title: Prospective randomized trial to compare the outcome and tolerability of delivering the same total dose of radiation in 61/2 weeks versus 51/2 weeks time in head and neck cancers.
abstract: BACKGROUND
  Concurrent chemoradiation is currently considered to be the standard of care in the treatment of head and neck cancer. In developing countries like ours, a good number of patients cannot tolerate chemoradiation because of the poor general condition and financial constraints. Those patients are treated with radiation alone. The optimum radiotherapy (RT) schedule for best local control and acceptable toxicity is not yet clear. We aimed to find out whether shortening of treatment time using six instead of five RT fractions per week improves the locoregional control in squamous cell carcinoma of head and neck.
  
  
  METHODS
  We conducted a prospective randomized study for a period of 2 years from September 2007 to August 2009 in 109 untreated patients of squamous cell carcinoma of head and neck with histologically confirmed diagnosis and no evidence of distant metastasis. Study group (55 patients) received accelerated RT with 6 fractions per week (66 Gy/33#/51/2 weeks). Control group (54 patients) received conventional RT with 5 fractions per week (66 Gy/33#/61/2 weeks). Tumor control, survival, acute and late toxicities were assessed.
  
  
  RESULTS
  At a median follow-up of 43 months, 29 patients (52.7%) in the 6 fractions group and 24 patients (44.4%) in the 5 fractions group were disease-free (P = 0.852). The benefit of shortening was higher for advanced disease control though it was not statistically significant. Grade 3 and 4 skin toxicity was significantly higher in the accelerated RT (70.9%) arm as compared to conventional (35.1%) arm (P = 0.04). Grade 3 mucositis was significantly higher in the accelerated RT arm (32.7% vs. 16.6%; P = 0.041). Those acute toxicities were managed conservatively. There was no difference in late toxicities between the two arms.
  
  
  CONCLUSIONS
  Use of 6 fractions per week instead of 5 fractions per week is feasible, tolerable, and results in a better outcome in the patients of head and neck cancers.
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Manoj
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Siddharth
authors.initials: S
authors.lastname: Vats
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Tapesh
authors.initials: T
authors.lastname: Bhattacharyya
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Rajeev K
authors.initials: RK
authors.lastname: Seem
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Manish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Radiation Oncology, Indira Gandhi Medical College, Shimla, Himachal Pradesh, India.
authors.forename: Rohit
authors.initials: R
authors.lastname: Mahajan
keywords: Accelerated fractionation; head and neck cancer; radiotherapy