PROSPECTIVE STUDY COMPARING SINGLE-AGENT VERSUS DOUBLET-AGENT CONCURRENT CHEMORADIOTHERAPY IN LOCALLY ADVANCED ORAL CAVITY AND OROPHARYNGEAL SQUAMOUS CELL CARCINOMA
Journal Title: Journal of Advanced Medical and Dental Sciences Research - Year 2017, Vol 5, Issue 3
Abstract
Introduction: Concurrent chemoradiotherapy is the standard treatment for locoregionally advanced oropharyngeal and unresectable oral-cavity cancers. This study aims to make a comparative analysis of the efficacy and toxicity of single-agent chemoradiotherapy with weekly cisplatin versus doublet-agent chemoradiotherapy with cisplatin and 5-FU in locoregionally advanced oral-cavity and oropharyngeal cancer. Patients and Methods: In this open label randomised study, 60 patients with histologically proven Stage III – IVA oral-cavity and oropharyngeal cancer were randomly assigned between May 2013 and July 2014 to receive chemoradiation to a dose of 66-70 Gy in 33-35 fractions over 7 weeks with either weekly cisplatin 40 mg/m2 (Arm A) or weekly cisplatin 40 mg/m2 and 5-fluorouracil 375 mg/m2(Arm B). The tumorresponse, treatment compliance and toxicity profile were investigated. Results: Longer overall treatment time resulting from more treatment interruptions were associated with eight patients in Arm A(27.5%) and 15 patients in Arm B (51.7%) (p<0.060). The compliance to chemotherapy was superior in patients receiving weekly cisplatin alone with 22 patients receiving more than five cycles of chemotherapy as compared to 16 patients in Arm B (75.8% vs 55.1%). Sixteen patients in Arm A (55.1%) and 21 patients in Arm B (72.4%) developed grade 3-4 mucosal toxicity. Sixteen patients in Arm A (53.3%) and 11 patients in Arm B (36.6%) achieved complete response to treatment, whereas, ninepatients in Arm A (30%) and nine patients in Arm B (30%) had a partial response to treatment. (p=0.195) Conclusion: Doublet-agent chemoradiotherapy led to frequent treatment interruptions because of higher rates of acute mucosal, skin and haematological toxicity, thus leading to prolongation of overall treatment time, over the standard single-agent weekly cisplatin and did not confer any benefit in loco-regional tumour control.
Authors and Affiliations
Maneesh Singh, Pardeep Garg, Raja PS Banipal, Sapna Marcus, HP Yadav
Keywords
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