open access

Ahead of Print
Research paper
Published online: 2021-07-15
Get Citation

A pilot study on feasibility, toxicity and efficacy of a novel hypofractionated radiation therapy in advanced non-nasopharyngeal head and neck carcinoma treated with palliative intent

Suman Meyur, Suparna Kanti Pal, Sumana Maiti, Siddhartha Basu
DOI: 10.5603/PMPI.2021.0022

open access

Ahead of Print
Original articles
Published online: 2021-07-15

Abstract

Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancer hypofractionated radiotherapy is an efficient, cost-effective option, providing logistic advantage. Though there are multiple regimens prescribed, no standard of care has been confirmed. In this study a novel hypofractionated regimen has been tested for feasibility and toxicity along with assessment of objective treatment response and survival along with self–reported quality of life. Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngeal squamous cell carcinoma of Head and Neck (Stage IV) attending Radiotherapy Department of Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, given as 2 days a week (total 3.5 weeks). In patients with good response and tolerability 10 Gray boost in 2 fractions were given. Patients were followed up at regular intervals for at least 1 year. Results: The regimen faced a 97% treatment completion rate. Mean time to completion (from first contact) is 5.8 (95% CI = 5.7–6.0) weeks. The toxicity of this treatment regimen was tolerable with 23.3% acute and 33.3% incidence of chronic grade 3/4 toxicities. Objective response rate of this study was 66.7% (p = 0.001) with further 16.7% patients having stable disease. After one month of treatment significant improvement of quality of life was reported in terms of global health score, functional score and symptoms score. Mean progression free survival is 34.4 (95% CI = 27.8–41.1) weeks with 49.4 (95% CI = 44.3–54.5) weeks of overall survival in 1 year follow up period. Conclusions: The regimen is well tolerated and is highly feasible and has provided good response rate and improved quality of life immediately after treatment along with better one year overall survival rate.

Abstract

Introduction: For palliative treatment in patients with advanced inoperable stage IV head and neck cancer hypofractionated radiotherapy is an efficient, cost-effective option, providing logistic advantage. Though there are multiple regimens prescribed, no standard of care has been confirmed. In this study a novel hypofractionated regimen has been tested for feasibility and toxicity along with assessment of objective treatment response and survival along with self–reported quality of life. Patients and methods: 30 Patients, having pathologically proven advanced and metastatic non-nasopharyngeal squamous cell carcinoma of Head and Neck (Stage IV) attending Radiotherapy Department of Hospital were allocated to the prescribed hypofractionation regime with 35 Gray in 7 fractions, given as 2 days a week (total 3.5 weeks). In patients with good response and tolerability 10 Gray boost in 2 fractions were given. Patients were followed up at regular intervals for at least 1 year. Results: The regimen faced a 97% treatment completion rate. Mean time to completion (from first contact) is 5.8 (95% CI = 5.7–6.0) weeks. The toxicity of this treatment regimen was tolerable with 23.3% acute and 33.3% incidence of chronic grade 3/4 toxicities. Objective response rate of this study was 66.7% (p = 0.001) with further 16.7% patients having stable disease. After one month of treatment significant improvement of quality of life was reported in terms of global health score, functional score and symptoms score. Mean progression free survival is 34.4 (95% CI = 27.8–41.1) weeks with 49.4 (95% CI = 44.3–54.5) weeks of overall survival in 1 year follow up period. Conclusions: The regimen is well tolerated and is highly feasible and has provided good response rate and improved quality of life immediately after treatment along with better one year overall survival rate.

