Hypofractionated radiotherapy for palliation in locally advanced head and neck cancer

Spartacus, RK; Dana, Rohitashwa; Rastogi, Kartick; Bhatnagar, Aseem; Daga, Dhiraj; Gupta, Kampra

doi:10.4103/ijpc.ijpc_9_17

Cited by 5 publications

(4 citation statements)

References 10 publications

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“…In a study by Spartacus et al, the hypofractionated palliative RT schedule of 25 Gy in 4 weekly fractions of 6.25 Gy was found effective not only in providing symptomatic relief but also in terms of tolerance by 98 patients of locoregionally advanced head-and-neck cancer. [31] Similar results have also been found in case of bone metastasis in the present study.…”

Section: Discussionsupporting

confidence: 91%

Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy

Rastogi

Gupta

Bhaskar

et al. 2019

Indian Journal of Medical and Paediatric Oncology

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Context: Skeleton is the most common organ affected by metastases. Bone pain is the most common symptom of metastatic bone disease. The treatment of bone metastasis is primarily palliative requiring multidisciplinary therapies; radiotherapy (RT), however, remains the cornerstone of the treatment. Aims: The aim of this study is to measure the effectiveness of RT in terms of symptomatic relief in pain and insomnia, improvement in stability/movement, and decrease in the requirement of analgesics by patients using the Hundred Paisa Pain Scale. Subjects and Methods: The RT records of 226 patients with bone metastasis treated at the department of Radiotherapy, SMS Medical College, Jaipur; from July 2015 to December 2016 over cobalt-60 teletherapy unit were analyzed. The RT dose fractionation ranged from 30 Gy in 10 daily fractions, 20 Gy in 5 daily fractions, 12.5 Gy in 2 weekly fractions, and 8 Gy in single fraction. Results: The median age of the cohort was 54 (range, 29–84) years. The most common site of primary tumor was lung (30.1%), followed by breast (12.4%) and prostate (11.9%). The most common bone involved was vertebrae (71.2%), followed by pelvis (14.6%); among vertebrae, thoracic vertebrae were most commonly involved (63.9%), followed by lumbar vertebrae (57.8%). The maximum relief in pain was seen with 6.25 Gy/fraction schedule, whereas the maximum improvement in stability/movement was noted with 3 Gy/fraction schedule. The 8 Gy single-fraction schedule was associated with maximum relief in insomnia and decrease in analgesic requirement. Conclusion: The current institutional protocol of weekly hypofractionated palliative RT of 6.25 Gy per fraction up to a maximum of four fractions given on Saturday has shown results comparable with other schedules with well tolerance and achievement of acceptable symptom palliation. This weekly schedule is practically convenient to both the patients who mostly came from far-flung areas and the institute as it spares the already overburdened machine to carry on conventional RT from Monday to Friday.

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Section: Discussionsupporting

confidence: 91%

Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy

Rastogi

Gupta

Bhaskar

et al. 2019

Indian Journal of Medical and Paediatric Oncology

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“…The reduction in number of fractions avoids long waiting times. There is no doubt that hypofractionation offers major potential advantages to patients and to the economy of health systems [19,28,29].…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated radiotherapy with concurrent chemotherapy with weekly cisplatin in locally advanced relatively radioresistent subsites of head and neck cancers

Baidya

Devi²,

Devi³

et al. 2022

ijmmr

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Background. Locoregionally advanced head and neck cancers are more aggressive and locoregional failure rate after conventional radiotherapy is high. Objective. The aim of the study is to assess the tumor response and toxicities of hypofractionated radiation therapy with concurrent chemotherapy in treatment of four relatively radioresistent tumor sites of head and neck. Methods. A prospective randomised control trial was conducted in 27 head and neck cancer patients. All patients were treated with hypofractionated radiotherapy at 250cGy/fraction once daily to a maximum of 62.5Gy in 25 fractions with concurrent cisplatin 30 mg/m2. Data were evaluated with SPSS version 21.0 for Windows with p-value <0.05. Results. Complete and partial responses were achieved in 15 (57.7%) and 8 (30.8%) patients respectively with an overall response rate of 88.5% and three patients having stable disease. Grade 3 and 4 acute mucositis was experienced by 17 patients (65.4%) and seven patients (27%), respectively. Grade 3 dysphagia was found in 21 patients (80.7%) and grade 3 and 4 skin reactions – in 11 and 2 patients, respectively. Most patients had manageable acute toxicities. Most of the late complications were of grade 2 and 3. The median time to locoregional recurrence was 12 months and one year progression-free survival attained by 61.5% patients. Conclusion. Treatment with hypofractionated radiotherapy with concurrent cisplatin appears feasible and safe and is associated with a good response rate. Although grade 3 and 4 toxicities were comparatively high but it was manageable. Late toxicities were within tolerable levels.

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“…One of the characteristics of this disease is a favorable response to initial treatment but the rate of distant metastases is similar to that of HPV-oropharyngeal cancers. The inferior results given by the replacement of Cisplatin with Cetuximab in this category of patients and the increased risk of distant metastases highlight the role of systemic treatment in this subcategory of H&N [64][65][66][67][68].…”

Section: Discussionmentioning

confidence: 99%

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

Mireștean

Crişan

Mitrea

et al. 2021

JCM

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Locally advanced head and neck cancer is a unique challenge for cancer management in the Covid-19 situation. The negative consequences of delaying radio-chemotherapy treatment make it necessary to prioritize these patients, the continuation of radiotherapy being indicated even if SARS-CoV-2 infection is confirmed in the case of patients with moderate and mild symptoms. For an early scenario, the standard chemo-radiotherapy using simultaneous integrated boost (SIB) technique is the preferred option, because it reduces the overall treatment time. For a late scenario with limited resources, hypo-fractionated treatment, with possible omission of chemotherapy for elderly patients and for those who have comorbidities, is recommended. Concurrent chemotherapy is controversial for dose values >2.4 Gy per fraction. The implementation of hypo-fractionated regimens should be based on a careful assessment of dose-volume constraints for organs at risks (OARs), using recommendations from clinical trials or dose conversion based on the linear-quadratic (LQ) model. Induction chemotherapy is not considered the optimal solution in this situation because of the risk of immunosuppression even though in selected groups of patients TPF regimen may bring benefits. Although the MACH-NC meta-analysis of chemotherapy in head and neck cancers did not demonstrate the superiority of induction chemotherapy over concurrent chemoradiotherapy, an induction regimen could be considered for cases with an increased risk of metastasis even in the case of a possible Covid-19 pandemic scenario.

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Hypofractionated radiotherapy for palliation in locally advanced head and neck cancer

Cited by 5 publications

References 10 publications

Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy

Symptom Palliation in Patients with Bone Metastases Treated with Radiotherapy

Hypofractionated radiotherapy with concurrent chemotherapy with weekly cisplatin in locally advanced relatively radioresistent subsites of head and neck cancers

New Challenges of Treatment for Locally Advanced Head and Neck Cancers in the Covid-19 Pandemic Era

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