Correlation of Monocytes, Lymphocytes and Monocyte Ratio (LMR) and Circulating Tumor Cells (CTCs) Presence in Head and Neck Cancer (HNC) Patients during Radiotherapy (RT)

Abstract

IMPT used conventional fractionation in 17 (65%), SBRT in 8 (31%), and hyperfractionation in 1 (4%) patients. IMRT utilized hyperfractionation in 14 (78%), conventional in 3 (17%) and 1 (6%) SBRT. IMPT was found to have significantly lower rates of physician-reported overall grade 3 (G3) acute toxicities 31% vs 73% in IMRT (pZ0.01). This included dysphagia (4% vs 39%, pZ0.01), mucositis (8% vs 39%, pZ0.001), and dermatitis (12% vs 33%, pZ0.03). Commonly treated sites were 52% mucosal (nZ23), 14% neck/nodal sites (nZ6), and 32% both mucosal and neck sites (nZ14), and 2% (nZ1) cutaneous only treatment. IMPT patients with mucosal site RR had lower chances of G3 dysphagia (5% vs 40%, pZ0.01) and lower G3 mucositis (9% vs 47%, pZ0.02); and those with neck nodal/neck RR had lower chances of G3 dermatitis (18% vs 56%, pZ0.16). OS at 2-year was 69% with IMPT compared to 58% with IMRT cohort (pZ0.26). 2-year LR was 9.5% with IMPT vs 6.5% with IMRT (pZ0.66). 2-year DFS was 54% with IMRT compared to 46% with IMPT, respectively (pZ0.94). Conclusion: RR is a safe and effective treatment option in the management of recurrent HNC. IMPT RR was found to carry reduced rates of grade 3 toxicity compared to IMRT. IMPT appears to confer a similar rate of OS, DFS and LR compared to IMRT, although these results warrant further exploration in the form of larger prospective studies with longer follow up.