Get Citation

Keywords

palliative radiotherapy, hypofractionation, pilot study, head and neck cancer, quality of life, feasibility trial

About this article
Title

A pilot study on feasibility, toxicity and efficacy of a novel hypofractionated radiation therapy in advanced non-nasopharyngeal head and neck carcinoma treated with palliative intent

Journal

Palliative Medicine in Practice

Issue

Ahead of Print

Article type

Research paper

Published online

2021-07-15

DOI

10.5603/PMPI.2021.0022

Keywords

palliative radiotherapy
hypofractionation
pilot study
head and neck cancer
quality of life
feasibility trial

Authors

Suman Meyur
Suparna Kanti Pal
Sumana Maiti
Siddhartha Basu

References (32)
  1. Kulkarni M. Head and Neck Cancer Burden in India. International Journal of Head and Neck Surgery. 2013; 4(1): 29–35.
  2. Murthy NS, Chaudhry K, Rath GK. Burden of cancer and projections for 2016, Indian scenario: gaps in the availability of radiotherapy treatment facilities. Asian Pac J Cancer Prev. 2008; 9(4): 671–677.
  3. Leemans CR, Braakhuis BJM, Brakenhoff RH. The molecular biology of head and neck cancer. Nat Rev Cancer. 2011; 11(1): 9–22.
  4. Chen AM, Vaughan A, Narayan S, et al. Palliative radiation therapy for head and neck cancer: toward an optimal fractionation scheme. Head Neck. 2008; 30(12): 1586–1591.
  5. Johnstone C, Lutz ST. The role of hypofractionated radiation in the management of non-osseous metastatic or uncontrolled local cancer. Ann Palliat Med. 2014; 3(4): 291–303.
  6. Pulte D, Brenner H. Changes in survival in head and neck cancers in the late 20th and early 21st century: a period analysis. Oncologist. 2010; 15(9): 994–1001.
  7. Monnier L, Touboul E, Durdux C, et al. Hypofractionated palliative radiotherapy for advanced head and neck cancer: the IHF2SQ regimen. Head Neck. 2013; 35(12): 1683–1688.
  8. Smith GL, Smith BD. Radiation treatment in older patients: a framework for clinical decision making. J Clin Oncol. 2014; 32(24): 2669–2678.
  9. Corry J, Peters LJ, Costa ID', et al. The 'QUAD SHOT' – a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiother Oncol. 2005; 77(2): 137–142.
  10. Ghoshal S, Chakraborty S, Moudgil N, et al. Quad shot: a short but effective schedule for palliative radiation for head and neck carcinoma. Indian J Palliat Care. 2009; 15(2): 137–140.
  11. Al-mamgani A, Tans L, Van rooij PHE, et al. Hypofractionated radiotherapy denoted as the "Christie scheme": an effective means of palliating patients with head and neck cancers not suitable for curative treatment. Acta Oncol. 2009; 48(4): 562–570.
  12. Ali MY, Alam M, Mannan MA, et al. Short Course Palliative Radiotherapy in Locally Advanced Squamous Cell Carcinoma of Head and Neck. Journal of Armed Forces Medical College, Bangladesh. 1970; 6(1): 16–20.
  13. Porceddu SV, Rosser B, Burmeister BH, et al. Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment--"Hypo Trial". Radiother Oncol. 2007; 85(3): 456–462.
  14. Zubrod C, Schneiderman M, Frei E, et al. Appraisal of methods for the study of chemotherapy of cancer in man: Comparative therapeutic trial of nitrogen mustard and triethylene thiophosphoramide. Journal of Chronic Diseases. 1960; 11(1): 7–33.
  15. Eldridge SM, Chan CL, Campbell MJ, et al. PAFS consensus group. CONSORT 2010 statement: extension to randomised pilot and feasibility trials. BMJ. 2016; 355: i5239.
  16. Common Terminology Criteria for Adverse Events (CTCAE) Version 4.0(2009) US Department of Health and Human Services. http://www.hrc.govt.nz/sites/default/files/CTCAE%20manual%20-%20DMCC.pdf (05.08.2009).
