Role of hyperfractionated radiotherapy with weekly docetaxel in locally advanced unresectable head and neck cancer

AIMS AND OBJECTIVES: 1. To assess the immediate loco regional response rates of locally advanced unresectable squamous cell carcinomas of the head and neck cancer treated with hyperfractionated radiotherapy and concurrent weekly Docetaxel. 2. To assess the acute toxicities of the treatment. MATERIALS AND METHODS: Eligible 30 patients were taken up for concurrent chemotheraphy with hyperfractionated radiotherapy 120 centigray twice daily fractions with a gap of 6 hours, 5 days in a week along with inj.docetoxel 20 mg/m2 weekly. Patients were assessed clinically during treatment for toxicity and response 6 weeks after completion of treatment. RESULTS: Female sex showed higher complete responses than male. Stage-III cancers shows higher complete responses than stage IV A. Moderately and poorly differentiated cancers showed a considerable complete response. Lower the T stage higher is the complete response. Lower the N stage higher is the complete response and lower the TNM stage group higher is the complete response. Hypopharyngeal and oropharyngeal tumors produced greater complete response. Complete response rate in primary T3 and T4A tumors are 90% and 70% respectively. Complete response rates attained by N0, N1, N2A, and N2C nodes are 100%, 90%, 50% and 63% respectively. Primary and secondary complete response was achieved by 76% high complete responses were achieved by T3N0 (100%), T3 N1 (100%), then by T3N2A (50%),T3 N2C (66.66%),T4A N1 (70%) and last by T4A N2C (60%). 63.33% had grade 3 mucositis. 73.33% had grade 2 and 3.33% had grade 3 skin toxicities. 10% had grade 3 laryngitis. No grade 3, 4 hematological toxicities and in anemia. No Grade 3, 4 hematological toxicities in leucopenia or thrombocytopenia were observed. There was no grade III or IV vomiting. CONCLUSION: Docetaxel is one of the effective agent in head and neck cancers with manageable toxicities. This study shows that concurrent chemo radiotherapy using hyperfractionated radiotherapy combined with low dose weekly docetaxel produces complete response rate 76%