Docetaxel, Cisplatin, Leucovorin and 5- Fluorouracil versus Leucovorin, 5-Fluorouracil, and Cisplatin as Neoadjuvant Chemotherapy Followed by Chemoradiation in Head and Neck Cancer

Background: HNSCC is the fifth most common cancer in the world and one of the most prevalent cancers in Bangladesh. Despite significant improvement in radiotherapy, the high incidence of loco-regional recurrences is a major challenge for radiation oncologists. This study was done to compare the response and toxicity of Docetaxel, Cisplatin, Leucovorin and 5- Fluorouracil (TPLF) vs Leucovorin, 5- Fluorouracil, and Cisplatin (LFP) as neoadjuvant chemotherapy followed by concurrent chemo-radiation with Cisplatin in the treatment of locally advanced head and neck cancer of squamous cell carcinoma. Materials and Methods: This study was carried out among 60 patients of locally advanced of head and neck cancer at Khwaja Yunus Ali Medical College & Hospital, Sirajganj from January 2015 to December 2015. In Arm-A, 30 patients received three cycles of neoadjuvant chemotherapy with Docetaxel 75 mg/m2 on D1, Cisplatin 75 mg/m2 on D1, Leukovorine 30 mg on D1-D3, 5-Flourouracil 750 mg/m2 on D1-D5 and in Arm B 30 patients received neoadjuvant chemotherapy with Cisplatin 75 mg/m 2 on D1, Leucovorine 30 mg on D1-D3, 5-Flourouracil 750mg/m 2 on D1-D5 3 cycles with three weeks interval followed by concurrent chemoradiotherapy with 66 Gy in 33 fractions and weekly Cisplatin 40 mg/m 2 started on the first day of radiation. Results: Most of the patients were male and middle-aged group. In Arm-A, 21 patients (70%) showed complete response whereas in Arm-B regimen complete response was noticed in 16 patients (53.3%) which was statistically significant; however, partial responses were significantly more found in Arm-B. Regarding toxicity, with Arm-A patients experienced slightly more toxicities in comparison to Arm-B which was statistically non-significant. Conclusion: So, it could be concluded from this study that the therapeutic gain was better obtained in Arm-A compared to Arm-B in patients with locally advanced head and neck cancer.