HYPOFRACTIONATED RADIOTHERAPY WITH CONCURRENT CHEMOTHERAPY WITH WEEKLY CISPLATIN IN LOCALLY ADVANCED RELATIVELY RADIORESISTENT SUBSITES OF HEAD AND NECK CANCERS

Authors

DOI:

https://doi.org/10.11603/ijmmr.2413-6077.2022.2.13118

Keywords:

head and neck cancer, hypofractionated, radioresistent, response, mucositis

Abstract

Background. Locoregionally advanced head and neck cancers are more aggressive and locoregional failure rate after conventional radiotherapy is high.

Objective. The aim of the study is to assess the tumor response and toxicities of hypofractionated radiation therapy with concurrent chemotherapy in treatment of four relatively radioresistent tumor sites of head and neck.

Methods. A prospective randomised control trial was conducted in 27 head and neck cancer patients. All patients were treated with hypofractionated radiotherapy at 250cGy/fraction once daily to a maximum of 62.5Gy in 25 fractions with concurrent cisplatin 30 mg/m2. Data were evaluated with SPSS version 21.0 for Windows with p-value <0.05.

Results. Complete and partial responses were achieved in 15 (57.7%) and 8 (30.8%) patients respectively with an overall response rate of 88.5% and three patients having stable disease. Grade 3 and 4 acute mucositis was experienced by 17 patients (65.4%) and seven patients (27%), respectively. Grade 3 dysphagia was found in 21 patients (80.7%) and grade 3 and 4 skin reactions – in 11 and 2 patients, respectively. Most patients had manageable acute toxicities. Most of the late complications were of grade 2 and 3. The median time to locoregional recurrence was 12 months and one year progression-free survival attained by 61.5% patients.

Conclusion. Treatment with hypofractionated radiotherapy with concurrent cisplatin appears feasible and safe and is associated with a good response rate. Although grade 3 and 4 toxicities were comparatively high but it was manageable. Late toxicities were within tolerable levels.

Author Biographies

K. Baidya, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Senior Resident, Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal, Manipur, India

Y. S. Devi, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Associate Professor, Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal, Manipur, India

A. S. Devi, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Medical officer, Manipur Health Services, Manipur, India

Y. I. Singh, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Professor, Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal, Manipur, India

D. Das, ATAL BIHARI VAJPAYEE REGIONAL CANCER INSTITUTE, AGARTALA, TRIPURA, INDIA

Medical Officer, Department of Radiation Oncology, Atal Bihari Vajpayee Regional Cancer Institute, Agartala, Tripura, India

R. Mahawar, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Post graduate trainee, Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal, Manipur, India

N. N. Devi, REGIONAL INSTITUTE OF MEDICAL SCIENCES, IMPHAL, MANIPUR, INDIA

Post graduate trainee, Department of Radiation Oncology, Regional Institute of Medical Sciences, Imphal, Manipur, India

References

Semple C, Parahoo K, Norman A, McCaughan E, Humphris G, Mills M. Psychosocial interventions for patients with head and neck cancer. Cochrane Database Syst Rev 2013; 7: CD009441.

doi: 10.1002/14651858.CD009441.pub2.

Bray F, Ferlay J, Soerjomataram I, Siegel RL, Torre LA, Jemal A. Global cancer statistics 2018: GLOBOCAN estimates of mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin 2018; 68(6):394-424.

doi: 10.3322/caac.21492.

Report of National Cancer Registry Programme (ICMR-NCDIR), Bengaluru, India 2020. Available at: https://www.ncdirindia.org/All_Reports/Report_2020/default.aspx. Accessed on 26.12.2022.

Mendenhall WM, Werning JW, Pfister DG. Cancer of the head and neck. In: DeVita VT, Hellman S, Rosenberg SA, editors. Cancer: Principals and practice of Oncology. 10th ed. Philadelphia: Wolters Kluwer; 2015. p. 422-24.

Agarwal JP, Nemade B, Murthy V, Laskar SG, Budrukkar A, Gupta T, et al. Hypofractionated, palliative radiotherapy for advanced head and neck cancer. Radiotherapy and Oncology 2008;89(1):51-6.

doi: 10.1016/j.radonc.2008.06.007.

