Prospective randomized trial to compare accelerated (six fractions a week) radiotherapy against concurrent chemoradiotherapy (using conventional fractionation) in locally advanced head and neck cancers.

Abstract

Concurrent chemoradiation (CCRT) is currently considered to be the standard of care in locally advanced head and neck cancer. The optimum radiotherapy schedule for best local control and acceptable toxicity is not yet clear. We aimed at shortening of treatment time by using accelerated radiation, thereby comparing the disease response, loco-regional tumor control and tolerability of accelerated radiation (six fractions per week) against CCRT in locally advanced head and neck cancer. We conducted the prospective randomized study for a period of 2 years from June 2011 to May 2013 in 133 untreated patients of histologically confirmed squamous cell carcinoma of head and neck. Study group (66 patients) received accelerated radiotherapy with 6 fractions per week (66Gy/33#/5½ weeks). Control group (67 patients) received CCRT with 5 fractions per week radiation (66 Gy/33#/6½ weeks) along with intravenous cisplatin 30 mg/m(2) weekly. Tumor control, survival, acute and late toxicities were assessed. Median overall treatment time was 38 days and 45 days in the accelerated radiotherapy and concurrent chemoradiation arm, respectively. At a median follow up of 12 months, 41 patients (62.1%) in the accelerated radiotherapy arm and 47 patients (70.1%) in the CCRT arm were disease free (P = 0.402). Local disease control was comparable in both the arms. Acute toxicities were significantly higher in the CCRT arm as compared with accelerated radiotherapy arm. There was no difference in late toxicities between the two arms. We can achieve, same or near to the same local control, with lower toxicities with accelerated six fractions per week radiation compared with CCRT especially for Indian population.