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Hypofractionated Palliative Radiotherapy in Locally Advanced Inoperable Head and Neck Cancer: CMC Vellore Experience.

Das S, Thomas S, Pal SK, Isiah R, John S - Indian J Palliat Care (2013)

Bottom Line: Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance).Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status.Median overall survival of the cohort was 7 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT

Background: A novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer was evaluated in terms of palliation of cancer-related symptoms and acute toxicities.

Materials and methods: Thirty-six patients with inoperable head and neck cancer were included in the study (2010-2012). All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria. Functional Assessment of Cancer Therapy (Head and Neck, FACT H and N) quality of life (QOL) tool was administered before starting and at the completion of radiotherapy. Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance).

Results: Thirty-three patients (male: 29, female: 4, mean age: 57.8 ± 9.7 years) were included in the analysis (three patients discontinued treatment due to socioeconomic reasons). All patients had advanced inoperable head and neck cancers (27% IVA, 61% IVB, 9% IVC, TNM stage and 3% recurrent disease). Distressing pain at primary site (42%), dysphagia (18%), neck swelling (30%), and hoarseness (10%) were common presentations. Incidence of grade III mucositis and dermatitis and pain was 18%, 3%, and 24%, respectively. Planned radiotherapy without any interruptions was completed by 73% patients. QOL assessment showed improvement in social well-being (17.4 vs. 20.01, P = 0.03), but no significant change was observed in head and neck specific score (25.1 vs. 25.0, P = NS) after treatment. Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status. Median overall survival of the cohort was 7 months.

Conclusions: The study shows that this short duration palliative radiotherapy schedule is a clinically viable option for advanced inoperable head and neck cancer to achieve significant palliation of the main presenting symptoms like pain, dysphagia, and throat pain.

No MeSH data available.


Related in: MedlinePlus

Simulator film of a patient: 69-year-old gentleman, a chronic smoker and a known case of Hansen's disease evaluated for neck swelling and hoarseness of voice for 6 months. ENT examination revealed a slough covered growth in the right pyriform sinus extending to the arytenoids, aryepiglottic fold up to the left arytenoids. Fine needle aspiration cytology from the node was reported as metastaic squamous cell carcinoma and was staged T2N3M0 (stage IVB disease inoperable stage) was planned for palliative radiotherapy. The node has been outlined with lead wire during simulation
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Figure 1: Simulator film of a patient: 69-year-old gentleman, a chronic smoker and a known case of Hansen's disease evaluated for neck swelling and hoarseness of voice for 6 months. ENT examination revealed a slough covered growth in the right pyriform sinus extending to the arytenoids, aryepiglottic fold up to the left arytenoids. Fine needle aspiration cytology from the node was reported as metastaic squamous cell carcinoma and was staged T2N3M0 (stage IVB disease inoperable stage) was planned for palliative radiotherapy. The node has been outlined with lead wire during simulation

Mentions: All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week (Monday and Thursday or Tuesday and Friday, equivalent weekly dose 10 Gy). Patients were immobilized in supine position and head fixed with thermoplastic ray cast. Primary and nodal gross tumor volumes were outlined based on clinical examination, ENT examination including nasopharyngolaryngo endoscopy. Radiotherapy portal included gross tumor volume with 2 cm margin and the high-risk nodal regions. Prophylactic radiation of anterior neck was not done. Radiotherapy was delivered by parallel opposed lateral technique in telecobalt machine (Theratron 780C). Spine shielding was done at 32 Gy, if the nodal volume was situated anterior to the spine. If the nodal volume was posterior to the spine, shielding was omitted [Figure 1].


Hypofractionated Palliative Radiotherapy in Locally Advanced Inoperable Head and Neck Cancer: CMC Vellore Experience.

Das S, Thomas S, Pal SK, Isiah R, John S - Indian J Palliat Care (2013)

Simulator film of a patient: 69-year-old gentleman, a chronic smoker and a known case of Hansen's disease evaluated for neck swelling and hoarseness of voice for 6 months. ENT examination revealed a slough covered growth in the right pyriform sinus extending to the arytenoids, aryepiglottic fold up to the left arytenoids. Fine needle aspiration cytology from the node was reported as metastaic squamous cell carcinoma and was staged T2N3M0 (stage IVB disease inoperable stage) was planned for palliative radiotherapy. The node has been outlined with lead wire during simulation
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3775031&req=5

Figure 1: Simulator film of a patient: 69-year-old gentleman, a chronic smoker and a known case of Hansen's disease evaluated for neck swelling and hoarseness of voice for 6 months. ENT examination revealed a slough covered growth in the right pyriform sinus extending to the arytenoids, aryepiglottic fold up to the left arytenoids. Fine needle aspiration cytology from the node was reported as metastaic squamous cell carcinoma and was staged T2N3M0 (stage IVB disease inoperable stage) was planned for palliative radiotherapy. The node has been outlined with lead wire during simulation
Mentions: All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week (Monday and Thursday or Tuesday and Friday, equivalent weekly dose 10 Gy). Patients were immobilized in supine position and head fixed with thermoplastic ray cast. Primary and nodal gross tumor volumes were outlined based on clinical examination, ENT examination including nasopharyngolaryngo endoscopy. Radiotherapy portal included gross tumor volume with 2 cm margin and the high-risk nodal regions. Prophylactic radiation of anterior neck was not done. Radiotherapy was delivered by parallel opposed lateral technique in telecobalt machine (Theratron 780C). Spine shielding was done at 32 Gy, if the nodal volume was situated anterior to the spine. If the nodal volume was posterior to the spine, shielding was omitted [Figure 1].

Bottom Line: Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance).Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status.Median overall survival of the cohort was 7 months.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, Christian Medical College, Vellore, Tamil Nadu, India.

ABSTRACT

Background: A novel, short duration, palliative radiotherapy schedule for inoperable head and neck cancer was evaluated in terms of palliation of cancer-related symptoms and acute toxicities.

Materials and methods: Thirty-six patients with inoperable head and neck cancer were included in the study (2010-2012). All patients received 40 Gy in 10 fractions (equivalent dose: 49.8 Gy in conventional fractionation) with 2 fractions per week. Treatment-related toxicity was assessed using Radiation Therapy Oncology Group criteria. Functional Assessment of Cancer Therapy (Head and Neck, FACT H and N) quality of life (QOL) tool was administered before starting and at the completion of radiotherapy. Mean value before and after treatment was compared (paired t-test, P = 0.05, two-tailed for significance).

Results: Thirty-three patients (male: 29, female: 4, mean age: 57.8 ± 9.7 years) were included in the analysis (three patients discontinued treatment due to socioeconomic reasons). All patients had advanced inoperable head and neck cancers (27% IVA, 61% IVB, 9% IVC, TNM stage and 3% recurrent disease). Distressing pain at primary site (42%), dysphagia (18%), neck swelling (30%), and hoarseness (10%) were common presentations. Incidence of grade III mucositis and dermatitis and pain was 18%, 3%, and 24%, respectively. Planned radiotherapy without any interruptions was completed by 73% patients. QOL assessment showed improvement in social well-being (17.4 vs. 20.01, P = 0.03), but no significant change was observed in head and neck specific score (25.1 vs. 25.0, P = NS) after treatment. Reduction of pain was observed in 88% patients and 60% patients had improvement of performance status. Median overall survival of the cohort was 7 months.

Conclusions: The study shows that this short duration palliative radiotherapy schedule is a clinically viable option for advanced inoperable head and neck cancer to achieve significant palliation of the main presenting symptoms like pain, dysphagia, and throat pain.

No MeSH data available.


Related in: MedlinePlus