Howlader N, Noone AM, Krapcho M, Miller D, Bishop K, Altekruse SF, et al. SEER Cancer Statistics Review, 1975-2013. Bethesda, MD: National Cancer Institute (2016). Available from: http://seer.cancer.gov/csr/1975_2013. Accessed on 27.12.2022.

Szturz P and Vermorken JB. Treatment of Elderly Patients with Squamous Cell Carcinoma of the Head and Neck. Front Oncol 2016; 6:199.

doi: 10.3389/fonc.2016.00199

Hall EJ, Garcia AJ. Time, dose and fractionation in radiotherapy. In: Hall EJ, Garcia AJ eds. Radiobiology for the radiologists. 8th ed. Philadelphia: Lippincott Williams and Wilkins; 2018. p. 417-36.

Carlson DJ, Keall PJ, Loo BW, Chen ZJ, Brown JM. Hypofractionation results in reduced tumor cell kill compared to conventional fractionation for tumors with regions of hypoxia. Int J Radiat Oncol Biol Phys 2011;79(4):1188-95.

doi: 10.1016/j.ijrobp.2010.10.007.

Porceddu SV, Rosser B, Burmeister BH, Jonesc M, Hickeya B, Baumannd K, et al. Hypofrac­tionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment-hypo trial. Radiother Oncol 2007;85(3):456-62.

doi: 10.1016/j.radonc.2007.10.020.

Shuryak I, Hall EJ, Brenner DJ. Optimized hy­po­fractionation can markedly improve tumor control and decrease late effects for head and neck cancer. Int J Radiation Oncol Biol Phys 2019;104(2):272-8.

doi: 10.1016/j.ijrobp.2019.02.025.

Lacas B, Carmel A, Landais C, Wong SJ, Licitra L, Tobias JS, et al. Meta-analysis of chemo­therapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021; 156:281-293.

doi: 10.1016/j.radonc.2021.01.013.

Eisenhauer EA, Therasse P, Bogaerts J, Schwartz LH, Sargent D, Ford R, et al. New response evaluation criteria in solid tumors: Revised RECIST guideline (version 1.1). European J of Cancer 2009;45(2):228-47.

doi: 10.1016/j.ejca.2008.10.026.

Radiation Therapy Oncology Group. RTOG acute and late Radiation Morbidity Scoring criteria. Available at: http://www.rtog.org/Research­Asso­ciates/ Adverse Event Reporting/Acute and late Radiation Morbidity Scoring Criteria.aspx. Accessed on 10.07.2019.

National Comprehensive Cancer Network. Head and Neck Cancers (Version 1.2022). Available at: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf. Accessed on 26/12/2022.

Shunyu NB, Syiemlieh J. Prevalence of Head and Neck Cancer in the State of Meghalaya: Hospi­talbased Study. Int J Head and Neck Surg 2013;4(1):1-5.

Al-mamgani A, Tans L, Van rooij PHE, Noever I, Baatenburg de jong RJ, Levendag PC. Hypofractionated radiotherapy denoted as the “Christie scheme”: An effective means of palliating patients with head and neck cancers not suitable for curative treatment, Acta Oncologica 2009;48(4):562-70.

doi: 10.1080/02841860902740899.

Thomson DJ, Palma D, Guckenberger M, Balermpas P, Beitler J, Blanchard P, et al. Practice recommendations for risk-adapted head and neck cancer radiation therapy during the COVID-19 pandemic: an ASTRO-ESTRO consensus statement. Int J Radiat Oncol Biol Phys 2020;107(4):618-27.

doi: 10.1016/j.ijrobp.2020.04.016.

Mudgal A, Arya AK, Yadav I, Chaudhary S. Role of hypofractionated palliative radiotherapy in patients with stage four head-and-neck squamous cell carcinoma. J Can Res Ther 2019;15:528-32.

doi: 10.4103/jcrt.JCRT_116_18.

