A PROSPECTIVE RANDOMIZED STUDY TO COMPARE THE EFFICACY OF CONCURRENT HYPOFRACTIONATED RADIOTHERAPY WITH CONCURRENT CONVENTIONAL RADIOTHERAPY IN LOCALLY ADVANCED HEAD AND NECK CARCINOMA

Abstract

Background: Management of loco-regionally advanced head and neck squamous cell
carcinoma with curative intent has evolved considerably over time. Strategies that modulate the
biological response of tumors or normal tissues to radiation include altered fractionation
schedules, combined modality treatments using chemotherapeutic agents.Hypofractionated
radiotherapy schedule, offer potential benefits to the patients and economy of health system,
particularly in a busy radiotherapy setup.
Aim and objectives: The aim of this study was to investigate tumor response in locally
advanced head and neck squamous cell carcinoma using concurrent hypofractionated
radiotherapy schedule and to compare its relative efficacy with standard concurrent
conventional fractionation schedule.
Material and Methods: Total 80 patients were enrolled and randomized into two treatment
arms. In hypofractionated arm (Arm A)-All patients received 60.5Gy @ 2.75 Gy per fraction
over 4.2 weeks, along with concurrent inj cisplatin 35mg/mt2
,weekly up to 4 weeks. In
conventional arm (Arm B) - All patients received, 70 Gy @ Gy per fraction over 7 weeks,
along with concurrent inj cisplatin 35mg/mt2 weekly up to 7 weeks.
Results: -In arm A (HFRT), 3 pts. (7.5%) and in arm B (conventional) - 2 pts. (5%) achieved
complete response.28 pts (70%) in arm A and 25 pts (62.5%) in arm B, attained partial
response over primary tumor site, while 2pts (5%) in arm A and 6 pts (15%) in arm B,
developed progressive disease. It was found that 7pts (17.5%) showed complete nodal
response, 26 pts (65%) achieved partial response in arm A. When overall treatment days were
compared it was found that patients in arm A saved 17 days as compared to arm B. At the end
of the radiotherapy, grade II oral mucositis was observed in 23 pts. (57.5%) in arm A and in 19
pts.(47.5%) in arm B.
Conclusion: Hypofractionated radiotherapy regimen has promise to deliver the reasonably
high dose to achieve primary and nodal relief with manageable acute toxicity especially in
patients with locally very advanced head and neck cancers.