A pilot study on feasibility, toxicity and efficacy of a novel hypofractionated radiation therapy in advanced non-nasopharyngeal head and neck carcinoma treated with palliative intent

Abstract

Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancer hypofractionated radiotherapy is an efficient, cost-effective option, providing logistic advantage. Though there are multiple regimens prescribed, no standard of care has been confirmed. In this study a novel hypofractionated regimen has been tested for feasibility and toxicity along with assessment of objective treatment response and survival along with self–reported quality of life. Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngeal squamous cell carcinoma of Head and Neck (Stage IV) attending Radiotherapy Department of Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, given as 2 days a week (total 3.5 weeks). In patients with good response and tolerability 10 Gray boost in 2 fractions were given. Patients were followed up at regular intervals for at least 1 year. Results: The regimen faced a 97% treatment completion rate. Mean time to completion (from first contact) is 5.8 (95% CI = 5.7–6.0) weeks. The toxicity of this treatment regimen was tolerable with 23.3% acute and 33.3% incidence of chronic grade 3/4 toxicities. Objective response rate of this study was 66.7% (p = 0.001) with further 16.7% patients having stable disease. After one month of treatment significant improvement of quality of life was reported in terms of global health score, functional score and symptoms score. Mean progression free survival is 34.4 (95% CI = 27.8–41.1) weeks with 49.4 (95% CI = 44.3–54.5) weeks of overall survival in 1 year follow up period. Conclusions: The regimen is well tolerated and is highly feasible and has provided good response rate and improved quality of life immediately after treatment along with better one year overall survival rate.