Evaluation of purely accelerated six fractions per week radiotherapy in postoperative oral cavity squamous cell carcinoma

Abstract

No-EP 1132 (Titled "Toxicity analysis of pure modestly accelerated radiotherapy in post-operative oral cavity carcinomas") and published in Radiotherapy and Oncology (127) Supplement 1, Page S637. AbstractObjectives: Randomized controlled trials have shown improved loco-regional control (LRC) and disease-free survival (DFS) by modest acceleration using six fractions per-week radiotherapy (RT) as compared to conventional fractionation in patients of head and neck squamous cell carcinoma.We aimed to evaluate the role of pure modestly accelerated fractionated radiotherapy (PM-ART) using six fractions per-week in patients of postoperative oral cavity squamous cell carcinoma (OCSCC). Materials and Methods:Between May 2015 and July 2016, 40 OCSCC patients with ≥ 1 indication of RT were treated with adjuvant PM-ART, 60 Gray in 30 fractions over 5 weeks by threedimensional conformal technique on a linear accelerator with a sixth 2 Gray fraction on Saturday using same fields. Primary endpoint was to assess acute toxicity, which was reviewed weekly during RT using Radiation Therapy Oncology Group criteria. Results:Maximal grade 3 oral mucositis, pharynx/esophageal toxicity, and skin toxicity were seen in 77.5%, 25%, and 17.5%, respectively. Two patients had grade 4 mucositis. 47.5% were on tube feeding during RT. All the patients were taken off Ryle's tube within 4 weeks of RT completion. The median RT completion duration was 36 days. Three patients had treatment interruptions. With a median follow-up of 21.2 months, the 2-year LRC, DFS, and overall survival rates were 87.5%, 83.5%, and 85%, respectively. There were two distant failures.Conclusion: PM-ART is feasible and tolerable. The high acute mucositis rates did not result in increased consequential late toxicity.

Management of hypopharyngeal mucositis in patients undergoing chemoradiotherapy in the head and neck region and its impact on swallowing: an integrative literature review

“…On the other hand, RDT-induced hypopharyngeal mucositis is little studied. Only 4 studies on this subject were identified, in which patients presented oral squamous cell carcinoma with metastasis in cervical lymph nodes (10) , lung adenocarcinoma (11) , laryngeal carcinoma of squamous cells (12) and another, also in the oral cavity (13) , and in all cases, as a form of treatment, they underwent chemotherapy and radiotherapy in the head and neck region. The RDT dose received by the patients in the studies ranged from 30Gy to 66Gy, with an average of 60Gy.…”

“…In the last study analyzed (13) , patients were submitted to a total dose of 60 Gy, using three-dimensional conformal RDT. Throughout the radiotherapy treatment, 3 patients had to interrupt the RDT sessions, 2 of them due to grade 4 oropharyngeal mucositis and one of them due to grade 3 pharyngeal toxicity.…”

“…At the end of the fifth week, 33 patients had grade 3 or greater oropharyngeal mucositis; grade 4 mucositis was uncovered in two patients. Grade 3 pharyngeal and esophageal toxicity was diagnosed in 10 patients (13) . The study cited that the average weight loss of patients was 4 kg.…”

“…29 of the 40 patients required an alternative feeding route, with a mean length of stay of 22 days from the start of RDT. All patients returned to the safe oral route approximately 4 weeks after completion of RDT (13) . The research did not describe the method of evaluating oropharyngeal mucositis and pharyngoesophageal toxicity.…”

Response to “Evaluation of purely accelerated six fractions per week radiotherapy in postoperative oral cavity squamous cell carcinoma”—Does it require to irradiate neck in pN0 disease?

“…We read with interest the article by Rath et al 1 . The authors reported outcomes on 40 postoperative patients with oral cavity squamous cell cancer (OCSCC) with intermediate risk disease, treated with accelerated radiotherapy (ART) 60 Gy in 30 fractions in 5 weeks (six fractions per week, Monday to Saturday).…”