TREATMENT OUTCOME AND TOXICITY OF HYPOFRACTIONATED RADIOTHERAPY WITH CONCOMITANT CHEMOTHERAPY VERSUS CONVENTIONAL FRACTIONATED CONCOMITANT CHEMORADIATION IN LOCALLY ADVANCED HEAD-AND-NECK CARCINOMA: A COMPARATIVE STUDY

UDDIPTYA GOSWAMI; SAPTARSHI  BANERJEE; SHATARUPA   DUTTA; ANJAN  BERA

doi:10.22159/ajpcr.2022.v15i7.44857

Authors

UDDIPTYA GOSWAMI Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.
SAPTARSHI BANERJEE Department of Radiotherapy, Medical College and Hospital, Kolkata-73, West Bengal, India.
SHATARUPA DUTTA Department of Radiotherapy, RG KAR Medical College and Hospital, Kolkata-04, West Bengal, India.
ANJAN BERA Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.

DOI:

https://doi.org/10.22159/ajpcr.2022.v15i7.44857

Keywords:

Hypofractionation, Head-and-neck cancer, Chemoradiation

Abstract

Objectives: In our study, radiation of a higher dose per fraction (2.75 Gy/fraction, total dose of 55 Gy/20 fractions/4 weeks) with concomitant chemotherapy was compared with conventional chemoradiation (2 Gy/fraction, a total dose of 66 Gy/33 fractions/6 and half weeks, with concomitant chemotherapy), in patients of locally advanced squamous cell carcinomas of head and neck in terms of efficacy and toxicities.

Methods: A total of 75 patients registered at the Department of Radiotherapy, NRS Medical College and Hospital, Kolkata, were allotted in two arms chronologically in a 1:1 ratio. Arm A – Patients received hypofractionated radiotherapy, 55 Gy/20 fractions in 4 weeks with concomitant weekly cisplatin (40 mg/m2). Arm B – Patients received conventional radiotherapy, 66 Gy/33 fractions in 6½ weeks with concomitant weekly cisplatin (40 mg/m2).

Results: Both in terms of efficacy and toxicities, the hypofractionation arm was comparable to the conventional arm, and no statistically significant difference was present between the arms. For the study arm, complete response was 56.6%, partial response was 36.6%, and for control arm, complete response 50% and partial response 37.5% (p=0.750). In terms of acute toxicities and late dysphagia, both the arms were almost similar.

Conclusion: The hypofractionated regimen was associated with tolerable acute and late toxicities and satisfactory local control. Considering the patient load, the overall treatment time, and the cost of hospital stay, this hypofractionated regimen is a good treatment option in our low-resource setup.

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Author Biographies

UDDIPTYA GOSWAMI, Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.

Senior Resident, Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.

SAPTARSHI BANERJEE, Department of Radiotherapy, Medical College and Hospital, Kolkata-73, West Bengal, India.

Assistant Professor, Department of Radiotherapy, Medical College and Hospital, Kolkata-73, West Bengal, India.

SHATARUPA DUTTA, Department of Radiotherapy, RG KAR Medical College and Hospital, Kolkata-04, West Bengal, India.

Assistant Professor, Department of Radiotherapy, RG KAR Medical College and Hospital, Kolkata-04, West Bengal, India.

ANJAN BERA, Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.

Associate Professor, Department of Radiotherapy, NRS Medical College and Hospital, Kolkata-14, West Bengal, India.

References

REFERENCES

M. L. Gillison. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol. 2004; 31(6):744-54.

F. Bray, R. Sankila, J. Ferlay, and D. M. Parkin. Estimates of cancer incidence and mortality in Europe in 1995. Eur J Cancer. 2002; 38(1):99-166.

D. M. Parkin, F. Bray, J. Ferlay, and P. Pisani. Global cancer statistics 2002.CA Cancer J Clin. 2005; 55(2):74-108.

Licitra L, Bernier J, Grandi C, Merlano M, Bruzzi P, Lefebvre JL. Cancer of the oropharynx. Critical Reviews in Oncology/Hematology. 2002; 41(1):107-22.

Lefebvre JL, Chevalier D, Luboinski B, Kirkpatrick A, Collette L, Sahmoud T.Larynx preservation in pyriform sinus cancer: preliminary results of a European Organization for Research and Treatment of Cancer phase III trial. EORTC Head and Neck Cancer Cooperative Group. J Natl Cancer Inst. 1996; 88:890-9.

Wolf GT, Fisher SG, Hong WK, Hillman R, Spaulding M, Laramore GE, et al. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. The Department of Veterans Affairs Laryngeal Cancer Study Group. N Engl J Med. 1991; 324:1685-1690.

Pignon JP, le Maitre A, Maillard E, Bourhis J. MACH-NC Collaborative Group: Metaanalysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiotherapy Oncol. 2009; 92:4-14.

Ang KK, Zhang Q, Rosenthal DI, et al. Randomized phase III trial of concurrent accelerated radiation plus cisplatin with or without cetuximab for stage III to IV head and neck carcinoma: RTOG 0522. J Clin Oncol. 2014;32(27):2940–50.

Dische S, Saunders M, Barrett A. A randomized multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiotherapy Oncol. 1997; 44:123-36.

Bentzen SM, Saunders MI, Dische S. Repair half-times estimated from observations of treatment -related morbidity after CHART. Radiother Oncol. 1999; 53:219-26.

Bentzen SM, Saunders MI, Dische S. Radiotherapy related early morbidity in head and neck cancer: Quantitative clinical radiobiology as deduced from the CHART trial. Radiother Oncol. 2001; 60: 123-35.

