Induction vs Concurrent chemotherapy in Head and Neck Cancer

In the green journal today there is an update of the Pignon Meta-analysis for radiation and chemotherapy.

87 trials with 16,485 patients. With chemotherapy in addition to radiotherapy, HR for death was 0.88 (p less than 0.0001) with an absolute reduction of mortality of4.5% at 5 year. There was an interaction (p less than 0.0001) in chemotherapy timing, i.e. adjuvant, induction or concomitant. Concomitant chemotherapy was superior to induction chemotherapy, with HR 0.81 (p less than 0.0001) absolute reduction of 6.5% at 5 years. Chemo was also of less utility with older patients (p = 0.003, test for trend).

Thus more fuel for the induction vs. concurrent debate. One must point out though that the Posner trial however used induction and concurrent chemotherapy, thus a comparison of optimal induction with concurrent treatment vs. optimal concurrent chemoradiotherapy remains unanswered...