Abstract

Background: Head and Neck Squamous Cell Carcinoma (HNSCC) is a major cause of morbidity and mortality in India. Though concurrent Chemo-Radiation treatment is the standard of care, optimal radiation schedule in patients who are not fit for chemotherapy is unclear. Accelerated Fractionation Radio-Therapy (AFRT) used as an alternative, reducing overall treatment time is potentially attractive in centers with high patient-resource ratio.

Aim: We intended to prospectively analyze feasibility, efficacy and safety of AFRT in a public-sector teaching hospital with constrained resources.  Methods: From January2013 to July2014, newly diagnosed patients with HNSCC having creatinine-clearance of <80ml/minute were screened. Radiotherapy (RT) of 66Gy in 33-fractions, 6-fractions/week was given using Cobalt60 tele-therapy machine. Toxicity evaluations were done weekly during treatment, response assessment at 6-weeks post-RT and loco-regional evaluation at scheduled follow-ups. Survival-analysis was done using Kaplan-Meir method (SPSS 20.0).

Results: Out of 120 patients screened, 51 were analyzed. Median age was 60-years and 44(86%) were males. Complete-Response (CR) was seen in 47(92.2%) patients. Female-gender, ECOG performance status-1, Poorly-differentiated-tumors and carcinoma-larynx showed 100% CR. At median follow-up of 12-months, 78.4% had loco-regional control. Skin reactions and dysphagia were the commonest acute-toxicities. However, all were manageable and only 6(11.8%) required treatment-breaks. At the median follow-up, Overall Survival (OS) was 80.4% (±5.6). OS was significantly related to <60 years (p=0.0293) and CR (83.3% vs 33.3%; p=0.0122).  OS was inversely related to treatment-breaks (41.7%vs92.3%;p=0.0001).

Conclusion: AFRT, which offers decreased overall treatment time, is a fair option for high-risk HNSCCin centers with high patient-resource ratio, since there sponse and survival are good and the increased acute-toxicity is manageable. Age, Complete-Response and treatment-breaks are the major determinants of survival.

Keywords: AFRT, Accelerated fractionation, Head and neck squamous cell carcinoma, Head and neck cancer, HNSCC, radiotherapy.

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