  17. Schwartz LH, Litière S, de Vries E, et al. RECIST 1.1-Update and clarification: From the RECIST committee. Eur J Cancer. 2016; 62: 132–137.
  18. Singer S, Araújo C, Arraras JI, et al. EORTC Quality of Life and the EORTC Head and Neck Cancer Groups. Measuring quality of life in patients with head and neck cancer: Update of the EORTC QLQ-H&N Module, Phase III. Head Neck. 2015; 37(9): 1358–1367.
  19. Cocks H, Ah-See K, Capel M, et al. Palliative and supportive care in head and neck cancer: United Kingdom National Multidisciplinary Guidelines. J Laryngol Otol. 2016; 130(S2): S198–S207.
  20. Yang YC, Chiang CS. Challenges of Using High-Dose Fractionation Radiotherapy in Combination Therapy. Front Oncol. 2016; 6: 165.
  21. Brown JM, Carlson DJ, Brenner DJ. The tumor radiobiology of SRS and SBRT: are more than the 5 Rs involved? Int J Radiat Oncol Biol Phys. 2014; 88(2): 254–262.
  22. Das S, Thomas S, Pal SK, et al. Hypofractionated Palliative Radiotherapy in Locally Advanced Inoperable Head and Neck Cancer: CMC Vellore Experience. Indian J Palliat Care. 2013; 19(2): 93–98.
  23. Ghoshal S, Patel F, Mudgil N, et al. Palliative radiotherapy in locally advanced head and neck cancer – a prospective trial. Indian J Palliat Care. 2004; 10(1): 19.
  24. Hagen NA, Biondo PD, Brasher PMA, et al. Formal feasibility studies in palliative care: why they are important and how to conduct them. J Pain Symptom Manage. 2011; 42(2): 278–289.
  25. Agarwal JP, Nemade B, Murthy V, et al. Hypofractionated, palliative radiotherapy for advanced head and neck cancer. Radiother Oncol. 2008; 89(1): 51–56.
  26. Al-Mamgani A, Kessels R, Verhoef CG, et al. Randomized controlled trial to identify the optimal radiotherapy scheme for palliative treatment of incurable head and neck squamous cell carcinoma. Radiother Oncol. 2020; 149: 181–188.
  27. Hall EJ, Giaccia AJ. Radiobiology for the Radiologist. Lippincott Williams & Wilkins, Philadelphia 2006.
  28. Brenner DJ. The linear-quadratic model is an appropriate methodology for determining isoeffective doses at large doses per fraction. Semin Radiat Oncol. 2008; 18(4): 234–239.
  29. Eisbruch A, Harris J, Garden AS, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2010; 76(5): 1333–1338.
  30. Choudhary A, Gupta A. Conventional Fractionation versus Quad Shot in Advanced Head-and-Neck Cancers: A Randomized Controlled Trial. Indian J Palliat Care. 2019; 25(4): 527–534.
  31. Grewal AS, Jones J, Lin A. Palliative Radiation Therapy for Head and Neck Cancers. Int J Radiat Oncol Biol Phys. 2019; 105(2): 254–266.
  32. Fabian A, Domschikowski J, Hoffmann M, et al. Patient-Reported Outcomes Assessing the Impact of Palliative Radiotherapy on Quality of Life and Symptom Burden in Head and Neck Cancer Patients: A Systematic Review. Front Oncol. 2021; 11: 683042.

Important: This website uses cookies. More >>

The cookies allow us to identify your computer and find out details about your last visit. They remembering whether you've visited the site before, so that you remain logged in - or to help us work out how many new website visitors we get each month. Most internet browsers accept cookies automatically, but you can change the settings of your browser to erase cookies or prevent automatic acceptance if you prefer.

Czasopismo Medycyna Paliatywna w Praktyce dostęne jest również w Ikamed - księgarnia medyczna

Wydawcą serwisu jest  "Via Medica sp. z o.o." sp.k., ul. Świętokrzyska 73, 80–180 Gdańsk

tel.:+48 58 320 94 94, faks:+48 58 320 94 60, e-mail:  viamedica@viamedica.pl