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Background: Head and neck cancers are the most common malignancy among males in India. Carcinoma of buccal mucosa is the most common cancer among head and neck cancers due to high rate of tobacco chewing habit. Aim and objectives: To study the comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. Materials and methods: It was a prospective study of acute toxicity and response in patients diagnosed with head and neck malignancy. Patients with oral cavity site, previously untreated locally advanced III, IV-A and IV -B, age of 20-60 years. Results: Primary tumor site of the patients included in the both CRT arm and HFRT was not significant (P=0.755). Majority of patients included were T3 (44% in CRT arm and 46.7% in HFRT arm) and T2 (24% in CRT arm and 26.7% in HFRT arm) lesions. The tumors with respect to T stage, the difference between two arms was not statistically significant (P = 0.988). Most of the patients presented with N1 (44% of CRT arm and 40% of HFRT arm) and N2 (28% of CRT arm and 26.7% of HFRT arm) stage. With respect to nodal (N) stage at presentation, CRT arm and HFRT arm were comparable (P=0.987). In HFRT arm, 7 (46.7%) patients were presented in stage III Kuppa Prakash, A. Ravi Chandran, M. Vijay Kumar. Comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. IAIM, 2016; 3(9): 228-237. Page 229 and 8 (53.3%) patients were in stage IV. With respect to TNM stage, CRT arm and HFRT arm were comparable (P=0.87). Radiotherapy treatment compared in both CRT Arm and HFRT arms was not statistically significant (P=0.493). In CRT arm Grade 2 toxicity: 13/22 (59%) patients developed skin toxicity, 12/22 (55%) patients developed mucous membrane toxicity, 15/22 (68%) patients developed nausea, 8/22 (36%) patients developed vomiting, 10/22 (45%) salivary gland toxicity. Grade 3 toxicity: 2/22 (9%) patients developed skin toxicity, 10/22 (45%) patients developed mucous membrane toxicity, 5/22 (23%) patients developed nausea, 6/22 (27%) patients developed vomiting. Conclusion: Standard chemo radiation is better than HFRT in Head and Neck (oral cavity) cancers because of less toxicity, less mean overall treatment time, less number of treatment breaks and better response.
RESUMEN
PURPOSE: The standard treatment of locally advanced nasopharyngeal cancer is a concurrent chemoradiotherapy (CCRT), and cisplatin has been used as the most popular chemotherapeutic agent. But many different doses and schedules for cisplatin administration such as daily, weekly and 3 week cycles have been proposed. We compared and analyzed the tumor response, the overall survival, the toxicity and the chemotherapy dose intensity in the patients with locally advanced nasopharyngeal cancer who were treated with CCRT. MATERIALS AND METHODS: We performed a retrospective study on 55 patients with locally advanced nasopharyngeal cancer, and they were treated with CCRT as a front-line treatment from Jan 1996 to Jun 2007 at Kangnam Saint Mary's Hospital. RESULTS: The patients had a median age of 53 years (range: 19~75 years). Of the total 55 patients, a 3-week cycle of 100mg cisplatin was administered in 31 patients and 30 mg weekly cisplatin was administered in 24 patients combined with radiotherapy. Twenty one patients had a complete response and four patients had a partial response for a response rate of 71.4% (95% CI: 59.5~83.3) after CCRT and followed by adjuvant chemo-therapy. The complete response rates for the 30 mg and 100 mg cisplatin groups were 72.7% (95% CI: 54.9~90.5) and 54.2% (95% CI: 36.7~71.7), respectively (p= 0.23). The duration of CCRT in the 100mg cisplatin group was significantly longer than that of the 30mg cisplatin group (11.1+/-2.9 weeks vs. 9.0+/-1.2 weeks, p= 0.003). The major deviation group, which was defined as prolongation of the radiotherapy duration for more than 2 weeks, had a significantly lower objective response rate than did the non-deviation group (56.3% vs 84.2%, respectively, p= 0.002). The major severe toxicities were leucopenia (49.1%), pharyngoesophagitis (49.1%), anorexia (43.6%), nausea (41.8%) and vomiting (40%). CONCLUSIONS: Weekly 30mg cisplatin-based CCRT is a practical, feasible cisplatin schedule for the patients with locally advanced nasopharyngeal cancer in regard to decreasing the interruption of radiation treatment and decreasing the treatment-related acute toxicities.