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Place de la chimiothérapie d’induction dans les carcinomes épidermoïdes de la tête et du cou localement avancés inopérables (hors préservation laryngée)

Recent advances in head and neck carcinoma: pros and cons of induction therapy in inoperable cases

  • Synthèse / Review Article
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Oncologie

Abstract

Head and neck carcinomas are serious diseases for which surgery is the main treatment. In roughly two thirds of cases, diagnosis is made at an advanced stage, which prevents optimal surgical resection. In this frequently occurring situation, the treatment usually recommended was a combination of radiotherapy and platinum-based chemotherapy. Several phase III trials have recently assessed an induction chemotherapy with platinum, docetaxel and 5 fluorouracil (TPF) followed by either radiotherapy or radiochemotherapy. These trials show an overall survival rate after induction chemotherapy equal or superior to conventional radiochemotherapy. The meaning of these studies is limited by several factors: a non-optimal comparison arm, patient selection depending on a good PS and the real TPF toxicity in non-selected patients. The use of induction chemotherapy must be conditional on cautious thorough evaluation after multidisciplinary discussion based on pros and cons. The latter will be discussed herein.

Résumé

Les carcinomes épidermoïdes de la tête et du cou sont des affections graves dont le traitement repose sur l’exérèse chirurgicale. Dans près de deux tiers des cas, le diagnostic de la maladie est réalisé à un stade avancé qui rend impossible la résection tumorale de facçon carcinologiquement satisfaisante. Dans cette situation fréquente, le traitement de référence reposait sur l’association de radiothérapie et de chimiothérapie concomitante à base de sels de platine. Récemment, plusieurs essais de phase III ont évalué un traitement d’induction par cisplatine, docétaxel et 5-fluoro-uracile (TPF) suivi d’une radiothérapie ou d’une radiochimiothérapie. Ces essais retrouvent des taux de survie, après chimiothérapie d’induction, comparables ou supérieurs à une radiochimiothérapie conventionnelle. Les limites de ces travaux sont le choix d’un bras de référence non optimal, la sursélection de patients en bon état général et la toxicité réelle du TPF chez des patients non sélectionnés. Les indications d’une chimiothérapie d’induction doivent être évaluées avec précaution et discussion pluridisciplinaire à la lumière du bénéfice risque. Ce sont ces avantages et inconvénients que nous nous proposons d’évaluer ici.

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Authors and Affiliations

  1. Centre Antoine-Lacassagne, 33, avenue de Valombrose, F-06189, Nice cedex 02, France

    F. Peyrade, P. Follana, C. Ortholan, A. Bozec & L. Gastaud

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  1. F. Peyrade
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  2. P. Follana
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  3. C. Ortholan
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  4. A. Bozec
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  5. L. Gastaud
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Correspondence to F. Peyrade.

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Peyrade, F., Follana, P., Ortholan, C. et al. Place de la chimiothérapie d’induction dans les carcinomes épidermoïdes de la tête et du cou localement avancés inopérables (hors préservation laryngée). Oncologie 11, 133–139 (2009). https://doi.org/10.1007/s10269-008-1039-4

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