Comparison of altered fractionation schedule with concurrent chemo-radiation for squamous cell carcinoma of head and neck
Keywords:Acute toxicity, Altered fractionation, Concurrent chemo-radiation, Radiotherapy, Squamous cell carcinoma of head and neck
Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.
Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.
Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05). When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.
Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.
Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyper-fractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys. 2000;48:7-16.
Cummings BJ. Benefits of accelerated hyper fractionation for head and neck cancer. Acta Oncol. 1999;38:131-6.
Hliniak A, Gwiazdowska B, Szutkowski Z, Kraszewska E, Kukolowicz P, Jarzabski A, et al. A multicenter randomized controlled trial of a conventional versus modestly accelerated radiotherapy in laryngeal cancer: influence of a one week shortening overall time. Radiother Oncol. 2002;62:1-10.
Skladowski K, Maciejewski B, Golen M, Pilecki B, Przeorek W, Tarnawski R. Randomized clinical trial on 7 day continous accelerated irradiation (CIAR) of head and neck cancer: report on 3 year tumour control and normal tissue toxicity. Radiother Oncol. 2000;55:101-10.
Horiot JC, Bontemps P, van den Bogaert W, Fur RL, van den Weijngaert D, Bolla M, et al. Accelerated fractionation compared to conventional fractionation improves loco regional control in radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Radiother Oncol. 1997;44:111-21.
Bourhis J, Pignon JPP. Meta-analysis in head and neck squamous cell carcinoma: What is the role of chemotherapy? Hematol Oncol Clin North Am. 1999;13:769-75.
Brizel DM, Alsbers M, Fisher S. Hyper fractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med. 1998;338:1798-804.
Pignon JP, Bourhis J, Domenge C, Designe L. On behalf of the MACH-NC Collaborative Group. Chemotherapy added to locoregional treatment for head and neck squamous cell carcinoma: three meta-analysis of updated individual data. Lancet. 2000;355:949-55.
Al-SarrafM, Pajak TF, Marcial VA, Mowry P, Cooper JS, J Stetz J ,et al. Concurrent radiotherapy and chemo therapy with cisplatin in inoperable squamous cell carcinoma of the head and neck. An RTOG study. Cancer. 1987;59:259-65.
Maciejewski B, Preuss-Bayer G, Trott KR. The influence of the number of fractions and overall treatment time on local control and late complication rate in squamous cell carcinoma of larynx. Int J Radiat Oncol Biol Phys. 1983;9:321-8.
Bourhis J. Very accelerated radiotherapy in advanced HNSCC: results of the GORTEC 94-02 randomized trial. Radiother. Oncol. 2000;56(Suppl):S4.
Poulsen MG, Denham JW, Peters LJ, Lamb DS, Spry NA, Hindley A, et al. A randomized trial of accelerated and conventional radiotherapy for stage III and IV squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group Study. Radiother Oncol. 2001 Aug 1;60(2):113-22.
Dobrowsky W, Naude J. Continuous hyper fractionated accelerated radiotherapy with/without mitomycin C in head and neck cancers. Radiother Oncol. 2000;57:119-24.
Jackson SM, Weir LM, Hay JH, Tsang VH, Durham JS. A randomized trial of accelerated versus conventional radiotherapy in head and neck cancer. Radiother Oncol. 1997;43:39-46.
Hansen O, Overgaard J, Hansen HS, Overgaard M, Höyer M, Jörgensen KE, et al. The importance of overall treatment time for the outcome of radiotherapy of advanced head and neck carcinoma: dependency on tumor differentiation. Radiother Oncol. 1997;43:47-51.
Dische S, Saunders M, Barrett A, Harvey A, Gibson D, Parmar M. A randomized multicentre trial of CHART vs conventional radiotherapy in head and neck cancer. Radiother Oncol. 1997;44:123-36.