Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma (original) (raw)
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Clinical Cancer Investigation Journal, 2023
In fast-growing tumors such as locally advanced head and neck cancers (LA-HNC), hypofractionation effectively overcomes tumor repopulation. We aimed at evaluating the safety and efficacy of moderately hypofractionated radiotherapy with concurrent cisplatin in comparison to the conventional concurrent chemoradiotherapy (CCRT) in LA-HNC. Fifty-four patients with LA-HNC were randomized to receive either: 70Gy in 35 fractions in 7 weeks concurrently with weekly cisplatin 40 mg/m2 (Arm A), or 55Gy in 20 fractions in 4 weeks concurrently with weekly cisplatin 35mg/m2 (Arm B). Volumetric modulated arc therapy/ Intensity-modulated radiotherapy (VMAT/IMRT) plans were done for both arms. Local control (LC), acute toxicity, and progression-free survival (PFS) were recorded and compared between both arms. A total of 34 patients were in arm A versus 20 patients in arm B, with a median follow-up period of 14.2 months (range 5.1-43.6 months). There was no significant difference in LC, PFS, or acute toxicity between both arms. Complete response occurred in 52.9%(18/34) and 45 %(9/20) in arm A and arm B respectively. In LA-HNC, moderate hypofractionation concurrently with cisplatin appears to be safe and feasible and is associated with a comparable response rate, PFS, and acute toxicity with conventional CCRT protocol.
Radiotherapy and Oncology, 2011
We retrospectively reviewed acute toxicity with cetuximab and radiotherapy, comparing it with a matched cisplatin group. The cetuximab group experienced significantly more toxicity -grade P3 oral mucositis (p = 0.014), skin dermatitis (p = 0.0004), P10% weight loss (p = 0.03), and enteral feeding requirement (p = 0.05). This finding of enhanced toxicity is similar to recent publications. Ó This is the first large community experience comparing tolerability and toxicity of cetuximab (CTX) and radiotherapy (RT), with the hitherto conventional approach of RT and cisplatin (CDDP).
2017
Introduction: Locally advanced head and neck carcinomas (HNSCC) constitute a substantial proportion of cancer patients in India. This is treated by combined multimodality which includes surgery, radiotherapy, and chemotherapy. Aims: To investigate tumor response and toxicity in HNSCC using hypofractionated schedule compared with conventional fractionation. Material and Methods: In conventional arm (Arm A), each patient received 70 Gy/2 Gy/fraction/7 weeks. In hypofractionated arm (Arm B), each patient received 55 Gy/2.75 Gy/fraction/4 weeks. Both arms received weekly cisplatin (40 mg/m 2 ). The end points were tumor response, acute and late toxicities, and overall survival (OS). Results: 17 patients (68%) in a conventional arm (Arm A) achieved a complete response (CR) and 15 patients (60%) in hypofractionated arm (Arm B) had a CR (p=0.55). The acute skin toxicity (grade≥2) was significantly higher in Arm B than in Arm A (28% vs. 17%; p ≤ 0.001). Grade ≥ 2 mucositis was also higher i...
International Journal of Radiation Oncology*Biology*Physics, 2007
To assess the feasibility and efficacy of accelerated weekly 6 fractionated 66-Gy postoperative radiation therapy (PORT) using a single fraction regimen from Monday to Thursday and a concomitant boost in the Friday afternoon sessions combined with concomitant cisplatin chemotherapy (CT) in patients with locally-advanced head and neck cancer (LAHNC). Materials/Methods: Between March 2001 and April 2006, 40 (male to female ratio: 35/5; median age: 60 years [range: 36-81]) patients with pT1-pT4 and/or pN0-pN3 LAHNC (15 oral cavity, 8 oropharynx, 8 hypopharynx, 7 larynx, and 2 unknown primary) were included in this pilot study. Indications of PORT/CT were positive surgical margins (n = 9; all R1), T4 R0 tumors (n = 5), 3 or more positive lymph nodes without extranodal infiltration (all R0; n = 2) in 16 (40%) patients; or extranodal infiltration with (all R1; n = 13) or without (n = 11) positive surgical margins in 24 (60%) patients. Median