PP127: Comparing the efficacy of concomitant boost radiotherapy and concurrent chemo-radiation for organ preservation in locally advanced carcinoma of larynx and hypopharynx: A preliminary analysis

Abstract

To evaluate the efficacy of accelerated fractionation with concomitant boost for organ preservation as compared to concurrent chemoradiation in patients with locally advanced carcinoma of larynx and hypopharynx. Forty newly diagnosed patients of locally advanced carcinoma of larynx and hypopharynx were selected following a pre-decided inclusion and exclusion criteria. They were randomized to receive either concurrent chemoradiation using Injection Cisplatin 100 mg/m2 every 3 weeks and external radiation 66 Gy/6.5 weeks/33# (Arm A) or accelerated radiotherapy with concomitant boost (Arm B) delivering 45 Gy/5 weeks/25# to entire tumour bearing region and a boost of 22.5 Gy/3 weeks/15# to the gross tumour. The boost was given as a second daily dose during the last 3 weeks of treatment and the BED of radiation given to both arms were comparable. The primary endpoint was to assess the functional organ preservation at one year. The acute toxicities of treatment and change in quality of life were also compared between the two arms. The statistical significance was calculated using SPSS v18. All the patients completed treatment as planned. Only one patient in Arm B had residual disease requiring laryngectomy. Functional organ preservation with good voice and swallowing functions were seen in 90% in Arm A and 95% in Arm B. Statistically significant difference was seen in Grade 3 dysphagia scoring, Arm A 60%, Arm B 30% ( p = 0.024). All other acute toxicities and quality of life scores were comparable. This preliminary analysis suggests that accelerated radiation with concomitant boost is as effective as chemoradiation for functional organ preservation in locally advanced cancers of larynx and hypopharynx. A bigger study is underway to see if concomitant boost can be offered as an alternative to chemoradiation in these patients.