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Category: Volume 07 Issue 06 June 2019
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Title: Palliative single agent Methotrexate followed by Hypo-fractionated Radiotherapy in Advanced Inoperable Head and Neck Cancer not suitable for definitive treatment

Authors: Dr Jitendra Kumar Verma, Dr SN Prasad, Dr Pramod Kumar Singh, Dr Mangesh Korde, Dr Dharmaraj

 DOI: https://dx.doi.org/10.18535/jmscr/v7i6.118

Abstract

Context:  Locally advanced oral cavity cancer with fungating mass or fistula formation are incurable. The number of cases with such advanced stage are increasing due to late diagnosis or negligence. Also, these patients have limited life expectancy.

Aim: To evaluate the symptomatic response, improvement in Quality of Life and acute toxicity after Injection Methotrexate followed by Palliative Radiotherapy.

Methods and Material: total of 54Patients registered in our institute who were histo-pathologically proven as squamous cell carcinoma of oral cavity with inoperable stage IV and KPS > 70 were chosen for study. All patients received 6 doses of weekly injection Methotrexate followed by Palliative dose of 16Gy with 4Gy single fraction weekly for 4 consecutive weeks. Patients were evaluated after 4 weeks of completion of Radiotherapy for disease response (WHO criteria), symptomatic response, acute toxicities (RTOG) and quality of life(UW-QOL).

Results: Most common presenting complaint was pain followed by dysphagia and discharge from fun gating mass. Majority of patients (70-80%) got 90%relief from their presenting symptom. In our study, we observed Partial Response (PR) in majority of patients i.e. 89%.RTOG toxicity grading of the patients showed grade one and two acute skin and mucosal toxicities one month after completion of treatment about 41%and 18% respectively.

Conclusion: Combined MTX with Palliative weekly Radiotherapy proved good for symptomatic response and relief and improved Quality of Life and also helpful in decreasing burden of machine.

Keywords: Palliative Methotrexate, Hypofractionation in Advanced Head and Neck

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Corresponding Author

Dr Jitendra Kumar Verma

MD Radiotherapy, FAROI. Assistant Professor, JK Cancer Institute, Kanpur