A prospective interventional study of split-course accelerated hypofractionated radiotherapy (scahrt) for locoregionally advanced head and neck cancer(lahnc)

Introduction: Achieving locoregional control in high-risk patients with head and neck cancer who are poor candidates for standard Concurrent Chemo-Radio-Therapy (CCRT) due to advanced age, comorbidities, or very advanced disease is challenging. In an effort to safely achieve locoregional control (LRC) in LAHNC patients, in our institution we experienced this planned split-course regimen of accelerated Hypofractionated radiotherapy (SCAHRT).
Patients and Methods: The SCAHRT regimen was used for patients with advanced age, significant co-morbidities, anticipated intolerance to definitive (chemo) radiation. EBRT of 30 Gy is delivered in 10 fractions with 3 Gy per fraction in phase I. This is followed by at least 4 week gap to allow for recovery from toxicity and the II phase is delivered by 30 Gy/10 fractions with same dose fractionations. Considering available error of 15% in response rate, the required sample size is taken 50 patients of LAHNC.
Results: 48 out of 50 patients are being gone for assessment of results in form of tumor response, toxicities and compliance. RECIST Criteria (Response Evaluation Criteria In Solid Tumors) version 1.1.is being used for tumor response and National Cancer Institute’s Common Terminology Criteria for Adverse Events (CTCAE) version 4.0.3 is being used for toxicities assessment. Locoregional control in term of response was 90.6%{CR,n=32(74%) and PR,n=7(16.25%)} at the primary site and 86%{CR,n=20(46.5%) and PR,n=17(39.5%)} at Nodal site. In both phases 96% patients completed phase I (30Gy/10 Fr) and phase II (30 Gy/10Fr) with atleast 4 weeks gap with minimum toxicities. SCAHRT was well tolerated by most patients due to gap between fractions to allow for normal tissue healing.
Conclusion: Our effort is for establishment of evidence that SCAHRT is a safe, well-tolerated and effective method of achieving durable locoregional disease control and effective palliation in these high risk LAHNC patients, those are not suitable for definitive CTRT.