Accelerated Fractionation versus Concomitant Chemoradiation in Locally Advanced Head and Neck Cancer- A Prospective Study

Abstract

Introduction: Cancers of head and neck region is one of the most common cancer type found in Indian population. Concomitant chemoradiation is the standard treatment for locally advanced head and neck cancer. Different altered fractionation regime has been tried to optimise the outcome. Aim: To compare the response, treatment outcomes and toxicities between accelerated fractionation and concomitant chemoradiation in locally advanced squamous cell cancer of head and neck region. Materials and Methods: This prospective study was conducted at College of Medicine and Sagore Dutta Hospital, West Bengal, Kolkata, India, from March 2020 to December 2020. The study evaluated total of 45 patients of histologically proved locally advanced Tumour (T) Node (N) Metastasis (M) of T2-4 N1-3 M0 squamous cell carcinoma of head and neck region (larynx, oropharynx, hypopharynx and oral cavity). The patients were divided into two groups- Group A (n=22) and Group B (n=23) according to the treatment decided in each subject based on their clinical details and risk factors. Patients in group A received only radiation with accelerated fractionation with 2 Gray (Gy)/fraction, single fraction/day, 6 days/week. Patients allotted in the group B were treated with external beam radiotherapy in conventional fractionation. Concomitant cisplatin was administered at the dose of 100 mg/m2 of Body Surface Area (BSA) in first, fourth and seventh week of radiation. In both the groups, 66-70 Gy of total dose of radiation was prescribed. Patients were followed-up at monthly interval for first three months and at three monthly intervals thereafter. The collected data was tabulated in Microsoft excel sheet and frequency and percentage analysis was done. The significance between two variables was calculated by two tailed Fisher’s-Exact test. Results: Total of 45 patients (43 males and 2 females) were evaluated. The 22 patients (median age 60 years) were included in group A and 23 patients (median age 58 years) in group B. The median overall treatment time observed was 45 days and 59 days in group A and B. The prolongation of treatment was significantly different in between the both groups (p-value=0.0001). A total of 3 (13.04%) patients of group B and 1 (4.54%) patients of study arm could not complete the prescribed radiation (p-value=0.607). Complete Response (CR) was achieved in 8 (36.36%) patients in group A vs 8 (34.78%) patients in the group B and Partial Response (PR) was achieved in 11 patients (50%) vs 10 patients (43.48% cases) of group A and B respectively. Grade II/III vomiting noted in 10 patients (45.45%) vs 18 patients (78.26% cases) (p=0.03) in group A and B respectively. Grade III mucositis was observed in 16 patients (72.73%) vs 18 patients (78.26%) cases (p-value=0.513) in group A and B respectively. Grade III anaemia was observed in 6 patients (27.27%) in group A while in 15 patients (65.22%) in group B (p-value=0.016). No significant difference in late toxicity could be documented. Conclusion: The response rate with accelerated fractionation is not inferior to concomitant chemoradiation. Accelerated fractionation was tolerated well by patients of the present study.