Concurrent Chemoradiation by Conventional Fractionation versus Concomitant Boost Radiation in Locally Advanced Squamous Cell Carcinoma of Head and Neck

Abstract

Introduction: Most of the patients with head and neck cancer present with advanced-stage disease. Randomized studies point to improved therapeutic ratios with altered fractionation schedules with no increase in late toxicity. There is a paucity of data regarding results of altered fractionation from the Indian subcontinent. Materials and Methods: Sixty patients of histologically proven stage III-IV-A oropharyngeal, laryngeal & hypopharyngeal carcinoma were randomized in two arms. The control arm was treated with conventional fractionation whereas study arm received concomitant boost, both with weekly chemotherapy. Response and toxicity profile were assessed at 6, 12 and 24 weeks post-treatment. Results: Most of the patients presented in 5th-6th decade of life with oropharynx being the most common site. Majority of patients in both the arms presented with stage IVA disease. Loco-regional control at both primary and nodal sites was similar in both the arms on follow-up. Nodal involvement and stage at presentation adversely affected the outcome. Mucositis was the most common acute toxicity observed and was significantly more in the study arm (p=.0014, SS)  Late toxicity (laryngeal edema, subcutaneous fibrosis, hoarseness of voice) was comparable in the two arms. Conclusion: In patients with locally advanced unresectable head and neck carcinoma, altered fractionation with concomitant boost is a feasible schedule with acceptable toxicities. The compliance to therapy is high, and the loco-regional control achieved compares favourably with concurrent chemo-radiation by conventional fractionation with weekly cisplatin. However, pooling of data from different centers has been advocated to derive conclusive results.