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Comparison between hypo-fractionated dose-escalated volumetric modulated arc therapy and conventional concurrent chemo-radiation in locally advanced head and neck cancer: a pilot study

Published online by Cambridge University Press:  17 May 2019

Ehab Saad Open the ORCID record for Ehab Saad [Opens in a new window] ,
Riham Hani Radwan  and
Eman Abdel Hadi
Ehab Saad*
Affiliation:
Department of clinical oncology and nuclear medicine, Cairo University, Cairo, Egypt
Riham Hani Radwan
Affiliation:
Department of clinical oncology and nuclear medicine, Cairo University, Cairo, Egypt
Eman Abdel Hadi
Affiliation:
Department of clinical oncology and nuclear medicine, Cairo University, Cairo, Egypt
*
Author for correspondence: Ehab Saad, Lecturer of clinical oncology and radiotherapy, Kasr alainy hospital, Cairo, Egypt. Tel: 00201143650739. Fax: 002023653360. E-mail: ehab.saad239@gmail.com
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Abstract

Objective:

In the treatment of locally advanced head and neck cancer (LA-HNC), both dose escalation and hypo-fractionation can improve tumour control rates with uncertain role of addition of concurrent chemotherapy. We aimed at developing a new radiotherapy protocol for patients not eligible to receive the standard concurrent chemo-radiation therapy (CCRT) with little toxicity profile.

Methods:

A total of 63 LA-HNC patients were randomised to receive either: 70 Gy in 35 fx in 7 weeks concurrently with cisplatin 100 mg/m2 every 3 weeks for 3 doses (Arm A) or 74 Gy in 33 fx in 6·5 weeks (Arm B). Volumetric modulated arc therapy plans were created for both treatment arms. We compared the local control (LC), progression-free survival (PFS), overall survival (OS) and acute and late toxicity between the two arms.

Results:

A total of 33 patients were in Arm A versus 30 patients in Arm B with median follow-up 24·2 months. No significant differences in LC, PFS and OS between the two arms. Complete remission occurred in 54·5 and 63·3% of patients in Arms A and B, respectively. All toxicities were significantly less in Arm B than Arm A.

Conclusion:

Slightly dose-escalated hypo-fractionated regimen is safe and feasible and has comparable efficacy and less acute and late side effects than conventional dose CCRT with avoidance of chemotherapy-related toxicities in LA-HNC patients.

Keywords

concurrent chemo-radiationdose-escalated radiotherapyhypo-fractionated radiotherapylocally advanced head and neck cancer
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 19 , Issue 2 , June 2020 , pp. 132 - 138
Copyright
© Cambridge University Press 2019

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Footnotes

A written consent was obtained from each patient before recruitment in the study.

The study was approved by the local ethics committee of the department of clinical oncology and nuclear medicine, Cairo University (Ref: a12016).

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