008 to 2012. All these patients were referred for NACT for various indications from a multidisciplinary clinic. Descriptive analysis of indications for NACT in this data base is presented.
RESULTS: A total of 862 patients received NACT within the stipulated time period. The sites where oral cavity 721 patients (83.6%), maxilla 41 patients (4.8%), larynx 33 patients (3.8%), laryngopharynx 8 patients (0.9%) and hypopharynx 59 patients (8.2%). Out of
oral cancers, the major indication for NACT was to make the
cancer resectable in all (100%) patients. The indication in
carcinoma of maxilla was to make the disease resectable in 29 patients (70.7% of maxillary
cancers) and in 12 patients (29.3% of maxillary
cancers) it was given as an attempt to preserve the eyeball. The indication for NACT in
laryngeal cancers was organ preservation in 14 patients (42.4% of larnyngeal
cancer) and to achieve resectability in 19 patients (57.6% of larnyngeal
cancer). The group with laryngopharynx is a cohort of eight patients in whom NACT was given to prevent
tracheostomy, these patients had presented with early
stridor (common terminology criteria for adverse events Version 4.02). The reason for NACT in
hypopharyngeal cancers was for organ preservation in 24 patients (40.7% of
hypopharyngeal cancer) and for achievement of resectability in 35 patients (59.3% of
hypopharyngeal cancer).
CONCLUSION: The major indication for NACT is to make disease resectable at our center while cases for organ preservation are few.