2839 - Practice Patterns and Perceived Outcomes of Neoadjuvant Systemic Therapy in Head and Neck Cancer : Insights from a Multi-Institutional Indian Survey
Presenter(s)
B. Pramanik1, A. Ray2, S. S. Das2, L. Mondal3, and S. Gupta4; 1Ruby General Hospital, Kolkata, India, 2Chittaranjan National Cancer Institute, Kolkata, India, 3Cancer Institute(WIA), Adyar, Chennai, India, 4Sahyadri Narayana Multispeciality Hospital, Shimoga, India
Purpose/Objective(s):
Neoadjuvant systemic therapy (NAST), including chemotherapy and immunotherapy, is recommended by international guidelines (NCCN, ASCO, ESMO) primarily in selected clinical scenarios such as bulky or borderline resectable disease or within clinical trials, with cautious integration pending mature survival data. However, its real world adoption and impact on definitive radiotherapy decision making in resource variable settings remain poorly characterized. We conducted a national survey to evaluate practice patterns, structural determinants, and radiotherapy implications of NAST use across India.
Materials/Methods:
An anonymous web based survey was distributed to oncology professionals across government, academic, and private institutions in India. Domains included NAST utilization, regimen preference, immunotherapy integration, PD-L1 testing availability, influence on definitive local therapy (surgery vs chemoradiation), treatment timelines, perceived outcomes, and barriers to implementation. Associations between practice characteristics and neoadjuvant immunotherapy use were analyzed using chi-square testing.
Results:
A total of 123 clinicians responded. NAST was used routinely or selectively by 98.4%, with TPF as the preferred induction regimen (73.2%). Neoadjuvant immunotherapy was adopted by 29.3%. Adoption differed significantly by practice setting (p = 0.032). PD-L1 availability was strongly associated with immunotherapy use (OR 4.35, 95% CI 1.32–14.30; p = 0.015). Neoadjuvant response influenced definitive local therapy in 91.1% of cases (often 48.0%, sometimes 43.1%). Following partial response, 38.2% favored definitive chemoradiation, while 52.8% proceeded with surgery. Conversion to resectability in >25% of selected patients was reported by 18.7%. Definitive treatment timelines remained acceptable, with 92.7% initiating surgery or radiotherapy within 6 weeks of NAST completion. Only 15.4% perceived a survival advantage over upfront local therapy. Despite this, 71.5% rated overall clinical value as moderate to high. Cost remained the dominant barrier to immunotherapy adoption (81.3%).
Conclusion:
Although guidelines recommend selective use of neoadjuvant systemic therapy, it is widely integrated into Indian head and neck oncology practice and substantially influences definitive radiotherapy selection and treatment sequencing. Immunotherapy adoption is strongly determined by biomarker access and institutional resources, reflecting structural inequities in oncology care delivery. The disconnect between widespread adoption and limited perceived survival benefit underscores the need for prospective, resource stratified outcome data. Access sensitive implementation strategies including expanded biomarker availability and affordability frameworks are essential to ensure equitable integration of neoadjuvant approaches in resource limited environments.