Nguyen NT, Doerwald-Munoz L, Zhang H, Kim DH, Sagar S, Wright JR, et al. 0-7-21 hypofrac­tionated palliative radiotherapy: an effective treat­ment for advanced head and neck cancers. Br J Radiol 2015;88(1049): 20140646.

doi: 10.1259/bjr.20140646.

Teckie S, Benjamin H, Rao S, Gutiontov SI, Yamada Y, Berry SL, et al. High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck. Oral Oncol 2016;60(1):74-80.

doi: 10.1016/j.oraloncology.2016.06.016.

Koukourakis MI, Tsoutsou PG, Karpouzis A, Tsiarkatsi M, Karapantzos I, Daniilidis V, et al. Radiochemotherapy with cetuximab, cisplatin, and amifostine for locally advanced head and neck cancer. A feasibility study. Int J Radiat Oncol 2010;77(1):9-15.

doi: 10.1016/j.ijrobp.2009.04.060.

Krstevska V, Stojkovski I, Zafirova-Ivanovska B. Concurrent radiochemotherapy in locally regionally advanced oropharyngeal squamous cell carcinoma. Analysis of treatment results and prognostic factors. J Radiat Oncol 2012;7(6):78-82.

doi: 10.1186/1748-717X-7-78

Yi J, Huang X, Xu Z, Liu S, Wang X, He X, et al. Phase III randomized trial of preoperative concurrent chemoradiotherapy versus preoperative radio_therapy for patients with locally advanced head and neck­ squamous cell carcinoma. Oncotarget 2017; 8(27):44842-50.

doi: 10.18632/oncotarget.15107.

Bonner JA, Harari PM, Giralt J, Cohen RB, Jones CU, Sur RK, et al. Radio therapy plus cetuximab for locoregionally advanced head and neck cancer: 5-year survival data from a phase 3 randomized, and relation between cetuximab induced rash and sur­vival. Lancet Oncol 2010;11(1):21-8.

doi: 10.1016/S1470-2045(09)70311-0.

Goswami U, Banerjee S, Dutta S, Bera A. Treatment outcome and toxicity of hypofractionated radiotherapy with concomitant chemotherapy versus conventional fractionated concomitant chemo­radiation in locally advanced head-and-neck carci­noma: a comparative study. Asian J Pharm Clin Res 2022;15(7):167-71.

doi: 10.22159/ajpcr.2022v15i7.44857.

Sanghera P, McConkey C, Ho KF, Glaholm J, Hartley A. Hypofractionated accelerated radiotherapy with concurrent chemotherapy for locally advanced squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2007;67(5):1342-51.

doi: 10.1016/j.ijrobp.2006.11.015.

Spartacus RK, Dana R, Rastogi K, Bhatnagar AR, Daga D, Gupta K. Hypofractionated Radiotherapy for Palliation in Locally Advanced Head and Neck Cancer. Indian J Palliat Care. 2017;23(3):313-16.

doi: 10.4103/IJPC.IJPC_9_17.

Kodaira T, Kagami Y, Shibata T, Shikama N, Nishimura Y, Ishikura S, et al. Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701). Ann Oncol. 2018;29(4):992-7.

doi: 10.1093/annonc/mdy036.

Lacas B, Bourhis J, Overgaard J, Zhang Q, Grégoire V, Nankivell M, et al. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 2017;18(9):1221–37.

doi:10.1016/s1470-2045(17)30458-8.

Downloads

Published

2023-04-26

How to Cite

Baidya, K., Devi, Y. S., Devi, A. S., Singh, Y. I., Das, D., Mahawar, R., & Devi, N. N. (2023). HYPOFRACTIONATED RADIOTHERAPY WITH CONCURRENT CHEMOTHERAPY WITH WEEKLY CISPLATIN IN LOCALLY ADVANCED RELATIVELY RADIORESISTENT SUBSITES OF HEAD AND NECK CANCERS. International Journal of Medicine and Medical Research, 8(2), 24–33. https://doi.org/10.11603/ijmmr.2413-6077.2022.2.13118