Concomitant boost Radiation Therapy in Loco-regionally advanced Head and Neck Squamous Cell Carcinomas

Dr.Prem kumar Devdoss; Dr.Naveen Ravel

Volume : VIII, Issue : II, February - 2019

Concomitant boost Radiation Therapy in Loco-regionally advanced Head and Neck Squamous Cell Carcinomas

Dr. Prem Kumar Devdoss, Dr. Naveen Ravel

Abstract :

Aim: To investigate the feasibility of combining concomitant boost accelerated radiation regimen (ACB) with weekly mono-chemotherapy using Cisplatin and to access its local response and acute toxicity patterns in patients with advanced locoregional head and neck squamous cell carcinoma (HNSCC). Materials and methods: It was a prospective study, 24 patients met the eligibility criteria of the protocol and were recruited. Eligibility criteria include: Patients with adequate bone marrow function, Creatinine clearance >50 ml/min determined by 24-hr collection or nomogram, No symptomatic coronary artery disease (angina) or myocardial infarction within the last 6 months and Patients with a history of non-melanoma skin cancer, or other previous malignancies from which the patient has remained continually disease free for > 3 years are eligible. Ineligibility Criteria: Histology other than squamous cell carcinoma, Evidence of metastases (below the clavicle or distant) by clinical or radiographic examinations, Prior chemotherapy for any reason or radiotherapy to the head and neck region, Initial surgical treatment excluding diagnostic biopsy of the primary site or neck disease, Patients with simultaneous primaries, Pregnant women because of the emyotoxic effects if chemotherapy and associated Co-morbid conditions like, DM,HT, IHD, etc. Results: Overall response to therapy was recorded in all patients (100%). This included a complete response in 19 patients (79.2%) and partial response in 5 patients (20.8%). Of the 5 patients with residual disease (partial response), 3 patients (12.4%) had residual disease at the primary site, 1(4.2%) patient had residual disease at the nodal site and 1(4.2%) patient had residual at the primary and nodal site. A significant observation was the association between the grade of squamous cell carcinoma and complete response with 33% of grade-I, 60% of grade-II, and 70% of grade-III carcinomas showing complete response (p<0.01). Site-wise 100% of laryngeal cancers, 66.7% of hypopharyngeal cancers and 81.25% of oropharyngeal cancers showed complete response (p=NS). 100% of T2 tumors, 100% of T3 tumors, and 61.5% of T4a tumors showed complete response (p=NS). Nodal response demonstrate 100% complete response among patients with N0, N1 and N2a lesions, while N2c lesions showed 28.5% complete response respectively (p=NS). Conclusion: This data shows that it is feasible to combine ACB and weekly mono-chemotherapy using cisplatin with manageable, although substantial, toxicity. The compliance to therapy is high, and the loco-regional response achieved compared favourably with ACB alone or other concurrent chemoradiation regiments using standard or altered fractionation regiments tested by the Institute. It also compares well with the available literature. An extended Phase - II trial, and a new Phase – III trial comp� ACB plus cisplatin against standard radiation plus cisplatin is being planned at the institute to determine whether the use of ACB in the concurrent chemoradiation setting further improves outcome.