A Comparative Study of Two Split Course Accelerated Hypo-fractionated Radiation Therapy (SCAHRT) Schedules in Locally Advanced Head and Neck Carcinoma

Abstract

Introduction: Head and neck cancers include malignant neoplasms that develop in the oral cavity, nasal cavity, paranasal sinuses, pharynx, larynx and salivary glands. Out of the newly diagnosed patients of head and neck carcinoma in India, most of the patients present in locally advanced stage. Because of extensive local disease and associated co-morbidities and compromised KPS, palliative radiation therapy is preferred treatment for these patients. Material and methods: The study was conducted on 60 previously untreated, histo-pathologically proven patients of locally advanced head and neck cancer who were randomized in two equal groups by draw of lots. Study group received radiation dose of 30 Gy/ 10 fractions / 2 weeks followed by repeat dose of 30 Gy/ 10 fractions / 2 weeks (Total dose 60 Gy in 20 fractions delivered with a gap of 4 weeks). Control group received radiation dose of 20 Gy/ 5 fractions/ 5 days followed by repeat dose of 20 Gy/ 5 fractions/ 5 days followed by repeat dose of 20 Gy/ 5 fractions/ 5 days (Total dose 60 Gy in 3 sessions with a gap of 3 weeks each). Objectives were to compare efficacy of above schedules based on symptomatic relief and overall tumor response and to compare the toxicities of the above schedules. Results and Conclusion: To expedite the treatment time in tertiary care centres, control group (20 Gy / 5 fractions / 1 week; 3 weekly X 3) was better than the study group (30 Gy / 10 fractions / 2 weeks; 4 weekly X 2) as it had comparable local control and toxicity (acute mucosal reactions being slightly higher in the study group) with the added advantage of only 15 total fractions (machine days) in control group rather than 20 total fractions (machine days) in study group. This reduced the patient visits to the hospital by one week (i.e. 5 fractions) with comparable local control and toxicity.