Accelerated hypofractionated chemoradiation for locally advanced head and neck cancer during COVID 19 pandemic: A tertiary care experience.

Abstract

PURPOSE:

To assess the role of Accelerated Hypofractionated Chemoradiation for Locally Advanced Head & Neck squamous cell cancer (HNSCC) during COVID 19 pandemic.

MATERIALS AND METHODS:

Previously untreated 20 patients with locally advanced HNSCC (Oral cavity/oropharynx/larynx/hypopharynx) were treated with definitive hypofractionated radiotherapy of 60Gy in 25 fractions with concurrent cisplatin @35 mg/m2 once weekly for 5 weeks from March 2020 to November 2021. The patients were treated on 6MV LINAC with Volumetric modulated arc therapy (VMAT) by the Sequential boost technique and concurrent chemotherapy @35 mg/m2. All the patients received 48Gy in 20 fractions to low-risk volume (CTV LR) in Phase I followed by 12Gy in 5 fractions boost to High-risk volume (CTV HR) in Phase II. The organs at risk (OARs) were contoured and appropriate constraints were given considering the hypofractionated regimen.

RESULTS:

Out of 20 patients, most of the patients were Stage IV (15;75%) & stage III 20%, out of which (55%) 11 were of the oral cavity, (40%) 8 were of the oropharynx, and (5%) 1 of larynx. All patients were treated with 60Gy/25#/5 weeks with the majority of the patients (17;85%) completing their treatment in less than 45 days. The Median follow-up was of 214 days. The locoregional control at 6 Months was 55%. Maximum acute toxicity was grade 3 mucositis which was observed in 18 (90%) patients. Ryle's tube feeding was needed in 11 (55%) patient. Out of 20 patients, 5 patients did not receive concurrent chemotherapy, and 8 (40%) patients received all 5 cycles of chemotherapy. 7, 35% of the patients could not complete all 5 cycles of concurrent chemotherapy due to grade 3 mucositis.

CONCLUSION:

During a pandemic crisis with limited manpower & technical resources accelerated hypofractionated radiotherapy with concurrent chemotherapy can be considered a feasible therapeutic option for HNSCC which can significantly reduce the overall Treatment Time (OTT) with comparable local control and manageable toxicities.

• Authors: Sumit Agarwal, Isha Jaiswal, Uday P Shahi, Abhijit Mandal, Lalit M Aggarwal, Ankita Singh, Anil Jaiswal, Nandlal Yadawa
• Journal: Journal of cancer research and therapeutics (J Cancer Res Ther) Vol. 20 Issue 1 Pg. 404-409 (Jan 01 2024) ISSN: 1998-4138 [Electronic] India
• PMID: 38554353 (Publication Type: Journal Article)
• Copyright: Copyright © 2023 Copyright: © 2023 Journal of Cancer Research and Therapeutics.

Chemical References

• Cisplatin

Topics

• Humans
• Squamous Cell Carcinoma of Head and Neck (drug therapy)
• Mucositis (epidemiology, etiology)
• Tertiary Healthcare
• Carcinoma, Squamous Cell (radiotherapy)
• COVID-19
• Head and Neck Neoplasms (radiotherapy)
• Cisplatin