RADICAL RADIOTHERAPY WITH CONCURRENT WEEKLY CISPLATIN IN LOCO-REGIONALLY ADVANCED SQUAMOUS CELL CARCINOMA OF THE HEAD AND NECK- A SINGLE INSTITUTION EXPERIENCE
Journal Title: Journal of Evolution of Medical and Dental Sciences - Year 2019, Vol 8, Issue 1
Abstract
BACKGROUND Concurrent chemotherapy by three weekly high dose cisplatin along with radical external beam radiation therapy is the standard of care for the treatment of Locally Advanced Squamous Cell Carcinoma of Head and Neck Cancers (LASCCHN). But this treatment regime is having certain disadvantages such as high toxicity profile, increased treatment cost and increased overall duration of treatment. Hence, the present study was undertaken to determine the acute toxicity and tumour response in Locally Advanced Head and Neck cancer (LASCCHN) patients who were treated with concurrent chemoirradiation using 30 mg/m2 weekly cisplatin. MATERIALS AND METHODS This single institution Prospective study included data of 60 patients who presented to Govt. Royapettah Hospital with locally advanced and unresectable (Either AJCC 8th Edition stage III or stage IV) stage and previously untreated squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx and maxillary antrum with age between 18 yrs. and 60 yrs of either gender. They were treated with intent of radical external radiation therapy with 66 Gy-70 Gy in 33-35# over 6-7 weeks and concurrent chemotherapy (Inj. Cisplatin 30 mg/m2) which was given weekly once to a total of six cycles and they were assessed for immediate response and toxicity and were analysed after four to six weeks of completion of treatment. RESULTS The mean age of the patients was 49.6 years. The most common site of involvement was tongue. The mean overall treatment time was 56.9 days. Out of sixty available patients, 26 (43%) patients showed complete response. Partial response was seen in 22 (37%) patients with an overall response rate of 80%. Twelve patients (20%) showed loco regional failure. The median radiotherapy dose was 70 Gy and median number of chemotherapy cycles was 6 (range 1–7). According to the Radiation Therapy Oncology Group (RTOG) acute radiation morbidity scoring criteria, acute grade 3 or worse mucositis and dermatitis was seen in 10 (17%) and 9 (15%) patients respectively, essentially in patients receiving doses ≥66 Gy. Organ injury was assessed using the Common Terminology Criteria for Adverse Events (CTCAE). Other toxicities (hematologic, nausea and vomiting) were found to be mild and self limiting. Chemotherapy is used to achieve maximum local control. Thus, comparatively newer modalities of concurrent chemoradiation particularly with Cisplatin and its combinations are giving increasingly rewarding results, by way of producing high loco regional control with significantly improved survival rates. CONCLUSION In this study, we found radical radiotherapy with concurrent low dose weekly cisplatin is having moderate efficacy. Toxicity levels were found to be within acceptable limits.
Authors and Affiliations
Vijayasree T. N. , Subramanian Saravanan
Keywords
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- EP ID EP553046
- DOI 10.14260/jemds/2019/12
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