Hypofractionated Accelerated Radiotherapy with Concurrent Chemotherapy Versus Conventional Fractionation for LAHNSCC Using IMRT/VMAT: A Pilot Study

In fast-growing tumors such as locally advanced head and neck cancers (LA-HNC), hypofractionation effectively overcomes tumor repopulation. We aimed at evaluating the safety and efficacy of moderately hypofractionated radiotherapy with concurrent cisplatin in comparison to the conventional concurrent chemoradiotherapy (CCRT) in LA-HNC. Fifty-four patients with LA-HNC were randomized to receive either: 70Gy in 35 fractions in 7 weeks concurrently with weekly cisplatin 40 mg/m2 (Arm A), or 55Gy in 20 fractions in 4 weeks concurrently with weekly cisplatin 35mg/m2 (Arm B). Volumetric modulated arc therapy/ Intensity-modulated radiotherapy (VMAT/IMRT) plans were done for both arms. Local control (LC), acute toxicity, and progression-free survival (PFS) were recorded and compared between both arms. A total of 34 patients were in arm A versus 20 patients in arm B, with a median follow-up period of 14.2 months (range 5.1-43.6 months). There was no significant difference in LC, PFS, or acute toxicity between both arms. Complete response occurred in 52.9%(18/34) and 45 %(9/20) in arm A and arm B respectively. In LA-HNC, moderate hypofractionation concurrently with cisplatin appears to be safe and feasible and is associated with a comparable response rate, PFS, and acute toxicity with conventional CCRT protocol.