Abstract

Introduction: In general head and neck cancer may be treated with single modality of treatment for early-stage disease but may require multimodality treatment protocol for advanced disease. concurrent chemoradiation is the current standard protocol for patients with locally advanced squamous cell carcinoma of head neck. Carcinoma of head and neck is common clinical entity approximately 4.8% of the total new- cancer cases. In Bangladesh, according to cancer Registry Report NICRH (20015-2017), approximately 2901(10.6%) patients ire registered with head and neck cancer.

Study Design and Objective: This prospective observational study is to compare the treatment response and acute toxicities with the treatment of low dose weekly Carboplatin(AUC:2) with radiation versus weekly Cisplatin with radiation therapy for histologically proven advanced squamous cell carcinoma of head neck.

Methods: All the patients were divided in two groups. Arm-A 30 number patients received injection Carboplatin (AUC:2), i/v 30 minutes infusion weekly for 6 weeks and Arm- B 30 number patients received injection Cisplatin 30mg/m², i/v 2 hrs. infusion weekly for 6 weeks. All patients received 66 Gray (Gy) radiation at the rate of 2Gy/day 5# in a week for 6.5 weeks.

Results: In this study ninety percent (90%) patients were smoker. The most common presenting features were cervical lymphadenopathy (Arm A 100% vs. Arm B 100%), pain (Arm A 73.33% vs. Arm B 66.67%), sore throat (Arm A 36.67% vs. Arm B 36.66%), hoarseness of voice (Arm A 36.67% vs. Arm B 36.66%) etc. Complete response of patients treated with concurrent chemoradiation with inj. Carboplatin was 63.33% in comparison to 53.33% complete response achieved in patients treated with concurrent chemoradiation with inj. Cisplatin. This difference was statistically not much more significant. Common toxicities related to treatment were mucositis, skin reaction, vomiting, nausea, weight loss, anemia, leucopenia, thrombocytopenia and diarrhea. The toxicities in Arm-A were more than that of Arm-B, but were manageable.

Conclusion: In this study the clinical response and toxicities produced by weekly low dose carboplatin with radiation in locally advanced squamous cell carcinoma of head and neck cancer were comparable to those of weekly Cisplatin schedule with radiation showed no additional efficacy. So, concurrent chemoradiotherapy with weekly Carboplatin (AUC:2) is suitable when Cisplatin is contraindicated for the patients with renal impairment.

Keywords: Carboplatin and Cisplatin: (are anti-cancer drugs). Gy(Gray): radiation unit. Concurrent chemoradiotherapy: when any anti-cancer drug added during radiotherapy