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CC BY-NC-ND 4.0 · South Asian J Cancer 2013; 02(01): 031-035
DOI: 10.4103/2278-330X.105890
Original Article

Different fractionation schedules of radiotherapy in locally advanced head and neck malignancy: A prospective randomized study to compare the results of treatment and toxicities of different protocols

Dipanjan Majumder
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
,
Kakali Choudhury
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
,
Pabitra Das
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
,
Suvrokanti Kundu
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
,
Debabrata Mitra
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India
› Author Affiliations Source of Support: Nill.
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Abstract

Context: Altered fractionated radiotherapy may have better result than conventional radiotherapy and concomitant chemoradiotherapy to treat locally advanced head and neck cancers. Aims: Evaluation of the response and toxicities in different fractionated radiotherapy schedules in locally advanced head and neck cancer. Materials and Methods: Sixty four histologically proved patients of locally advanced head and neck cancer were included in the study according to protocol and were randomized into three arms. Arm A (n = 21) received 66 Gy in 33 fractions (5 fractions/week from Monday to Friday) single fraction daily in 6½ weeks along with concomitant chemotherapy (injection Cisplatin 30 mg/m 2 intravenous once weekly) for 6 weeks. Arm B (n = 21) received 66 Gy in 33 fractions (6 fractions per week) single fraction daily in 5½ weeks, and arm C ( n = 22) received late hyperfractionation after 3 weeks; 30 Gy in 15 fractions in 3 weeks followed by 1.4 Gy twice daily (time gap between 2 fractions were 6 hours) for 15 days with a total of 72 Gy in 6 weeks. Response to treatment, compliance, and toxicities were compared in all the three arms. Statistical Analysis Used: Frequency table and chi square tests done. Results: Baseline data were comparable in all the three arms. Complete response in arm A, arm B, and arm C were 15%, 26.315%, and 23.81%, respectively ( P = 0.339). Grade 1 Neutropenia in arm A was 15%, arm B was 26.32%, and arm C was nil (P = 0.0486). Conclusion: Altered fractionation and concurrent chemoradiation showed similar response with comparable acute toxicities except nutropenia, which was significantly higher in arm B.

Key words

Accelerated fractionation - concomitant chemoradiotherapy - hyperfractionation - locally advanced head and neck cancer


Publication History

Article published online:
31 December 2020

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  • References

  • 1 Perez CA, Brady LW, Halperin CE. Principles and practice of radiation oncology. Oral cavity cancer, oropharynx, hypopharynx cancer Lippincott Williams and Wilkins. 4 th ed. A Wolters Kluwer business; 2008. p. 891-958.
  • 2 Mendenhall WM, Werning JW, Pfister DG. Treatment of Head and Neck Cancers. Devita VT, Lawrence TS, Rosenberg SA. CANCER Principles and Practice of Oncology. Lippincott Williams and Wilkins. 8 th ed. A Wolters Kluwer business; 2008; 809-13.
  • 3 Development of an atlas of cancer in India. National cancer registry programme (Indian Council of Medical Research). April 2004. Available from: http://www.canceratlasindia.org. [Last accessed date 27 th June, 2012].
  • 4 Rath GK, Mohanty BK, Bahadur S, Lal P, Gairola M, Cancer of head and neck, Text book of radiation oncology-principles and practice. 1 st ed. Elsevier: Reed Elsevier India private limited; 2000 reprinted 2007. Chapter 7. p. 131-99.
  • 5 Park K. Park′s textbook of preventive and social medicine. 19 th ed. M/S Banarsidas Bhanot, 2000. p. 319-20.
  • 6 Magnitude and leading sites of cancer. Available from: http://www.ncrpindia.org/Old_Reports/Five_Years_consolidated_HBCR_report_1994_98.pdf. [Last accessed on 2010 Oct].
  • 7 Parkin DM, Pisani P, Ferlay J. Estimates of the worldwide incidence of 25 major cancers in 1990. Int J Cancer 1999;80:827-41.
  • 8 Cummings B, Keane T, Pintilie M, Warde P, Waldron J, Payne D, et al. Five year results of a randomized trial comparing hyperfractionated to conventional radiotherapy over four weeks in locally advanced head and neck cancer. Radiother Oncol 2007;85:7-16.
  • 9 Hall Eric J, Giaccia Amato J. Time, Dose and Fractionation in Radiotherapy, Radiology For The Radiologists. 6 th edition. E. J Hall, Lippincott Williams and Wilkins; 2006. p. 378-397.
  • 10 Pignon JP, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head neck squamous cell cancer: Three meta analyses of updated individual data. MACH-NC Collaborative Group. Meta Analyses of Chemotherapy on Head and Neck cancer. Lancet 2000;355:949-55.
  • 11 Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009;45:228-47.
  • 12 Cox JD, Stetz J, Pajak TF. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) . Int J Radiat Oncol Biol Phys 1995;31 : 1341-6.
  • 13 Sharma A, Mohanti BK, Thakar A, Bahadur S, Bhasker S, Bahl A. Concomitant chemoradiation versus radiotherapy in advanced squamous cell carcinoma of oropharynx and nasopharynx using weekly cisplatin: Final result of a phase III trial. J Clin Oncol 2007;25:6030.
  • 14 Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head neck: DAHANCA 6 and 7 randomized controlled trial. Lancet 2003;362:933-40.
  • 15 Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7-16.
  • 16 Krstevska V, Crvenkova S. Altered and Conventional Fractionated Radiotherapy in Locoregional Control and Survival of Patients with Squamous Cell Carcinoma of the Larynx, Oropharynx, and Hypopharynx. Croat Med J 2006;47:42-52.
  • 17 Skladowski K, Maciejewski B, Golen M, Pilecki B, Przeorek W, Tarnawski R. Randomized clinical trial on 7-day-continuous accelerated irradiation (CAIR) of head and neck cancer-report on 3-year tumour control and normal tissue toxicity. Radiother Oncol 2000;55:101-10.
  • 18 Sanguineti G, Richetti A, Bignardi M, Corvo R, Gabriele P, Sormani MP, et al. Accelerated versus conventional fractionated postoperative radiotherapy for advanced head and neck cancer: Results of a multicenter Phase III study. Int J Radiat Oncol Biol Phys 2006;61:762-71.
  • 19 Trotti A, Fu KK, Pajak TF. Long term outcomes of RTOG 90-03: A comparison of hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2005;63:S70-1.