Comparative Study of Two Hypofractionated Palliative Radiotherapy Schedules-24Gy in 4 Fractions vs 30Gy in 10 Fractions in Stage IVA and IVB Squamous Cell Carcinoma of Head-neck Region

Abstract

Palliative radiotherapy relieves distressing symptoms and helps to manage localized tumor growth when curative treatment is not possible. The study aims to determine that a palliative regimen of 24 Gy in 4 fractions in 4 weeks, once weekly fractionation can achieve a similar response to another palliative radiation therapy of 30 Gy in 10 fractions in 2 weeks regarding symptom and tumor control in locally advanced head-neck cancers with manageable toxicities. This quasi-experimental study was done at the National Institute of Cancer Research and Hospital (NICRH), Dhaka. Sixty newly diagnosed patients of HNSCC (except the cases of the nasopharynx, salivary glands, and paranasal sinus malignancies) presented with stage IVA and IVB were included in two arms. The most common age in both arms was 51-60, with 46.7% in Arm A and 50% in Arm B. On the other hand, most of the participants were in the Taka 15000-24999 income group. 8.3% participants were diabetic 2(6.7%) in Arm A vs 3(10%) in Arm B. According to TNM staging, IVB constituted just above half 16(53.3%) in Arm A, and 15(50%) in Arm B. Before RT, there was no skin toxicity in any participant. After completing RT, there was 13(43.3%) skin toxicity in Arm A and 19(63.3%) in Arm B. This resolved with time, and at the end of the 6th week following RT, it was only 2 (6.7%) in Arm A and 3(10%) in Arm B. The palliative hypofractionated radiotherapy regimen of 24 Gy in 4 fractions administered once weekly, as observed in this study, exhibits similar effectiveness in terms of symptom management, tumor control, and minimal adverse effects when compared to the conventional 30 Gy delivered in 10 fractions.