Aims & Objectives: To analyse the loco regional control and acute toxicity in patients with locally advanced squamous cell carcinoma of the head and neck (oropharynx and larynx) in Conventional concurrent radiotherapy with weekly Cisplatin.

Materials and Methodology: A single arm prospective study of 30 consecutive cases of newly diagnosed patients with locolly advanced  Stage III & IVA Squamous cell carcinoma of oropharynx & larynx enrolled .All patients were irradiated with conventional fractionation to a dose of 66 Gy in 33 fractions over 6.5–7 weeks along with weekly Inj. Cisplatin 40mg/. The immediate locoregional response rates were assessed clinically and toxicity profile of the treatment was assessed with RTOG acute morbidity scoring criteria .The study was statistically analysed using Chi Square test.

Results: Out of thirty patients, seven percent (7%) have undergone tracheostomy. Out of thirty patients, eighty three (83%) were having complete response and seventeen percent (17%) were having partial response. All the patients experienced at least grade 1 skin reaction after 40 – 45 Gy. No grade 4 skin reactions were seen. Twenty three i.e. 77% patients had grade 2 patchy mucositis and 5 had grade 3 confluent mucositis.

Conclusion: The present schedule is well tolerated for all patients and can be safely used in older patients and patients with controlled co-morbidities. This conventional fractionation schedule suits the busy and heavy patient load in our institute and is highly cost effective.

Keywords: concurrent chemoradiation, weekly cisplatin, locoregional control, mucositis, skin reaction.

1. Beckmann GK, Hoppe F, Pfreundner L, Flentje MP. (2005) Hyperfractionated accelerated radiotherapy in combination with weekly cisplatin for locally advanced head and neck cancer. Head Neck 27: 36-43, 2005.
2. Jose Antonio Medina, Antonio Rueda, et al: A phase II study of concomitant boost radiation plus concurrent weekly cisplatin for locally advanced unresectable head and neck carcinomas. Radiotherapy and Oncology: 34-38, 2006.
3. Brizel D M (2007)The Role of Combined Radiotherapy and Chemotherapy in the Management of Locally Advanced Squamous Carcinoma of the Head and Neck In: Halprein E C, Perez C A, Brady L W, (eds.) Principles and Practice of Radiation Oncology, 5^th edn.Philadelphia, Wolters Kluwer Pp 807-19.
4. Shrivastava S K, Sarin R, et al. (2011) Evidence Based Management Guidelines Vol. IV Mumbai The Tata Memorial Hospital.
5. 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—MACH-NC Collaborative Group, Meta-Analysis of Chemotherapy on Head and Neck Cancer. Lancet 355:949-955, 2000
6. Bourhis J, Amand C, Pignon J P, on behalf of the MACH-NC Collaborative Group (2004) Update of MACH-NC (Meta-Analysis of Chemotherapy in Head & Neck Cancer) database focused on concomitant chemoradiotherapy. Journal of Clinical Oncology, 2004 ASCO Annual Meeting Proceedings (Post-Meeting Edition). Vol 22, No 14S (July 15 Supplement), 2004: 5505

7. Jean-Pierre Pignon , Aurélie le Maître , Emilie Maillard, Jean Bourhis, on behalf of the MACH-NC Collaborative Group (2009) Update of MACH-NC (Meta-Analysis of Chemotherapy in Head & Neck Cancer) database focused on concomitant chemoradiotherapy. Radiotherapy and Oncology Vol 92, 4 -14 (2009).
8. Tanguy Y Seiwert, Joseph K Salama and Everett E Vokes (2007) The Concurrent Chemoradiation Paradigm-General Principles. Nature Clinical Practice Oncology February 2007 Vol 4 No 2, Pp 86-100.
9. Steel GG and Peckham MJ (1979) Exploitable mechanisms in combined radiotherapy chemotherapy: the concept of additivity. Int J Radiat Oncol Biol Phys 5: 85–91
10. Brizel D M, Esclamado R, (2006) Concurrent Chemoradiotherapy for Locally Advanced, Non-metastatic, Squamous Carcinoma of the Head and Neck: Consensus, Controversy, and Conundrum. Journal of clinical oncology, volume 24 number 17 June 2006. Pp 2612-17.
11. Page D L, et al. (eds) AJCC Cancer Staging Manual 7^th edn, NY. Springer.

Dr L.Karpagavalli

Assistant Professor, Dept of Radiotherapy, Tamilnadu Government Multi Super Speciality Hospital, Chennai, Tamil Nadu, India