Short course palliative radiotherapy followed by chemoradiation with curative intent in advanced and unresectable head and neck cancer

In our country, majority of patients with head and neck malignancies present with locally advanced disease. Most of these patients are often found unfit for radical surgical treatment or chemo radiotherapy approaches due to poor general condition and poor nutritional status. These advanced head and neck cancer patients need Palliative Anti-cancer therapy and/or best supportive care (BSC). AIM AND OBJECTIVES: Primary Objective: To assess for degree of symptomatic relief & palliation. To assess the proportion of patients eligible for radical chemo radiotherapy. To assess immediate loco-regional disease control. Secondary Objective: To assess the acute toxicity to the treatment. MATERIALS AND METHODS: 30 advanced and unresectable head and neck cancer patients who attended department of radiotherapy were included in this study. All patients were treated with 20Gy radiotherapy in 5 fractions of 400cGy each. Response will be assessed after 1 month of radiotherapy. Patients achieving symptom relief of more than 50% and partial response at primary/nodal sites with good general condition were treated with further chemo radiotherapy at curative intent in 200cGy/# upto a total radiobiologically equivalent dose of 66Gy with inj.CDDP 40mg/m2 weekly. For other patients best supportive care was given. RESULTS: The study group had 24 male and 6 female patients with median age of 56 years. Symptom relief of more than 50% noted in 80% of the patients with pain, 73% of the patients with dysphagia. Partial response rate after palliative radiotherapy 76.6%. Grade 3 and grade 4 toxicity after palliative radiotherapy 0%. Patients eligible for further chemo radiotherapy at curative intent were 53%. 6 weeks after further chemo radiotherapy, 18.75% of the patients achieved complete response and 75% of the patients left with minimal residual disease. DISCUSSION: There is paucity of guidelines with inadequate information on time dose fractionation, toxicity of such palliative regimens and QOL issues. Palliative radiotherapy (PRT) regimens should be tailored individually. As per guidelines more hypofractionated schedules can be used for end stage patients due to limited prognosis and survival. In this study, a short course of hypofractionated palliative radiotherapy 20 Gy (5 fractions, 4 Gy per fraction) provided appreciable symptom relief with manageable acute toxicity. According to the guidelines, the treatment goal is cure even for advanced SCCHN with the intent of maximizing loco-regional control and achieving a potential cure. So this study offered further chemo radiotherapy at curative intent to good responders of palliative radiotherapy. CONCLUSION: Short course hypofractionated radiation is effective for palliation to relieve the symptoms quickly with manageable acute side effects in advanced and unresectable head and neck cancers. This study reduce the economic burden, treatment time, hospital stay and machine load. It also helps in selecting the patients for further chemo radiotherapy