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Modulated radiotherapy for head and neck carcinomas: an outcome study

Published online by Cambridge University Press:  26 July 2018

Tejinder Kataria
Affiliation:
Medanta, Gurgaon, Haryana, India
Saumya R. Mishra
Affiliation:
Medanta, Gurgaon, Haryana, India
Deepak Gupta
Affiliation:
Medanta, Gurgaon, Haryana, India
Shikha Goyal
Affiliation:
Medanta, Gurgaon, Haryana, India
Shyam S. Bisht
Affiliation:
Medanta, Gurgaon, Haryana, India
Abhidha Malik
Affiliation:
Medanta, Gurgaon, Haryana, India
Ashu Abhishek
Affiliation:
Medanta, Gurgaon, Haryana, India
Susovan Banerjee
Affiliation:
Medanta, Gurgaon, Haryana, India
Kushal Narang
Affiliation:
Medanta, Gurgaon, Haryana, India
Trinanjan Basu
Affiliation:
Medanta, Gurgaon, Haryana, India
Manoj Tayal
Affiliation:
Medanta, Gurgaon, Haryana, India
Corresponding
E-mail address:

Abstract

Background

To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).

Materials and methods

A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.

Results

Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.

Conclusions

In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.

Type
Original Article
Copyright
© Cambridge University Press 2018 

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