Comparison of Safety and Efficacy of Two Different Chemotherapy Dosing Schedules Used in Concurrent Chemoradiation of Head and Neck Cancer: A Retrospective Experience from a Tertiary Cancer Care Institute of Eastern India

Introduction: Concurrent chemoradiation has shown improvements in local control and survival in various multi-institutional trials and been the standard of care for locally advanced head and neck cancers. Platinum-based chemotherapy has shown the maximum benefit without any significant difference between mono- or polychemotherapy. Despite a general consensus that platinum-containing regimens are optimal, the actual dose schedule remained open questions. Our study aimed to assess the efficacy and toxicity of concurrent weekly cisplatin with radical radiotherapy and compare two different chemotherapy dosing schedules of concurrent chemoradiation in head and neck cancer. Materials and methods: The records of 62 eligible patients of locally advanced (T3-4a, N1-2) squamous cell carcinoma of oropharynx, hypopharynx and larynx registered between 2016 to 2020 at a regional cancer centre in India were analysed from the hospital database after approval of the Institutional Ethical Committee and informed consent taken from all the eligible patients.One group of patients (Group A) received Concurrent Chemo-radiation with injection Cisplatin 40 mg/m2 weekly with Radiotherapy to a dose of 66 Gy delivered in 33 fractions for six & half weeks and the patients of the other group (Group B) received injection Cisplatin 100 mg/m2 in three weekly schedule on Days 1, Day 22 & Day 43 along with the same radiation schedule. Results: There was no significant difference in the baseline characteristics between the two groups (p value≥0.05). Though the complete response occurred more in 3 weekly group compared to weekly cisplatin group at follow up of 6 weeks (67.7% vs 61.3%), 6 months (80.6% vs. 67.7%) and 12 months from the completion of CCRT (78.9% vs 65%), it was not statistically significant (p value≥0.05). No statistically significant differences were found in terms of both the acute toxicities (anaemia, leukopenia, mucositis, dermatitis, UGI toxicities, dysphagia) and late toxicities (laryngeal edema, dryness of mouth and edema of skin of neck) when weekly concurrent chemoradiotherapy was compared to three weekly chemoradiotherapy (p value ≥ 0.05).Conclusion: Weekly chemotherapy regimen can be delivered safely on a day care basis and can be helpful in a set up with limited logistics and considerable patient burden.