A Prospective Randomised Study of Comparison between Conventional and Accelerated Fractionation Radiotherapy in Treatment of Head and Neck Cancers

Abstract

Introduction: Treatment of locally advanced lesions of head and neck cancers include combined modality approach such as surgery, Radiotherapy (RT) and chemotherapy. The prognosis of patients with locally advanced head and neck squamous cell cancer (LAHNSCC) is poor and five year survival rate with conventional RT is 40-50%. Hence the realisation that conventional fractionation may not be the best fractionation for all situations have led to the concept of altered fractionation in RT. Aim: To compare feasibility, tolerability and efficacy of accelerated fractionation with conventional fractionation schedules in RT of head and neck cancers in terms of response to treatment, acute and late radiation induced toxicities and disease free survival. Materials and Methods: During the time period between March 2015 and March 2017, 68 patients with squamous cell carcinoma of head and neck were recruited into the study and divided into two arms, arm A (five fractions per week) and arm B (six fractions per week). Concurrent chemotherapy with weekly cisplatin 40 mg/m2 was given to patients in both the arms who were medically fit for chemotherapy. Results: Final analysis was done in 62 patients (32 patients in arm A and 30 patients in arm B). On first follow-up, 68% had complete response in conventional RT arm, 96% had complete response in accelerated RT arm (p=0.003). At median follow-up of 17 months, loco-regional control rates were 86% in conventional RT arm compared to 90% in accelerated arm. Disease free survival was slightly more in accelerated RT arm compared to conventional arm. This difference was not statistically significant (p=0.59). Acute complications were slightly more in the accelerated RT arm than those of conventional fractionation arm. Grade 2 and grade 3 skin reactions were higher in accelerated arm compared to conventional arm (89% vs. 61%; p=0.38). Acute grade 2 and grade 3 mucositis was also higher in accelerated arm compared to conventional arm (99% vs. 75%, p=0.49). Radiation induced late morbidity did not differ significantly between the groups. Conclusion: Accelerated fractionation can be considered as an alternative treatment strategy to conventional fractionation which is radiobiologically superior and is beneficial for centers where the patient load is much higher than the facility available.

Keywords

• altered fractionation
• chemotherapy
• standard fractionation