Concomitant Boost With Six Fractions of Radiation a Week in Locally Advanced Head and Neck Cancer Patients: A Prospective Study

TL;DR

This study tested a faster radiation therapy schedule for head and neck cancer, finding high remission rates and manageable side effects.

Contribution

A new accelerated radiation schedule with weekly cisplatin was tested in locally advanced head and neck cancer patients.

Findings

62.22% of patients achieved complete remission after six months.

Acute toxicities were mostly grade III mucositis and dermatitis, with most resolving within three months.

The regimen reduced overall treatment time without severe long-term side effects.

Abstract

Background and objective

Radiation therapy plays a significant role in the radical treatment of locally advanced head and neck cancers. Studies have shown the radiobiological advantage of accelerated chemoradiation over conventional chemoradiation as it reduces the chances of accelerated repopulation and decreases overall treatment time. This study aimed to assess the response and toxicities of accelerated concomitant chemoradiation in locally advanced head and neck cancer patients.

Methods

A total of 51 patients were enrolled and treated with accelerated concomitant chemoradiation, receiving one fraction of radiation per day, six fractions per week, with the sixth fraction as a boost on Saturdays, with weekly concurrent cisplatin at 40 mg/m2. Patients were followed up till six months after treatment completion. Radiological investigation was done to assess response according to Response Evaluation Criteria in Solid Tumors (RECIST) 1.128, and acute toxicities were assessed according to Radiation Therapy Oncology Group (RTOG) criteria.

Results

The median follow-up period was six months; 28 patients (62.22%) had a complete response and 17 (37.78%) had a partial response at six months post-completion of the treatment. The maximum acute toxicities developed at the completion of treatment. Grade III and IV mucositis developed in 14 patients (31.11%) and grade III dermatitis developed in one patient (2.22%), without any grade IV dermatitis during the total duration of treatment. The toxicities were manageable, and most of them resolved after three months of treatment completion.

Conclusions

Accelerated concomitant chemoradiation with six fractions of radiation in a week led to a decrease in overall treatment time. Of note, 62.22% of patients had complete remission, with manageable acute mucositis and dermatitis, which resolved in 82% and 67%, respectively within three months of treatment completion. However, further studies involving larger samples and longer follow-ups are needed for this regimen to be established as the standard of care in the future.

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