Gruppo di Studio Tumori della Testa e del Collo (GSTTC) in Head and Neck Cancer

Rodrigo Arrangoiz MS, MD, FACS, FSSO
  • Background:
    • While major phase III trials in North America (PARADIGM, DeCIDE):
      • Failed to demonstrate a survival benefit for induction chemotherapy (IC) with docetaxel, cisplatin, 5-FU (TPF) before chemoradiation:
        • Italian investigators from the Gruppo di Studio Tumori della Testa e del Collo (GSTTC):
          • Reported the only positive phase III trial in this setting
  • GSTTC Trial Findings (abstract form):
    • Design:
      • Randomized phase III trial comparing TPF induction chemotherapy:
        • Follow by CRT vs CRT alone in patients with locally advanced HNSCC
    • Results (as reported in abstract form):
      • Improved progression-free survival (PFS) in the induction arm
      • Superior overall survival (OS) compared with CRT alone
      • Benefit appeared most pronounced in patients with:
        • High-risk, bulky, or unresectable disease
      • Publication status:
        • Results have only been presented in abstract form, not yet fully peer-reviewed or published, limiting their integration into international guidelines
  • Interpretation and Clinical Implications:
    • Consistency issue:
      • Unlike GSTTC, large U.S. trials (PARADIGM, DeCIDE) were negative:
        • Raising questions about patient selection, trial design, and population differences
    • Potential value:
      • The GSTTC data suggest that selected patients:
        • Those with high tumor burden or unfavorable disease biology may benefit from TPF induction before CRT
    • Guideline stance:
      • Induction chemotherapy with TPF is not standard of care but can be considered in high-risk or organ-preservation cases within multidisciplinary discussion
    • Take-home point:
      • GSTTC provides the only phase III evidence suggesting a survival advantage with induction:
        • But the lack of full peer-reviewed publication and discordant international trial results prevent broad adoption
  • Summary sentence for surgeons:
    • The GSTTC phase III trial remains the only study to report superior outcomes with TPF induction followed by CRT versus CRT alone, though its abstract-only publication and contrast with negative U.S. trials mean that CRT alone continues as the standard, with induction reserved for carefully selected high-risk patients
Unknown's avatar

Published by Rodrigo Arrangoiz MS, MD, FACS, FSSO

My name is Rodrigo Arrangoiz I am a breast surgeon/ thyroid surgeon / parathyroid surgeon / head and neck surgeon / surgical oncologist that works at Center for Advanced Surgical Oncology in Miami, Florida. I was trained as a surgeon at Michigan State University from (2005 to 2010) where I was a chief resident in 2010. My surgical oncology and head and neck training was performed at the Fox Chase Cancer Center in Philadelphia from 2010 to 2012. At the same time I underwent a masters in science (Clinical research for health professionals) at the University of Drexel. Through the International Federation of Head and Neck Societies / Memorial Sloan Kettering Cancer Center I performed a two year head and neck surgery and oncology / endocrine fellowship that ended in 2016. Mi nombre es Rodrigo Arrangoiz, soy cirujano oncólogo / cirujano de tumores de cabeza y cuello / cirujano endocrino que trabaja Center for Advanced Surgical Oncology en Miami, Florida. Fui entrenado como cirujano en Michigan State University (2005 a 2010 ) donde fui jefe de residentes en 2010. Mi formación en oncología quirúrgica y e n tumores de cabeza y cuello se realizó en el Fox Chase Cancer Center en Filadelfia de 2010 a 2012. Al mismo tiempo, me sometí a una maestría en ciencias (investigación clínica para profesionales de la salud) en la Universidad de Drexel. A través de la Federación Internacional de Sociedades de Cabeza y Cuello / Memorial Sloan Kettering Cancer Center realicé una sub especialidad en cirugía de cabeza y cuello / cirugia endocrina de dos años que terminó en 2016.

Leave a comment