Background: Squamous-cell carcinoma of the head and neck is predominantly a locoregional disease, and the primary treatment methods are surgery and radiotherapy. A cause of treatment resistance could be radiation induced accelerated proliferation of clonogenic tumour cells. Reduced overall treatment time is expected to counteract the accelerated growth and thereby improve loco-regional control. Such shorter overall treatment time without a dose reduction can be achieved either by applying a higher dose per fraction or by applying more fractions per week. The aim of the study was to compare acute toxicities between the patients treated with 5 day vs 6 day a week radiotherapy.

Material and Methods: This was a prospective randomized controlled study performed at Regional Cancer Centre (RCC) Bikaner, Rajasthan, in which total 50 cases of LAHNC with no prior treatment were included. These cases were randomly divided into two arms:  in Arm A patients received 2Gy/fraction(#) for 5 days in a week for a total of 33#, while cases in Arm B patients received 2Gy/# for 6 days in a week for 33#. Patients were assessed during treatment, at the end of treatment, 3 and 6 months after completion of treatment for acute toxicities according to the RTOG guidelines.

Results: Median overall treatment time in Arm A was 46 days and for Arm B was 39 days. Grade I and II skin reactions were seen in 19 cases of Arm A and 14 cases of Arm B (p value = .998). Grade III skin reactions were significantly high in Arm B patients (11 patients in Arm B vs 6 in Arm A, p value = .034) at treatment completion. Though skin reactions were disappeared at 3 months follow up, patients in Arm B required more time to heal then Arm A. In both arms patients had most commonly grade I, II mucositis (21 patients in Arm A and 16 in Arm B, p value = 0.902). Grade III mucositis was present in 4 patients of Arm A and 9 patients of Arm B (p value = .031) at treatment completion. All patients recovered at 3 months follow up. No grade IV toxicity seen in any of the arm. Local tumor control was significantly higher in Arm B compared to Arm B (p value = 0.03)

Conclusion: This study concluded that reduction in overall treatment time resulted in improved local tumor control at the cost of increased acute toxicities.

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H. S. Kumar

Senior  Professor and Head, Department of Radiation Oncology, Acharya Tulsi Regional Cancer Treatment and Research Institute, S.P. Medical Collage, Bikaner, India