A COMPARATIVE PROSPECTIVE STUDY BETWEEN STANDARD AND ALTEREDFRACTIONATED RADIOTHERAPY FOR LOCALLY ADVANCED HEAD AND NECKSQUAMOUS CELL CARCINOMA

Abstract

Background and Purpose: To compare conventionally fractionated chemoradiotherapy (CF-CRT) with two variants of altered fractionated radiotherapy (AFRT) in patients with locally advanced head and neck squamous cell carcinoma (LAHNSCC). 64 patients diagnosed with LAHNSCC were randomized Material and Methods: either to receive CF-CRT (70 Gy/35 fractions) in Arm-I or hyper-fractionation radiotherapy (HFRT 81.6 Gy/68 fractions 1.2 Gy BID) in Arm-II or concomitant boost radiotherapy (CBT 71.6 Gy/28 fractions with last 16 fractions BID as concomitant boost) in Arm-III. 35mg/m2 cisplatin weekly was given as concurrent chemotherapy regimen in Arm-I. The primary objective was to assess acute toxicity, and the secondary endpoint was the radiotherapeutic response between CF-CRT and AFRT. Radiation Therapy Oncology Group (RTOG) criteria were used for evaluating acute toxicity. Response Evaluation Criteria In Solid Tumor 1.1 (RECIST 1.1) was used to assess response. Twenty-two, 21, and 21 Results: patients were randomly assigned to Arm-I, II, and III. The treatment was completed by 22, 17, and 18 patients in Arm-I, II, and III. The acute Grade-II skin toxicity was higher in Arm-II (58.8%) and III (50.0%) compared to Arm-I (36.3 %), but the correlation was insignicant (p- .17). Acute Grade-III mucosal toxicity was higher in Arm-II (35.2%) and III (38.8%), and it shows a trend towards signicance (p- .059). Arm-II had higher complete responder (52.9%) compared to Arm-I (27.2%), and the correlation was insignicant (p- .23). The AFRT Conclusion: arms II and III showed similar radiotherapeutic response as CF-CRT arm. Comparable acute toxicities were seen in all arms except for the mucosal toxicity, which was higher in Arm-II and III