Treatment Response and Locoregional Control in Locally Advanced Oral Cavity Cancers with Concurrent Chemoradiation and Radiation Alone
Journal Title: Indian Journal of Cancer Education and Research - Year 2017, Vol 5, Issue 1
Abstract
Aim: To clinically determine the treatment response and locoregional control in locally advanced oral cavity cancers with concurrent chemoradiation and radiation alone. Materials and Methods: This study was carried out in department of Radiotherapy, MNJ Institute of Oncology & Regional Cancer Center, Hyderabad from October 2010 to April 2012. A total of 50 patients with histologically proven squamous cell carcinoma of oral cavity was enrolled in this study. In this prospective study, patients were randomized to receive either chemoradiation alone (arm –A) or radiotherapy alone (armB). Response rate & locoregional control are primary end points, toxicity profile and feasibility are secondary end points. Inclusion Criteria: Patients with age < 60 years, both sexes. Patients with histologically proven advanced squamous cell cancer of the oral cavity (stage III & IV). Karnofsky’s performance scale 70. Haematopoietic : Hemogram >10 gm /dl, Total WBC count > 6000/mm3 and Platelet count > 1,00,000/ mm. Renal: Serum creatinine 1.5 mg/dl (or) creatinine clearance 60 ml/min, Hepatic : Bilirubin 1.5 times upper limit of Normal (ULN), AST (or) ALT < 2 times of ULN. Alkaline phosphate 1.5 times ULN , Normal chest Xray. Exclusion Criteria: Patients with age above 60 years. History of previous treatment with any of the following modalities–Surgery, radiotherapy, chemotherapy. Patient with distant metastasis. Hemoglobin <10 gm%. Associated comorbid conditions: Untreated tuberculosis, Uncontrolled diabetes mellitus and Uncontrolled Hypertension. Results: In this prospective study conducted from October 2010 to April 2012, a total of 50 patients proven cases of squamous cell carcinoma of oral cavity were enrolled, 25 patients in chemoradiation (armA) and 25 in radiotherapy alone (armB). Out of which 2 patient dropped out in armA. 23 patients in chemoradiation arm received cisplatin 40 mg/m2/ week for 6 cycles with Radiotherapy (66 Gy in 33 Fr 2 Gy/Fr, 5 days in a week) and 25 patients in radiation alone arm received 66 Gy in 33 Fr 2 Gy/Fr, 5 days in a week. There was good balance in prognostic factors, including performance status, tumor and nodal stages and histology between the two arms. buccal mucosa is predominant site of distribution in both arms. TNM Stage in armA, among 23 patients, 8 were in stage III and 11, 4 in stage IVA and IV B and in armB, out of 25patients, 8 in stage III and 13, 4 in stage IV A and IV B, respectively with a probability value (P=0.94) for stage. All the 100% patients in both arms completed the radiation procol that is 66 Gy in 33 Fr 2 Gy/Fr, 5 days in a week for 6.5 weeks. In armB (n=23), when compliance to chemotherapy considered, majority completed 6 cycles of chemotherapy. 87% (20/23) patients completed the full course of 6 cycles of chemotherapy. Only 13%(3/23) patients received cycles of chemotherapy. The complete response of primary tumor with T3 stage in chemoradiation arm was seen in 65%(5/8)and partial response in 35% (3/8) of the patients. The corresponding figures in the radiation alone arm were 50%(4/8) and 50% (4/ 8) respectively. The complete response seen in patients with T4a and T4b tumors in chemoradiation arm was 45%(5/11), 30%(1/4) and partial response was 55%(6/11) , 70%(3/4) while in the radiation alone arm, it is 35%(5/13), 20% complete response and 65% (8/13). 80% partial response. The median time to response from the end of the radiation was 3 months. Conclusion: Despite statistical insignificance locoregional control (tumor response) is superior (numerical benefit) with concurrent chemoradiation as compared to radiotherapy alone in locally
Authors and Affiliations
Anice Fathima
Keywords
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- EP ID EP459974
- DOI 10.21088/ijcer.2321.9815.5217.1
- Views 91
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