Abstract

The head and neck cancers rank among the top 10 cancers globally. A huge population with newly diagnosed cancers is registered in India every year. Of these oral cancers are the most common in India. Surgery forms the mainstay of treatment. Concurrent chemoradiotherapy has shown better results in comparison to surgery alone in advanced cases. Cisplatin is the best radio sensitizer and has been accepted as the standard reference regimen. The present study was carried out to compare two different dosing schedules of cisplatin in terms of tolerance and response to the treatment. The present prospective, comparative study was carried out in the Department of Radiation Oncology, Government Cancer Hospital, Indore. 60 patients with local advanced head and neck cancers were included, divided into two arms. Arm‐A with 30 patients received radical radiotherapy with cisplatin given every week during the radiotherapy sessions, while Arm‐B patients received radical radiotherapy with concurrent cisplatin on day 1, 22 and 43. The RECIST 1.1 criteria was used for finding out the response. Proportional comparison was done using Pearson Chi‐square test. There was a male preponderance in both the arms. 41.7% had moderately and 31.7% had poorly differentiated histological carcinoma grades. 55% had proliferative growth. 66.7% were in stage III and 33.3% were in stage IV disease. 60% in Arm‐A and 70% in Arm‐B had complete response. 10% in Arm‐A and 3% in Arm‐B had progression of the disease. Mucositis, dermatitis, xerostomia, trismus, dysphagia, anemia, thrombocytopenia, etc. all were comparable between the two arms (p>0.05). Our study found that cisplatin if given on day 1, 22 and 43 concurrently with radiation therapy has better outcome with lower incidence of disease progression.

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References

1. Ministry of Health and Family Welfare, 2019. National cancer control programme. Ministry of Health and Family Welfare, Government of India, India, https://main.mohfw.gov.in/Organisation/Departments-of-Health-and-Family-Welfare/national-cancer-control-programme.
2. Ali, I., W.A. Wani and K. Saleem, 2011. Cancer scenario in India with future perspectives. Cancer Ther., 8: 56-70.
3. Casciato, M.A. and M.C. Territo, 2012. Manual of Clinical Oncology. 7th Edn., Lippincott Williams and Wilkins, Philadelphia, Pennsylvania, USA., ISBN-14: 978-1451115604, Pages: 928.
4. Brizel, D.M., M.E. Albers, S.R. Fisher, R.L. Scher and W.J. Richtsmeier et al., 1998. Hyperfractionated irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. New Engl. J. Med., 338: 1798-1804.
5. Adelstein, D.J., Y. Li, G.L. Adams, H. Wagner and J.A. Kish et al., 2003. An intergroup phase iii comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J. Clin. Oncol., 21: 92-98.
6. Forastiere, A.A., H. Goepfert, M. Maor, T.F. Pajak and R. Weber et al., 2003. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. New. Engl. J. Med., 349: 2091-2098.
7. Denis, F., P. Garaud, E. Bardet, M. Alfonsi and C. Sire et al., 2004. Final results of the 94-01 french head and neck oncology and radiotherapy group randomized trial comparing radiotherapy alone with concomitant radiochemotherapy in advanced-stage oropharynx carcinoma. J. Clin. Oncol., 22: 69-76.
8. Spector, G.J., D.G. Sessions, J. Lenox, D. Newland, J. Simpson and B.H. Haughey, 2004. Management of stage iv glottic carcinoma: Therapeutic outcomes. Laryngoscope, 114: 1438-1446.
9. Haigentz, M., C.E. Silver, J. Corry, E.M. Genden, R.P. Takes, A. Rinaldo and A. Ferlito, 2009. Current trends in initial management of oropharyngeal cancer: The declining use of open surgery. Eur. Arch. Otorhinolaryngol., 266: 1845-1855.
10. Ho, K.F., R. Swindell and C.V. Brammer, 2008. Dose intensity comparison between weekly and 3-weekly cisplatin delivered concurrently with radical radiotherapy for head and neck cancer: A retrospective comparison from new cross hospital, wolverhampton, uk. Acta Oncol., 47: 1513-1518.
11. Prakash, K. and S. Shrivastva, 2016. Comparative study of quality of life, toxicity in weekly cisplatin vs three weekly cisplatin along with radiation in locally advanced head and neck malignancies. Asian Pac. J. Health Sci., 3: 108-119.
12. Tsan, D.L., C.Y. Lin, C.J. Kang, S.F. Huang and K.H. Fan et al., 2012. The comparison between weekly and three-weekly cisplatin delivered concurrently with radiotherapy for patients with postoperative high-risk squamous cell carcinoma of the oral cavity. Radiat. Oncol., Vol. 7. 10.1186/1748-717x-7-215.
13. Mitra, D., K. Choudhury and M.A. Rashid, 1970. Concurrent chemotherapy in advanced head and neck carcinoma – a prospective randomized trial. Banglad. J. Otorhinolaryngol., 17: 88-95.
14. Gupta, T., J.P. Agarwal, S. Ghosh-Laskar, P.M. Parikh, A.K. D'Cruz and K.A. Dinshaw, 2009. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: A single-institution experience. Head Neck Oncol., Vol. 1. 10.1186/1758-3284-1-17.
15. Noronha, V., A. Joshi, V.M. Patil, J. Agarwal and S. Ghosh-Laskar et al., 2018. Once-a-week versus once-every-3-weeks cisplatin chemoradiation for locally advanced head and neck cancer: A phase iii randomized noninferiority trial. J. Clin. Oncol., 36: 1064-1072.
16. Mackiewicz, J., A. Rybarczyk-Kasiuchnicz, I. Łasińska, M. Mazur-Roszak and D. Świniuch et al., 2017. The comparison of acute toxicity in 2 treatment courses. Medicine, Vol. 96. 10.1097/md.0000000000009151.