[quote=PaulB]
Induction chemo has been around for a while. after the success of Cisplatin, and used mainly in organ preservation for larynx, hypopharyngeal, BOT cancer. I believe it was initially used just with PF, then Taxotere was added, and found to make it work better, and now is used with other induction combinations, including
Erbitux. It is controversial, being it has a high rate of toxicities, which may delay the real curative treatment, which is radiation and surgery, and the possibly of too much chemo hampers tumor kill, but otherwise it is very effective for tumor control, distant metastases, but overall survival is not improved, in some studies, mainly done in the 80's-90's, and no real head to head comparison were completed yet with this vs chemoradiation, and some doctors are waiting for this, but others are using it outside clinical trials for treatment being it is effective.
There is also renewed interest witn Induction chemo with rise in
HPV in HNC, which shows better response to treatments, plus these patient are younger, have less comorbities, and are able to handle a more aggressive treatment regimine. Dr Posner, now at Mt. Sinai, did a study with
HPV pos vs non
HPV, with induction chemo, and showed an improved response rate, and OS with
HPV postive vs negative.
The NCCN added Induction Treatment to their Head and Neck Cancer Treatment Protocol for advanced Oropharyngeal cancer, and a lengthy discussion about It can be read. I think the link is posted here someplace. [/quote]
Yes, this is where I stand, in between a MO who recommends the induction before the main treatment, and the RO who feels it is still unproven (lack of definitive studies) and has fairly high risks, as you have experienced personally.
The MO follows the rationale that it can kill off all smaller distant cancers thus reducing recurrence, shrinks the main cancer making the main chemo-radio treatment work better, and the fact I am fairly young at 57 and in great health with no other issues, more able to hanlde the TPF side effects.
The HNC surgeon says take the most aggressive approach as this offers the best outcome, so am leaning that way but certainly not looking forward to entering ring with TPF. I've not read a single post saying TPF is a cakewalk.
