title: Comparison of concomitant boost radiotherapy against concurrent chemoradiation in locally advanced oropharyngeal cancers: a phase III randomised trial.
abstract: OBJECTIVE
  To test the toxicity and efficacy of concomitant boost radiotherapy alone against concurrent chemoradiation (conventional fractionation) in locally advanced oropharyngeal cancer in our patient population.
  
  
  METHODS
  In this open-label, randomised trial, 216 patients with histologically proven Stage III-IVA oropharyngeal cancer were randomly assigned between June 2006 and December 2010 to receive either chemoradiation (CRT) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m(2) on days 1, 22 and 43) or accelerated radiotherapy with concomitant boost (CBRT) to a dose of 67.5 Gy in 40 fractions over 5 weeks. The compliance, toxicity and quality of life were investigated. Disease-free survival (DFS) and overall survival (OS) curves were estimated with the Kaplan-Meier method and compared using log rank test.
  
  
  RESULTS
  The compliance to radiotherapy was superior in concomitant boost with lesser treatment interruptions (p=0.004). Expected acute toxicities were significantly higher in CRT, except for grade 3/4 mucositis which was seen more in CBRT arm (39% and 55% in CRT and CBRT, respectively; p=0.02). Late toxicities like Grade 3 xerostomia were significantly high in CRT arm than CBRT arm (33% versus 18%; p<0.0001). The quality of life was significantly poor in CRT arm at all follow up visits (p<0.0001). The rates of 2 year disease-free survival were similar with 56% in the chemoradiotherapy group and 61% in CBRT group (p=0.2; HR-0.81, 95%CI-0.53-1.2). Subgroup analysis revealed that patients with nodal size >2 cm had significantly better DFS with CRT (p=0.05; HR-1.59, 95%CI-0.93-2.7).
  
  
  CONCLUSIONS
  In selected patients of locally advanced oropharyngeal cancer, concomitant boost offers a better compliance, toxicity profile and quality of life with similar disease control, than chemoradiation.
authors.affiliation: Department of Radiotherapy and Oncology, Regional Cancer Centre, Postgraduate Institute of Medical Education and Research, Chandigarh, India. dranupamrishi.pgi@gmail.com
authors.forename: Anupam
authors.initials: A
authors.lastname: Rishi
authors.forename: Sushmita
authors.initials: S
authors.lastname: Ghoshal
authors.forename: Roshan
authors.initials: R
authors.lastname: Verma
authors.forename: Arun S
authors.initials: AS
authors.lastname: Oinam
authors.forename: Vijai M
authors.initials: VM
authors.lastname: Patil
authors.forename: Rakesh
authors.initials: R
authors.lastname: Mohinder
authors.forename: Suresh C
authors.initials: SC
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000401:mortality / Q000523:psychology / Q000628:therapy*; D010349:Patient Compliance; D011788:Quality of Life
keywords: Chemoradiation; Concomitant boost; Efficacy; Oropharynx; Toxicity