1574P Randomized study to assess effect of L-carnitine on multiple toxicities caused by chemoradiation in head and neck cancer

Abstract

While treating head neck cancer patients with chemoradiation, most important consideration is acute treatment related toxicities that lead to morbidity, poor quality of life and patients dropping out of the treatment. Aim of study to find way to reduce the treatment related toxicities without compromising efficacy of treatment. Main physiologic function of L-carnitine is translocation of long chain fatty acid from cytoplasm to mitochondria for beta oxidation of enzymes leading to energy production, protective action on lipid peroxidation, buffering of excess cytotoxic acyl co-A, antioxidant action mediated by scavenging of free radicals. We evaluated role of L-carnitine in preventing the treatment related acute side effects. Study conducted in Department of Radiotherapy- tertiary care centre, Northern India. Patients of head neck cancer receiving concurrent chemoradiotherapy from August 2018 to August 2020 included. Randomized into study and control arm- study arm received oral L-carnitine 500mg thrice daily during radiation. Toxicity assessment done two weekly during treatment(t/t) using RTOG(Radiation Therapy Oncology Group). Nutritional assessment done by Hemoglobin, albumin and weight loss recorded during t/t. Brief Fatigue Inventory(BFI) for fatigue, EORTC-QLQ- C30(European Organisation .of the Research and Treatment of Cancer Quality of Life Questionnaire) for quality of life and RECIST 1.1 (Response Evaluation Criteria In Solid Tumors) for response assessment used. 150 patients assessed - 99 enrolled and randomly divided into test arm and control arm. 96 completed planned treatment(t/t). Most patients had stage III(43.59%) and IVA(38.33%) disease. Significant decrease in severity and delay in the onset of dermatitis, mucositis, laryngeal reaction and dysphagia but NOT in xerostomia. T/t response in both arms comparable. Mean post-t/t BFI- test arm 37.22 and 52.24 control arm(p-0.042). 28.75% in control and none in test arm had albumin <3.4g/dl. Median weight loss in the test arm 5.2% and in control arm 7.4%. Using EORTC QLQ-C30 significant difference between test and control arm for fatigue and pain. L-carnitine can be used during radiation to ameliorate toxicities.