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Category: Volume 07 Issue 06 June 2019
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Title: A Prospective Study to Compare Concomitant Boost Radiotherapy and Conventional Radiotherapy in Oral Cavity Cancer

Authors: Shekhar Anand, S.N. Prasad

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.50

Abstract

Background: India accounts for the highest incidence of oral and oropharyngeal cancers. For early stages, chemoradiotherapy or surgery are equally effective. For advanced stages require multimodality treatment. Standard chemoradiotherapy requires 2Gy per fractios, 5 fractions per week for 7 weeks. Accelerated repopulation sets in the 4th week of conventional radiation. To offset this effect, concomitant boost radiotherapy may be used. This study was designed to compare prospectively conventional chemoradiotherapy with concomitant boost chemoradiotherapy.

Materials and Methods: Total 60 patients (30 for Arm A- conventional chemoradiation and 30 for Arm B- concomitant Boost) were selected from the cross section of patients registered at the J. K. cancer institute and other associated hospitals of G. S. V. M Medical College, Kanpur from December 2016 to August 2018. Histologically proven carcinoma patients by way of biopsy were evaluated. The data thus obtained were assessed, analyzed and compared to find out difference in all the groups in terms of tumor response and quality of life by using t test.

Results:  Out of 30 patients, in Arm A, 13 (43.33%) and in Arm B, 12 patients (40%) had complete response (CR) and the rest of the patients had partial response except for 3 patients and 4 patients in Arm A and 5 patients and 4 patients in Arm B they had stable disease progressive disease respectively.

Conclusion: Concomitant boost radiotherapy with concomitant cisplatin has a response comparable to the conventional chemoradiotherapy regimen with not significantly higher cases of oral mucositis. CBT is easily tolerated by patients, with slight enhancement in acute reactions and so far has given much better results as compared to conventional RT alone.

Keywords: Concomitant Boost, Chemoradiotherapy, Mucositis, Oral Cavity, Oropharyngeal Cancers.

References

  1. Saranath D, khanna A. Current status of cancer burden; global and Indian scenario. Biomed Res J. 2014;1:1-5.
  2. I. Saunders et al. Head and Neck Cancer: Altered Fractionation Schedules. The Oncologist. 1999;4:11-16.
  3. Krstevska V. Radiotherapy and chemotherapy in locally advanced head and neck squamous cell carcinoma. J BUON. 2009;14:361-73.
  4. Fu KK. Biological basis for the interaction of chemotherapeutic agents and radiation therapy. Cancer. 55:2123.1985.
  5. Maciejewski B, Preuss-Bayer G, Trott KR. The influence of the number of fractions and overall treatment time on local control and late complication rate in squamous cell carcinoma of the larynx. Int J Radiat Oncol Biol Phys. 1983;9:321-328.
  6. Withers, H.R., Taylor, J.M., Maciejewski, B. The hazard of accelerated tumor clonogen repopulation during radiotherapy ActaOncol. 1988;27:131–146.
  7. Pinto, L.H., Canary, P.C., Araujo, C.M., Bacelar, S.C., Souhami, L. Prospective randomized trial comparing hyperfractio-nated versus conventional radiotherapy in stages III and IV oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 1991;21:557–562.
  8. Horiot, J.C., Le Fur, R., N'Guyen, T. et al, Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol. 1992;25:231–241.
  9. Fu, K.K., Pajak, T.F., Trotti, A. et al, A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003.Int J Radiat Oncol Biol Phys. 2000;48:7–16.
  10. Overgaard, J., Hansen, H.S., Specht, L. et al, Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet. 2003;362:933–940.
  11. Bourhis, J.S.N., Overgaard, J., Ang, K.K. et al, Conventional vs modified fractionated radiotherapy. meta-analysis of radiotherapy in head and necksquamous cell carcinoma: a meta-analysis based on individual patient data. Int J Radiat Oncol Biol Phys. 2004;S190–S191.
  12. Withers H, Taylor J, Maciejewski B: The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 27:131-146, 1988.
  13. Withers H, Peters L, Taylor J, et al: Local control of carcinoma of the tonsil by radiation therapy: An analysis of patterns of fractionation in nine institutions. Int J Radiat Oncol Biol Phys 33:549-562, 1995.
  14. Butler E, Teh B, Grant III W, et al: SMART (Simultaneous Modulated Accelerated Radiation Therapy) boost: A new accelerated fractionation schedule for the treatment of head and neck cancer with intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 45:21-32, 1999.
  15. Overgaard J, Sand Hansen H, Overgaard M, et al: Importance of overall treatment time for the outcome of radiotherapy in head and neck carcinoma: Experience from the Danish Head and Neck Cancer Study, in Kogelnik H, Sedlmayer F (eds): Sixth International Meeting on Progress in Radio-Oncology, pp 743-752. Bologna, Italy, Monduzzi Editore, 1998.
  16. Skladowski K, Maciejewski B, Golen M, et al: Randomized clinical trial on 7-day-continuous accelerated irradiation (CAIR) of head and neck cancer ± report on 3-year tumour control and normal tissue toxicity. Radiother Oncol 55:101-110, 2000.
  17. Jackson S, Weir L, Hay J, et al: A randomised trial of accelerated vs conventional radiotherapy in head and neck cancer. Radiother Oncol 43:39-46, 1997.
  18. Knee R, Fields R, Peters LJ: Concomitant boost radiotherapy for advanced squamous cell carcinoma of the head and neck. Radiother Oncol 4:1-7, 1985.
  19. Ang KK, Peters LJ, Weber RS, et al: Concomitant radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx. Int J Radiat Oncol BiolPhys 19:1339-1345, 1990.
  20. Withers RH. Dose fractionation and regeneration in RT for Ca of the oral cavity and oropharynx. Part 2 – Normal tissue responses acute and late effects. Int Jour of Radiation OncolBiol and Phys. 1990;18:101-110.
  21. Kaanders JHAM, Van Daal WAJ, Hoogenraad WJ et al. Accelerated fractionation radiotherapy for laryngeal cancer, acute and late toxicity. Int. J. Rad. Oncol. Biol. And Phys. 1992;24:497.
  22. Yu E, Souhami L, Guerra J et al. Accelerated fractionation in inoperable non small cell lung cancer. A phase I-II study. Cancer. 1993;71:2727.
  23. Peters LJ, Ang KK, Thomas HD. Accelerated fractionation in the radiation treatment of head and neck cancer: A critical comparison of different treatment strategies. ActaOncol. 1988; (Suppl.2) 27:185-194.
  24. Withers HR, Taylor IMG, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988; (Suppl.2) 27: 131-146.
  25. Rishi A, Ghoshal S, Verma R, Oinam AS, Patil VM, Mohinder R et al. Comparison of concomitant boost radiotherapy against concurrent chemoradiation in locally advanced oropharyngeal cancers: a phase III randomised trial; radiotherapy and oncology. 2013;107:317-24.
  26. Srivastava K, Srivastava M. Concomitant boost radiotherapy vs conventional radiotherapy in advanced oral cavity and oropharyngeal cancers. Indian journal of radiology and imaging. 2001;11:127-30.1
  27. Pramod K S, Sunny K, Bhupendra k s, Mangesh K, Jitendra k v. A Prospective Study on Toxicity, Quality of Life and Local Control of Post Mastectomy External Shorter Course of Irradiation. Canc Therapy & Oncol Int J. 2017; 5(5): 555675. DOI: 10.19080/CTOIJ.2017.05.555675

Corresponding Author

Shekhar Anand

Resident, G.S.V.M. Medical College, Kanpur, Uttar Pradesh, India