A comparative study of two schedules of concomitant Chemo-radiation with Cisplatin in locally advanced Head and Neck Cancer in Southern Rajasthan of India

Abstract

Introduction: Head and neck cancer is the most common cancer in south-central Asia. It constitutes about 17.7% of all cancers occurring in India. Majority of them present with locoregionally advanced stage. Concurrent chemo-radiotherapy (CCRT) is recognized worldwide as a standard treatment option for locally advanced disease not amenable to surgical resection. Aims: To compare the differences in acute toxicities and response rate between two schedules (weekly and 3-weekly divided dose cisplatin-based) of concomitant chemo-radiation (CCRT) regimens in locally advanced head and neck squamous cell carcinoma (LHNSCC). Methods and Material: Total of 62 eligible patients of LHNSCC who satisfying the eligibility criteria were included in this study. After pre-treatment evaluation, patients were sequentially randomized into two arms: 31 patients were taken in each arm, Arm-A (weekly concurrent cisplatin group) and Arm- B (three weekly divided dose concurrent cisplatin groups). One patient in each arm dropped out due to poor compliance. In both the arms, radiotherapy was delivered to a dose of 66-70 Gy with a telecobalt machine as a conventional fractionation schedule. The primary endpoints of the study were to know the disease response and assessment of acute toxicity profile in both arms. Results: Among the in-field toxicity, we found mucositis as the commonest toxicity in both arms. Incidence of Grade-III (33.33% vs 40%) & Grade-IV mucositis (6.66% vs 10%), acute gastrointestinal toxicity (Nausea- 33.33% vs 46.33% & vomiting- 13.33% vs 20%), and acute renal toxicity (16.66% vs 10%) were found to be slightly higher in 3-weekly arm compared to weekly arm. Our study showed that higher the incidence of neutropenia grade-I (23.33% VS 16.66%) and acute skin reaction (40% vs 33.33%) occurred in the weekly CCRT arm compared to the 3-weekly CCRT arm. In view of treatment compliance and response rate, our study showed 3-weekly arm have a higher compliance rate of scheduled chemotherapy cycles and a higher response rate (CR=80% vs 70%) compared to the weekly arm. Conclusions: The present study concluded that the three weekly divided dose concurrent cisplatin arms having a slightly better response rate with a slight increase in mucosal toxicity while the weekly concurrent cisplatin arm having a reduced requirement of feeding tube placement, colony-stimulating factor and hospitalization for supportive care.