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CC BY-NC-ND 4.0 · South Asian J Cancer 2015; 04(03): 118-122
DOI: 10.4103/2278-330X.173168
HEAD AND NECK CANCERS : Original Article

Prospective randomized trial to compare the outcome and tolerability of delivering the same total dose of radiation in 61/2 weeks versus 51/2 weeks time in head and neck cancers

Manoj Gupta
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Siddharth Vats
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Tapesh Bhattacharyya
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Rajeev K. Seem
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Manish Gupta
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
,
Rohit Mahajan
Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India
› Author Affiliations Source of Support: Nill.
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Abstract

Background: Concurrent chemoradiation is currently considered to be the standard of care in the treatment of head and neck cancer. In developing countries like ours, a good number of patients cannot tolerate chemoradiation because of the poor general condition and financial constraints. Those patients are treated with radiation alone. The optimum radiotherapy (RT) schedule for best local control and acceptable toxicity is not yet clear. We aimed to find out whether shortening of treatment time using six instead of five RT fractions per week improves the locoregional control in squamous cell carcinoma of head and neck. Materials and Methods: We conducted a prospective randomized study for a period of 2 years from September 2007 to August 2009 in 109 untreated patients of squamous cell carcinoma of head and neck with histologically confirmed diagnosis and no evidence of distant metastasis. Study group (55 patients) received accelerated RT with 6 fractions per week (66 Gy/33#/51/2 weeks). Control group (54 patients) received conventional RT with 5 fractions per week (66 Gy/33#/61/2 weeks). Tumor control, survival, acute and late toxicities were assessed. Results: At a median follow-up of 43 months, 29 patients (52.7%) in the 6 fractions group and 24 patients (44.4%) in the 5 fractions group were disease-free (P = 0.852). The benefit of shortening was higher for advanced disease control though it was not statistically significant. Grade 3 and 4 skin toxicity was significantly higher in the accelerated RT (70.9%) arm as compared to conventional (35.1%) arm (P = 0.04). Grade 3 mucositis was significantly higher in the accelerated RT arm (32.7% vs. 16.6%; P = 0.041). Those acute toxicities were managed conservatively. There was no difference in late toxicities between the two arms. Conclusion: Use of 6 fractions per week instead of 5 fractions per week is feasible, tolerable, and results in a better outcome in the patients of head and neck cancers.

Key words

Accelerated fractionation - head and neck cancer - radiotherapy


Publication History

Article published online:
31 December 2020

© 2015. MedIntel Services Pvt Ltd. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/.)

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