title: Assessing feasibility, compliance and toxicity of concomitant chemo-radiotherapy in head and neck cancers in the Northern Territory: initial experience and challenges.
abstract: BACKGROUND
  Comprehensive oncology services have recently been introduced in the Northern Territory (NT) enabling delivery of concurrent chemo-radiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LAHNSC). The purpose of this study is to assess feasibility, compliance and toxicity of CCRT in remote Australia.
  
  
  METHODS
  Chart review was conducted for all patients >18 years, with biopsy-proven LAHNSC, receiving curative intent CCRT between January 2010 and September 2012.
  
  
  RESULTS
  The study population comprised of 26 patients, 20 Caucasian and 6 Indigenous, having a median age of 58 years, with most common sites of involvement being the oropharynx (n = 16) and the oral cavity (n = 6). Major risk factors were smoking and alcoholism. Cardiovascular disease, viral hepatitis, latent tuberculosis and strongyloidosis were the major comorbidities. Fifty-eight per cent (n = 15) required assisted feeding. All patients received intensity modulated radiotherapy. Systemic therapy comprised of cisplatin or carboplatin/cetuximab. Most common acute (grade 3/4) toxicities were mucositis, dysphagia and dermatological in 54%, 31% and 23% respectively. Complications were infection and gastrostomy insertion related. Hospitalisation occurred in 23%, treatment break >2 days in 38%, with no difference in toxicities between indigenous and nonindigenous patients. Platinum use was associated with greater nausea (P = 0.003), renal dysfunction (P = 0.03) and ototoxicity (P = 0.04) and cetuximab with dermatological reactions (P = 0.05). At median follow-up of 16 months, overall survival was 58% with progression-free survival of 50%.
  
  
  CONCLUSIONS
  We have demonstrated good compliance rates, tolerance and feasibility outcomes. The seeming preponderance of LAHNSC in the NT is cause for concern.
authors.affiliation: Medical Oncology, Asian Cancer Centre, New Delhi, India.|Medical Oncology, Royal Darwin Hospital, Tiwi, Northern Territory, Australia.
authors.forename: Ajay
authors.initials: A
authors.lastname: Gupta
authors.affiliation: Radiation Oncology, South West Radiation Oncology Service, Bunbury, Western Australia, Australia.|Radiation Oncology, NTRO, Alan Walker Cancer Centre, Royal Darwin Hospital, Northern Territory, Australia.
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Baxi
authors.affiliation: Radiation Oncology, NTRO, Alan Walker Cancer Centre, Royal Darwin Hospital, Northern Territory, Australia.|Ballarat Regional Integrated Cancer Centre, Ballarat, Victoria, Australia.
authors.forename: Christopher
authors.initials: C
authors.lastname: Hoyne
mesh_terms: D000328:Adult; D000368:Aged; D059248:Chemoradiotherapy / Q000009:adverse effects* / Q000706:statistics & numerical data*; D005240:Feasibility Studies; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015876:Northern Territory; D010349:Patient Compliance / Q000706:statistics & numerical data*
keywords: Cetuximab; Northern Territory; chemotherapy; cisplatin; head and neck cancers; radiotherapy