interval between surgery and RT was 46 days (range: 24-112). RT consisted of 66 Gy (2 Gy/fr) in 5.5 weeks. Median RT duration was 39 days (range: 35-62). Five-field 3D conformal or intensity-modulated RT was performed in all patients according to the GORTEC/EORTC/RTOG guidelines. Concomitant cisplatin chemotherapy was planned at 100 mg/m 2 in days 1, 22, and 43 in all but one patient where carboplatin was chosen due to impaired renal function. Prophylactic percutaneous endoscopic gastrostomy was performed in 18 (45%) patients, and 3 (8%) patients required nasogastric feeding tube. Median follow-up was 37 months (range: 5-66). Results: All but two patients received the planned total dose without unplanned interruption (66 Gy in 38, 64 Gy in 1, and 58 Gy in 1). According to the CTC/NCI v3.0 toxicity criteria, acute morbidity was acceptable: grade 3 mucositis in 10 (25%), grade 3 dysphagia in 9 (23%), grade 3 skin erythema in 5 (13%) patients. CT-related anemia was observed in 2 patients (grade 3 in 1, and grade 4 in 1), leukopenia in 4 patients (grade 3 in 2, and grade 4 in 2), and no grade 3 or 4 thrombocytopenia was observed. Grade 3 renal-function impairment was observed only in one patient. Median weight loss was 3.5 kg (range: 0-14.5). No treatmentrelated mortality was observed. Considering the late effects, grade 0, 1, or 2 xerostomia was observed in 9 (23%), 22 (55%), and 9 (23%) patients, respectively; grade 0, 1, and 2 edema in 25 (63%), 14 (35%), and 1 (3%) patients, respectively. Locoregional relapse was observed in 8 (20%) patients, and only 7 (18%) patients developed distant metastases. Median time to locoregional relapse was 6 months (range: 1-40). The 3-year overall, cause-specific, disease-free survival, and locoregional control rates were 65%, 69%, 64%, and 82%, respectively. Distant metastasis probability at 3 and 5 years was 19%. Univariate and multivariate analyses revealed that the only prognostic factor influencing the outcome was nodal status. Conclusions: We conclude that reducing the overall treatment time using accelerated PORT/CT by weekly concomitant boost (6 fractions per week) combined to concomitant cisplatin chemotherapy is easily feasible with good locoregional and distant metastases control for patients operated with curative intent for LAHNC. Acute and late RT/CT-related morbidity is acceptable.
https://www.ijrrjournal.com/IJRR\_Vol.6\_Issue.11\_Nov2019/Abstract\_IJRR0058.html, 2019
Introduction: Concurrent chemoradiation is currently the standard of care in LAHNSCC. Neoadjuvant Chemotherapy (NACT) causes tumour down staging, facilitating organ preservation and has potential to prevent distant metastasis albeit at the cost of increased toxicities. However potential benefit of adding NACT before CTRT in LAHNSCC still remains unclear. Aims and Objectives: This study compared NACT followed by CTRT versus CTRT alone in LAHNSCC in terms of Locoregional response (LRR), Toxicities and Progression Free Survival (PFS). Materials and method: Patients with LAHNSCC of oral cavity, oropharynx, larynx & hypopharynx (AJCC Stage III-IVB), recruited from January 2013 to January 2015 were randomised into two arms (90 each) to receive either NACT (Paclitaxel 175mg/m 2 and Carboplatin AUC 5 q 3 weeks 3 cycles) followed by CTRT (Arm A) or CTRT alone (Arm B). EBRT dose was 66-70 Gy in conventional fractionation with three weekly Inj. Cisplatin 100 mg/m 2. Results: Median follow up period was 37 months. After NACT, 58.9% of patients achieved PR and CR 7.8%. Response 4 months after treatment showed LRR 56/65 in arm A vs. 53/71 in arm B. Median PFS was 48 months in Arm A vs. 42 months in Arm B; log rank p=0.176. Grade ≥ 3 acute toxicities included myalgia (10%), neutropenia (4.4 %), thrombocytopenia(3.3%) and anemia (3.3%) during NACT. During CTRT more haematotoxicities and mucositis in arm A whereas dermatitis and dysphagia were more in arm B. Regarding late toxicities, grade ≥ 3 neuropathy seen in Arm A. Conclusion: NACT before CTRT is feasible and may be used in LAHNSCC to downstage tumour with no significantly added toxicity.