W Landuyt, J Fowler, A Ruifrokb, G Stiiben, A van der Kogeld, E van der Schuerena. Kinetics of repair in the spinal cord of the rat. Radiother Oncol. 1997; 45(1):55-62.

Overgaard J, Hansen HS, Specht L. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomized controlled trial. Lancet 2003;362:933–40.

Bourhis J, Lapeyre M, Tortochaux J. Phase III randomized trial of very accelerated compared with conventional radiation therapy in squamous cell head and neck cancer: a GORTEC trial. J Clin Oncol. 2006;24:2873–78.

Fowler JF, Harari P. Confirmation of improved local-regional control with altered fractionation in head and neck cancer. Int J Radiation Oncol Biology Phys. 2000; 48:3-6.

Withers HR, Peters LJ. Transmutability of dose and time. Commentary on the first report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000; 48: 1-2.

James ND, Robertson G, Squire CJ, Forbes H, Jones K, Cottier B, et al. A national audit of radiotherapy in head and neck cancer. Clin Oncol (R Coll Radiol). 2003; 15:41-6.

Jones L, Hoban P, Metcalfe P. The use of the linear-quadratic model in radiotherapy: a review. Australian Phys Eng Sci Med.2001;24(3):132-46.

Fowler JF. Practical time-dose evaluation, or how to stop worrying and love LQ. In: Levitt SH, Purdy JA, Perez CA, Poortmans, P (Eds). The technical basis of radiation therapy. 5th revised edition. Heidelberg: Springer-Verlag; 2012. p9-46.

Denis F, Garaud P, Bardet E. Final results of the 94-01 French Head and Neck Oncology & Radiotherapy Group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J Clin Oncol. 2004; 22:69–6.

Brizel DM, Albers ME, Fisher SR. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998; 338:1798–04.

Bernier J, Domenge C, Ozsahin M. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med. 2004; 350:1945–52.

Semrau R, Mueller RP, Stetzer H. Efficacy of intensified hypofractionated and accelerated radiotherapy and concurrent chemotherapy with carboplatin and 5 fluorouracil: Updated results of a randomized multicentric trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2006; 64:1308–16.

Budach V, Stuschke M, Budach W. Hyperfractionated accelerated chemoradiation with concurrent fluorouracil-mitomycin is more effective than dose-escalated hypofractionated accelerated radiation therapy alone in locally advanced head and neck cancer: Final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 Prospective Randomized Trial. J Clin Oncol. 2005; 23:1125–35.

Kasibhatla M, Kirkpatrick JP, Brizel DM. How much radiation is the chemotherapy worth in advanced head and neck cancer Int J Radiat Oncol Biol Phys. 2007; 68:1491– 5.

Staar S, Rudat V, Stuetzer H, Dietz A, Volling P, Schroeder M, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy— results of a multicentric randomized German trial in advanced head-and-neck cancer. Int J Radiat Oncol Biol Phys .2001; 50(5):1161–71.

ICRU Report 50, 62 & 83. Prescribing, Recording, and Reporting Photon-Beam Radiation Therapy. International Commission on Radiation Units and Measurements, 2010.

Gregoire V, Levendag P, Ang KK, Bernier J, Braaksma M, Budach V, et al. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol. 2003; 69:227-6.

Gregoire V, Eisbruch A, Hamoir M, Levendag P. Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol. 2006; 79:15-20.

Blanchard P, Landais C, Petit C, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 100 randomized trials and 19,248 patients, on behalf of MACH-NC group. Ann Oncol. 2016; 27(6):328-50.

R J D Prestwich, K Kancherla, DC Oksuz, D Williamson, K E Dyker, Catherine Coyle, et al. A single-center experience with sequential and concomitant chemoradiotherapy in locally advanced stage IV tonsillar cancer. Radiother Oncol. 2010; 5: 121-7.

H. Benghiat, P. Sanghera, J. Cashmore, J. Hodson, H. Mehanna, R. Simmons, et al. Four Week Hypofractionated Accelerated Intensity Modulated Radiotherapy and Synchronous Carboplatin or Cetuximab in Biologically Staged Oropharyngeal Carcinoma. Cancer and clinical oncology. 2014; vol 3 (Number 2):1-9

Chan A. K., Sanghera Paul, Choo B. A, et al. Hypofractionated accelerated radiotherapy with concurrent carboplatin for locally advanced squamous cell carcinoma of the head and neck. Clin Oncol. 2011; Volume 23 (Number 1):34-9.

Roy S, Mallik C, Ghorai S, Hazra A, Majumdar A. Hypofractionated versus conventional radiotherapy with or without chemotherapy in head and neck cancer: A comparative study. Clin Cancer Invest J. 2015; vol 4 (2): 140-6.

A Eisbruch, J Harris, A S. Garden, C KS Chao, W Straube, P M. Harari et al. Multiinstitutional Trial of Accelerated Hypofractionated Intensity-Modulated Radiation Therapy for Early-Stage Oropharyngeal Cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010; vol76(5):1333–8.

Chatterjee S, Kelly C, Arunsingh M, Chakrabarty C, Mott J. Feasibility of PET-CT based hypofractionated accelerated dose escalation in oropharyngeal cancers: Final dosimetric results of the VORTIGERN study. J Can Res Ther. 2015; vol 11:391-6.

Bakst RL, Lee N, Pfister DG, Zelefsky MJ, Hunt MA, Kraus DH, et al. Hypofractionated dose-painting intensity-modulated radiation therapy with chemotherapy for nasopharyngeal carcinoma: A prospective trial. Int J Radiat Oncol Biol Phys. 2011; 80:148-53.