HYPOFRACTIONATED INTENSITY MODULATED RADIOTHERAPY WITH CONCURRENT CHEMOTHERAPY FOR LOCALLY ADVANCED SQUAMOUS CELL CARCINOMA OF HEAD AND NECK -A PILOT STUDY

Bhaskar Vishwanathan*, Dr. Christopher and Swathi Reddy

ABSTRACT

Introduction: Head and neck carcinoma is common cancer in India often presenting in advanced stage and unresectable. These patients are usually relegated to palliative treatment. Study undertaken with the intention of treating these patients with radical intent using, hypo-fractionated IMRT and concurrent chemotherapy. Primary objective is to assess loco-regional response and post-treatment resectable status. Secondary objective is to assess the toxicity. Methods and Materials: 20 patients of stage III and IV Head and Neck squamous cell carcinoma (HNSCC) were treated with Hypofractionated IMRT and chemotherapy. RT of 45Gy in 15 Fractions delivered to the primary tumor and involved lymph nodes, 37.5Gy in 15 Fractions to low intermediate risk areas with simultaneous Integrated Boost (SIB), using 6MV photons with an overall treatment time (OTT) of 3 weeks. Infusion Cisplatin (70mg/m2) on day 1 and last day of treatment was given. Resectable tumors underwent surgery and remaining patients boosted to a radical dose of 16Gy in 8 fractions. Results: 90% (18/20) completed treatment & 45% (9/20) made resectable following hypofractionated neo-adjuvant chemoradition. 35%(7/20) underwent surgery. At three months, 50% (10/20) were loco regionally controlled.30% (6/20) developed grade II, 60% (12/20) grade III and 5% (1/20) grade IV mucositis. 20% (4/20) had grade I, 60% (12/20) grade II and (1/20) 5% Grade III skin reactions. Conclusion and Discussion: Neo-adjuvant Hypofractionated IMRT with concurrent chemo radiation is clinically feasible with good response rates in the treatment of locally advanced HNSCC with acceptable toxicities and conversion rates to surgery.

Keywords: Hypofractionation, Locally advanced squamous cell cancer of head and neck, chemotherapy, cisplatin.