Technology in Cancer Research & Treatment, 2013
IMRT and helical tomotherapy for head and neck cancer (HNC) treatment are associated with higher doses to certain non-target tissues than traditional static beam techniques. We hypothesized that this may lead to higher acute mucosal and hematologic toxicities. This analysis was limited to 178 patients receiving >60 Gy with concurrent weekly cisplatin. Radiation delivery used 3D-CRT in 41 patients (23%), conventional IMRT in 56 patients (31%), and helical tomotherapy in 81 patients (46%). Acute mucositis rates, weekly hematologic parameters, and ability to deliver planned chemotherapy cycles were examined for each patient during their course of chemoradiotherapy. Analysis showed patients were well balanced with regard to sex, age, and stage. Treatment time, as assessed by delivered monitor units, varied significantly between the 3D-CRT (median = 502), IMRT (median = 1087), and tomotherapy (median = 6757) cohorts. Acute mucositis grades did not significantly differ between the thre...
Asian Journal of Pharmaceutical and Clinical Research
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 si...
Aim: Co-adjuvant therapy for stage III or IV headache and nerve cancer has been linked to the concomitant presence of cisplatin and radiation alone. Methods: 175 patients were randomly selected to receive radiation doses on their own (68 Gy on 64⁄3 weeks) and 175 underwent the same treatment method in tandem of 100 mg cisplatin per square meter (1), 22 and 43 days of radiation therapy. Our current research was conducted at Sir Ganga Ram hospital, Lahore from March 2019 to February 2020. Results: For a mean 60-months following, in the combinations therapy community, progression-free survivors were slightly higher (p = 0.05 by log-rank test; disease progression incidence rate of 0.76; 96% confidence interval, 0.57% to 0.98) than in the radiation therapy group, for Kaplan-Meier 's 5-year progression-free survival rates respectively of 47% and 36%. The average survival of the combined therapy community was also slightly greater than for the radiation therapy group (P=0.02 by log-rank test; mortality chance, 0.70; 95 % confidence interval, 0.52 to 0.95), with Kaplan-Meier five-year figures of 53% and 40%, respectively. The cumulative survival rate was substantially higher. In the overall control group (P=0.008), the average rate of local or geographic relapses was considerably smaller. The average cumulative occurrence of local or regional recurrence over five years was 34% after radiation therapy, and 19% after combined therapy, considered mortality due to other causes as an equal possibility. Grade 4 or higher severe adverse effects were more frequent (42 percent) following combined therapy than after radiation therapy (23 percent, P=0.002), as were the rate of delayed adverse reactions in both categories. Conclusions: The concomitant postoperative administration of high-dose cisplatin with radiotherapy in patients with advanced locally cancer of the head and neck is more effective than radiotherapy alone and does not cause excessive amounts of late complications.
Aim The aim of this study was to investigate the treatment efficacy, acute and late toxicity using a hypofractionated irradiation schedule combined with oral administration of glutamine (GLN) in elderly patients with advanced squamous cell carcinoma of head and neck (SCCHN). Methods In a retrospective manner, we studied 31 patients with advanced SCCHN treated with hypofractionated radiotherapy and administration of GLN. The irradiation schedules consisted of three hypofractionated schedules. The first schedule consisted of 21 irradiation fractions (56.7 Gy) within 29 days by using intensive modulated radiation therapy technique or 3D conformal radiotherapy. The second and the third schedules were performed with 3D conformal techniques by 49.5 Gy in 18 daily fractions and 59.8 Gy in 26 daily fractions. All patients received 30 g powdered GLN daily as soon as oral mucositis was presented. The median follow-up was 18 months (range: 9-24). The severity of skin toxicity and oral mucositis was graded according to the Radiation Therapy Oncology Group/European Organization for Research and Treatment of Cancer (RTOG/EORTC) criteria. Results Overall complete response was seen in 12 patients (38.7%), while 5 patients (16.1%) had partial response, 7 patients (22.6%) had stable disease and 7 patients (22.6%) had progressive disease. The median relapse-free survival was 14 months. Three patients (9.7%) experienced grade III acute skin toxicity. Twenty-one (67.7%) and seven (22.6%) patients experienced grade II and grade I acute skin toxicity, respectively. A significant decrease was noted in the incidence of toxicity after the administration of GLN (P < 0.01, chi-square test). The mean score of dysphagia-related pain and oral mucositis regressed significantly (P < 0.01, Wilcoxon test) in the last week of irradiation after GLN administration. Conclusion In elderly patients suffering from SCCHN with co-morbitities and unsuitable for daily irradiation and chemotherapy, an alternative schedule of hypofractionation is possible when combined with GLN administration.