Evaluation of the Effectiveness and Safety of Neoadjuvant Chemotherapy with DCF Regimen (Docetaxel, Cisplatin, 5-Flurouracil) in Locally Advanced Head and Neck Squamous Cell Carcinoma Patients in a Tertiary Care Hospital in India: A Retrospective Study

Majority of patients with head and neck cancers present with locally advanced disease (stages III, IVA, or IVB) at diagnosis. Neoadjuvant chemotherapy (NACT) or induction chemotherapy is known to reduce tumor burden, eradicate micro metastases, preserve organ function, and improve symptoms. Landmark studies such as TAX 323 and TAX 324 demonstrated response rates of approximately 68% with the TPF regimen (docetaxel, cisplatin, and fluorouracil). Despite existing evidence, the optimal strategy for NACT remains uncertain, with results varying across ethnic groups, disease epidemiology, health care resources, and treatment availability. The objective of this study is to evaluate the effectiveness and safety of NACT with the DCF regimen in locally advanced head and neck squamous cell carcinoma (LA-HNSCC) patients This was a retrospective study conducted at a tertiary care hospital. Demographic, clinicopathological, and treatment data were collected from the clinical records of patients with LA-HNSCC from January to December 2023, who received DCF regimen as NACT. Tumor response was assessed after three cycles of NACT based on modified Response Evaluation Criteria in Solid Tumors. Definitive treatment modalities received post-NACT and adverse events reported were recorded. Patients with incomplete clinical records, incomplete pre- and post-NACT disease status or distant metastases were excluded. Descriptive statistics were used. Survival analysis was performed using Kaplan–Meier estimation, with log-rank tests applied to assess statistical significance between response groups (SPSS v25). A total of 31 patient records (27 male and 4 female) were included. Oral cavity was the most common site (18.58%). A total of 21 patients received three-weekly and 10 patients received weekly DCF regimen. Post-NACT reassessment scans showed complete response (CR) in 8 patients, partial response (PR) in 13, stable disease in 4, and progressive disease in 6 patients. Patients with CR and PR received combined chemo and radiotherapy and surgery as definitive treatment. The median follow-up period of the cohort was 10.7 months (95% confidence interval [CI]: 8.6–18.2). Median disease-free survival (DFS) was 5.0 months (95% CI: 4.27–5.73) and the mean DFS 6.27 months (95% CI: 4.86–7.68). Anemia (13, 42%), nausea and vomiting (18, 58%), and fatigue (13, 41%) were the common adverse events. DCF regimen can be effective as NACT in treating LA-HNSCC with a notable overall response rate of 67.7% and disease control rate of 80.6%. The treatment showed the best survival outcomes in patients who underwent surgery or chemoradiotherapy after achieving a complete or PR. Although tolerable hematological and gastrointestinal toxicities were observed, careful patient monitoring and management is necessary. Considering the limited sample size, further studies with prospective design and inclusion of a large sample size would provide additional evidence to support our findings.