Toxicity analysis in concomitant chemoradiotherapy versus accelerated radiation therapy following induction chemotherapy in locally advanced head-and-neck carcinoma in Indian scenario

Objective: Toxicity analysis in patients of locally advanced head and neck carcinoma (LAHNC) when induction chemotherapy (InCT) with TPF (docetaxel, carboplatin, 5-fluorouracil) is followed by concomitant chemoradiotherapy (CCRT) in one arm, and accelerated radiation therapy (RT) in other arm. Toxicity analysis in patients of locally advanced head-and-neck carcinoma (LAHNC) when induction chemotherapy (InCT) with TPF (docetaxel, carboplatin, and 5-fluorouracil) is followed by concomitant chemoradiotherapy (CCRT) in one arm and accelerated RT in other arm. Materials and Methods: Fifty patients with LAHNC were taken and divided into two arms of 25 each. All patients received three courses of 3-weekly InCT with docetaxel 80 mg/m2 , carboplatin 300 mg/m2 , and 5-fluorouracil 600 mg/m2 . This was followed by arm A patients receiving CCRT, wherein total radiation dose of 64 Gy/32 fractions/6.2 weeks (i.e., 2 Gy/fraction) with five fractions per week was given along with three weekly carboplatin 300 mg/m2 for three cycles. Arm B patients received accelerated RT given six fractions per week, total dose 64 Gy/32 fractions/5.2 weeks (i.e., 2 Gy/fraction). Results: Fifteen percentage of the total patients developed Grade 3 or 4 neutropenia during InCT. Grade 3 or 4 thrombocytopenia was seen 23% of all patients during InCT. Grade 3 or 4 neutropenia and thrombocytopenia was also reported in 31% and 23% patients of arm A during CCRT. Acute Grade 3 or 4 radiation dermatitis, mucositis, and pharyngitis was seen in 21%, 33%, and 12% patients of arm B as compared to 17%, 22%, and 9% patients of arm A, respectively, showing more of acute radiation reactions in the accelerated RT arm of the study. Late Grade 3 or 4 radiation-induced skin, mucosal, subcutaneous tissue, and salivary gland toxicity was not observed in any of the arms of the study. Disease status at last follow up, in arm A– 52% remained alive with no evidence of disease (NED), 39% remained alive with residual disease (RES) and 9% had locoregional recurrence (REC) while in arm B – 46% remained alive with NED, 46% remained alive with disease and 8% had locoregional recurrence. In arm B – 46% remained alive with NED, 46% remained alive with disease, and 8% had locoregional recurrence. Conclusion: InCT followed by either CCRT or accelerated RT are associated with slightly increased but manageable toxicity profile and good complete response rates. Therefore, both can be used as alternative treatment modality to CCRT alone in institutions where there is a lot of burden of patients and a long waiting list for RT