PP135: Hypofractionated radiotherapy for locally advanced cancer of the base of the tongue for patients unfit for long-course radiotherapy. Report of two cases and review of the literature

Abstract

Purpose Long-course concomitant radiochemotherapy is considered the standard therapy for locally advanced head and neck cancer. However, for unfit patients short-course hypofractionated radiotherapy is an appealing choice. Material We present the case of two patients presenting with progressive difficulties in swallowing and articulation that were referred to our department for radiochemotherapy for locally advanced squamous cell carcinoma of the base of the tongue. Method and material We decided to offer both patients a short-course of hypofractionated radiotherapy because of the denial of the one to have a long treatment course and the bad performance status of the other. Literature references support the use of different radiation therapy schedules for palliation of patients that are not candidates for the standard long-course radiotherapy. Sixteen fractions of 3.125 Gy give a total response rate of 73% and local control of 62% and 32% at one and three years, respectively. The HyPo trial (30 Gy/5fr/2 weeks and 6 Gy boost) reported an improvement in quality of life in 62% of patients. Both patients were referred for dental assessment and percutaneous gastric tube placement and had a planning CT scan of the head and neck. They were treated with 3D conformal radiotherapy receiving 30 Gy in 10 fractions in the primary tumor, neck and supraclavicular fossa and 15 Gy as a boost in the gross tumor volume in combination with weekly cisplatin. Reported toxicity was grade II mucositis. Results At the end of radiation therapy both patients had significant clinical improvement with substantial decrease of gross tumor volume and pain, increase of tongue mobility and improvement of articulation. Conclusion Although there are references in the literature of encouraging results by offering short course radiotherapy to patients with locally advanced head and neck cancer the optimum radiation therapy schedule has not been defined yet.