Introduction: Irrespectively of the modality of primary treatment for head and neck squamous cell carcinoma, local or locoregional residual or recurrent tumors represent the major cause of treatment failure, emphasizing the role of locoregional control for the patients' long-term survival. The study compares HFRT-CT and CTRT in stage III and IV carcinoma of oropharynx. Material and Methods: Study arm (HFRT-CT) 1.1 Gy per fraction, two fractions daily with a minimum interfraction interval of 6 hours, five days a week up to a total dose of 72.6 Gy in 66 fractions over 6-6 1/2 weeks and in the control arm (CTRT) 2 Gy per fraction, single fraction a day, five days a week to a total of 66Gy, over 6-6 ½ weeks, both the arms use concurrent chemotherapy with injection cisplatin 40mg/ m2 weekly. Results: At the end of 6 th week 28 patients in the HFRT-CT arm and 29 patients in CTRT arm were available for evaluation. In the HFRT-CT arm 24/28(85.7%)patients and in the CTRT arm 21/29(72.4%)patients showed complete response for primary. For nodal disease a complete response of 92.85% and 89.65% were seen in HFRT-CT and CTRT arm respectively. At the 6 th week out of the 16 stage III patients in the HFRT-CT arm 13 had complete response(81.3%) and 3 patients had a partial response (18.7%) and out of the 12 stage IV patients 9 patients had a complete response and 3 patients had partial response. Conclusion: Hyperfractionated radiotherapy with concurrent chemotherapy in locally advanced carcinoma, can be delivered with manageable toxicities. A trend towards better outcome for patients having T4 or N3 disease is noted, even though a statistical significance could not be seen.
Introduction: Treatment of locally advanced head and neck squamous cell carcinoma (LAHNSCC) is a challenging proposition. Prolongation of overall treatment time has shown to increase the failure rates. We aimed to shorten the overall treatment time by using accelerated fractionation-six fractions of radiation per week instead of 5 fractions. Study aimed to assess the response and toxicity profile of six fractions of radiation per week in LAHNSCC. Material and Methods: Stage III and IV LAHNSCC selected for radiation treatment alone with Co60 teletherapy machine. The total dose of 66Gy /33 fractions -6 fractions per week, from Monday to Saturday over a period of 5.3 weeks. Results: All the 45 patients received the planned treatment. All patients completed the treatment in stipulated overall treatment time. At the 6thweek of completion of radiation, responses were assessed. Out of 45 patients, 29 had the complete response (64.4%), and 12 had the partial response (26.66%), no response seen in 3 patients (6.66%) and progressive disease in 1 patient (2.22%). Patients reviewed twice weekly for assessing the toxicities. Major toxicities were mucosal and dermatological. 38 patients out of 45 had grade I and II skin reactions (83.6%), and 7 patients developed grade III skin reaction(16.4%). 29 out of 45 patients developed grade I and II mucosal reactions(65%) 16 out of 45(35%) patients had grade III mucosal reactions. None of the patients developed grade IV skin or mucosal reactions. Conclusion: This study shows that pure accelerated Radiotherapy 6 fractions per week in LAHNSCC is feasible and found to enhance the response rate with tolerable toxicities.
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