Different fractionation schedules of radiotherapy in locally advanced head and neck malignancy: A prospective randomized study to compare the results of treatment and toxicities of different protocols.
BACKGROUND
Altered fractionated radiotherapy may have better result than conventional radiotherapy and concomitant chemoradiotherapy to treat locally advanced head and neck cancers.


OBJECTIVE
Evaluation of the response and toxicities in different fractionated radiotherapy schedules in locally advanced head and neck cancer.


METHODS
Sixty four histologically proved patients of locally advanced head and neck cancer were included in the study according to protocol and were randomized into three arms. Arm A (n = 21) received 66 Gy in 33 fractions (5 fractions/week from Monday to Friday) single fraction daily in 6½ weeks along with concomitant chemotherapy (injection Cisplatin 30 mg/m(2) intravenous once weekly) for 6 weeks. Arm B (n = 21) received 66 Gy in 33 fractions (6 fractions per week) single fraction daily in 5½ weeks, and arm C (n = 22) received late hyperfractionation after 3 weeks; 30 Gy in 15 fractions in 3 weeks followed by 1.4 Gy twice daily (time gap between 2 fractions were 6 hours) for 15 days with a total of 72 Gy in 6 weeks. Response to treatment, compliance, and toxicities were compared in all the three arms.


METHODS
Frequency table and chi square tests done.


RESULTS
Baseline data were comparable in all the three arms. Complete response in arm A, arm B, and arm C were 15%, 26.315%, and 23.81%, respectively (P = 0.339). Grade 1 Neutropenia in arm A was 15%, arm B was 26.32%, and arm C was nil (P = 0.0486).


CONCLUSIONS
Altered fractionation and concurrent chemoradiation showed similar response with comparable acute toxicities except nutropenia, which was significantly higher in arm B.
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Dipanjan
D
Majumder
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Kakali
K
Choudhury
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Pabitra
P
Das
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Suvrokanti
S
Kundu
Department of Radiotherapy, Medical College, Kolkata, West Bengal, India.
Debabrata
D
Mitra
Accelerated fractionation; concomitant chemoradiotherapy; hyperfractionation; locally advanced head and neck cancer