Abstract

Background: Use of weekly single agent cisplatin (CDDP) in moderate doses (30-40
mg/m2) is now a standard. Concomitant chemoradiotherapy with cisplatin and 5FU
with weekly gaps may offer a benefit with less severe toxicity. Taking a cue from the
available data on this approach and our own experience with this regime, we used it for
the treatment of Locally Advanced Head and Neck Cancer and present an audit of the
same.Objective: To assess the efficacy in terms of overall response of head and neck
cancer patients receiving concurrent chemo-radiation.
Materials and Methods: All biopsy proven with head and neck squamous cell
carcinoma patients who attended the radiotherapy outpatient department of rural
medical college. Study Arm A (Control ARM: CTRT with Cisplatin): Patients were
treated with concomitant chemoradiation (CTRT) with weekly Inj. Cisplatin (40 mg/m2
IV) and necessary premedication, adequate hydration along with external beam
radiation 2 Gy/Day up to a total dose of 60-70 Gy using standard fractionation. Study
Arm B (ARM B: CTRT With Cisplatin Plus 5-Fluorouracil): Patients were treated with
concomitant chemoradiation (CTRT) with Inj. Cisplatin (60 mg/m2 IV) on day 1 and
Inj. 5-Fluorouracil (5FU) (800 mg/m2 iv) infusion days 1 to5 and with necessary
premedication, adequate hydration along with External Beam Radiation 2Gy/5 Days a
week, every other week for a total of 6-7 cycles (60-70 Gy in 12-13 weeks)
Results: 26 patients (74.29%) & 6 patients (17.14%) in Control arm have achieved CR
and PR whereas in Trial arm it was 23 patients (65.71%) and 5 patients (14.29 %)
respectively. (p=0.07). No significant difference could be made out from the results.
Treatment duration of control arm was around 7 weeks with a mean of 6.58 weeks and
that of trial arm was 13 weeks with a mean of 12.8 weeks. There was a significant
difference in the duration of treatment which was very difficult for the trial arm
patients to follow the schedule causing frequent incompliance to the treatment. PFS
when compared with the duration and stage of the patient no significant difference was
observed and due to a shorter duration of follow up median PFS could not be reached.
Conclusion: We conclude saying that regarding the toxicity issue administration of
multiagent chemoradiotherapy may not be that much of a harmful treatment modality.
Planned treatment gaps do not play a helpful role in treating locally advanced head and
neck cancer with respect to the long duration & patient compliance. Conventional
chemoradiotherapy with weekly Cisplatin is till date the best modality for treating
locally advanced head and neck cancer.