Background: Stage III-IVB Squamous cell carcinoma in the head & neck region (HNSCC) has been one of the foremost problems among oncologists to achieve good results, even with Combined modality approach. Chemotherapy with radiotherapy in different combinations and different schedules, has been tried by many researchers to achieve good loco-regional control, among those not amenable for surgery. Objective of this study, is to determine the loco regional response and acute toxicity patterns when combining Pure Accelerated Radiotherapy (6 Fractions(Fx)/week) with Concurrent Chemotherapy in patients with  advanced  loco  regional HNSCC.          

Methods: Patients presented to our Department with previously untreated stage III - stage IV HNSCC with age between 18yrs and 60 yrs of either gender, without systemic spread, were included in our study. They were treated with radical external radiation 6600 cGy/33(Fx), 200cGy/Fx, 6Fx/Week over 5.3 weeks (38 days) and concurrent chemotherapy Cisplatin (100 mg/m²) administered intravenously on days 1 and 22 of Radiotherapy. The primary end-point of the study was the loco regional response at 6 weeks. Additional end point includes acute toxicity rate.

Results: Among 28 patients recruited, 25 patients completed full course of treatment. 21 patients (84%) had complete response in and 4 (16%) had partial response, among them, 3(12%) patients had residual disease at nodal site, and 1(4%) at the primary and nodal site.7 (28%) and 17 (70.8%) patients experienced acute Grade-III and grade-II side effects respectively.

Conclusions: This data shows that it is feasible to combine Accelerated Radiotherapy and full dose mono-chemotherapy with manageable, although substantial, toxicity. The hospital stay is reduced. Hence it is an effective alternate regimen in centers with high work load. 

Keywords: Squamous cell carcinoma, Head and neck cancers, concurrent chemoradiation, Altered Fractionation.

1. Ang K.: Altered Fractionation in Head and Neck Cancer. Seminars in Radiation Oncology. 8:230-236, 1998.
2. Pignon JP, Bourhis J, Domenge C, et al: Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: Three meta-analyses of updated individual data. Lancet 355:949-955, 2000.
3. El-Sayed S., Nelson N.: Adjuvant and adjuctive chemotherapy in the management of squamous cell carcinoma of the head and neck region. A meta-analysis of prospective and randomised trials. Journal of Clinical Oncology. 14:838-847, 1996.
4. Marcial V.A., Pajak T.F., Mohiuddin M., Cooper J.S., Al-Sarraf M., Mowry P.A., Curran W., Crissman J., Rodriguez M., Velez-Garcia E.: Concomitant cisplatin chemotherapy and radiotherapy in advanced mucosal squamous cell carcinomas of the head and neck. Long-term results of the Radiation Therapy Oncology Group study 81-17. Cancer. 66:1861-1868, 1990.
5. Koch W.M., Lee D.J., Eisele D.W., Miller D., Poole M., Cummings C.W., Forastiere A.: Chemoradiotherapy for organ preservation in oral and pharyngeal carcinoma. Archives of Otolaryngology Head and Neck Surgery.121:974 -980, 1995.
6. Byfield J., Sharp T., Frankel S., Tang S., Callipari F.: Phase I and II trial of five-day infused 5-fluorouracil and radiation in advanced cancer of the head and neck. Journal of Clinical Oncology.2:406 - 413, 1984.
7. Al-Sarraf M, LeBlance M, Shanker PG, et al: Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: Phase III randomized intergroup study 0099. J ClinOncol 16:1310-1317, 1998
8. Adelstein DJ, Li Y, Adams GL, et al: An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradi-otherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21:92-98, 2003.
9. Forastiere AA, Goepfert H, Maor M, et al: Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 349:2091-2098, 2003
10. Cooper JS, Pajak TF, Forastiere AA, et al: Post-operative concurrent radiotherapy and chemotherapy for high-risk squmaous cell carcinoma of head and neck. N Engl J Med 350:1937-1944, 2004.
11. Bernier DM, Domenge C, Ozsahin M, et al: Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Engl J Med 350:1945-1952, 2004.
12. Power D, Alonzi R, Marcou Y, Eales C, et al: Combined chemotherapy with accelerated radiotherapy in the radical management of locally advanced headsneck malignancy. A feasibility study Intl J Radiation Oncol Biol Physics Vol 60, Number 1, Supplement 2004
13. Overgard J, Sand Hansen H , et al: Five compared with six fractions per week of conventional radiotherapy of HNSCC. Report of DAHANCA Trial 6&7 : The Lancet 2003: 362; 933-40
14. Staar S, Rudat V, Stuetzer H, et al: Intensified hyperfractionated accelerated radiotherapy limits the additional benefits of simultaneous chemotherapy. Results of a multicentre randomized German trial in advanced head and neck cancer.Int J Radiat Oncol Phy 50:1161-1171, 2001.
15. Bourhis J, Lapeyre M, Tortochaux J, et al: Preliminary results of the GORTEC 96-01 randomized trial comparing very accelerated radiotherapy versus concomitant radio-chemotherapy for locally inoperable HNSCC. Int J Radiat Oncol Biol Phys 51:39, 2001 (suppl)
16. Jeremic B, Shibamoto Y, Milicic B, et al: Hyperfractionated radiation therapy with or without concurrent low-dose daily cisplatin in locally advanced squamous cell carcinoma of the head and neck: A prospective randomized trial. J ClinOncol 18:1458-1464, 2000.
17. Wendt TG, Grabenbauer GG, Rodel CM, et al: Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: A randomized multicentre study. J ClinOncol 16:1318-1324
18. Calais G, Alfonsi M, Bardet E, et al: Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced stage oropharynx carcinoma. J Natl Cancer Inst 91: 2081-2086, 1999.
19. Bridget GP, Kwok B, Baldwin M, et al: Craniofacial resection for paranasal sinus cancers. Head Neck 22: 772-780, 2000
20. Fu KK, Pajak TF, Trotti A, et al: A Radiation Therapy Oncology Group (RTOG) Phase III randomized study to compare hyperfractionated and two variants of accelerated fractionation to standard fractionation radiotherapy for Head and Neck squamous cell carcinomas: First report of RTOG 9003.Intl J Radiation OncolBiol Physics 48:7-16, 2000.
21. Ang KK, Harris J, Garden AS, et al: Concomitant boost radiation plus concurrent cisplatin for advanced head and neck carcinomas: radiation therapy oncology group phase II trial 99-14. J ClinOncol 23: 3008-3015, 2005.
22. Trotti A, Bentzen SM: The need for adverse effects reporting standards in oncology clinical trials. J ClinOncol 22: 19-22, 2004.

Vijayasree T N

Associate Professor Govt Royapettah Hospital & Kilpauk Medical College, Chennai, Tamilnadu, India

Email: This email address is being protected from spambots. You need JavaScript enabled to view it., 9444132816