Hyperfractionated radiotherapy and concurrent chemotherapy in locally advanced hypopharyngeal cancers– an institutional experience
Abstract
Aim: To determine whether hyperfractionated radiotherapy with concurrent cisplatin improves outcome in advanced hypopharyngeal cancers.
Methodology: From 2012 to 2014, twenty three patients diagnosed with squamous cell carcinoma of hypopharynx (Stg III-7, Stg IVA-14, and Stg IVB-2) were assigned to receive total dose of 75.9 Gy in 66 fractions @ 1.15 Gy/fraction, twice daily with inter-fraction interval of 6 hours, 5 days/week, over 45 days. Spinal cord shielding was done at 50.6 Gy in 44 fractions. Concurrent chemotherapy was delivered with cisplatin 40 mg/m2 once weekly. The tumor response was assessed at 6 weeks and 3 months after the completion of treatment.
Results: All the recruited 23 patients completed the planned treatment. The complete response at 6 weeks and 3 months post treatment for primary and node was observed in 16/23 and 18/23, 13/23 and 16/23patients respectively. The grade I and II toxicities encountered during the treatment were mucositis (16 patients), radiation dermatitis (20 patients), neutropenia (9 patients), and leucopenia (18 patients). Grade 3 reactions seen were mucositis (6 patients), neutropenia (3 patients), leucopenia (2 patients), skin (2 patients) and none of the patients had grade IV reactions. The nutrition was maintained with feeding nasogastric tubes and parentral infusion though out the treatment. The median follow up was 18 months with a median overall survival of 24 months and median disease free survival was 18 months without any statistical significance.
Conclusion: Hyperfractionated radiotherapy combined with concurrent weekly cisplatin treatment for locally advanced hypopharyngeal cancers can be considered with rigorous monitoring and management of the toxicities.
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References
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