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Late toxicities among laryngopharyngeal cancers patients treated with different schedules of concurrent chemoradiation at a rural tertiary cancer care center
*Corresponding author: Dr. N.V. Vinin. vininnair@gmail.com
This article was originally published by Thieme Medical and Scientific Publishers Pvt. Ltd. and was migrated to Scientific Scholar after the change of Publisher.
Abstract
Abstract
Background: Concurrent chemoradiation is the treatment of choice for laryngeal-pharyngeal cancers. Apart from survival organ preservation remains major aims of the treatment. Advanced radiation techniques like VMAT have shown to reduce morbidity. The purpose of our study is to assess the late toxicities in patients treated with concurrent chemoradiation and its association with dose to organs at risk. Aims: Assessment of late toxicities following concurrent chemoradiation in patients with laryngopharyngeal cancers. Materials and Methods: Retrospective study at a tertiary cancer centre on patients with laryngeal and pharyngeal cancers treated with concurrent chemoradiation with VMAT upto a total dose of 69.3 -70 Gy in 33-35 fractions and concurrent chemotherapy with Cisplatin was done. Severe late toxicities and its association with demographic and clinical parameters and dose to OAR were studied. Data was analysed using EpiData analysis v2.2.2.182. Results: Of the 93 patients studied majority were males above 55 years. Oropharynx was the commonest site (58%) with T3 and N2 in majority. Late dysphagia and odynophagia was seen in 18(21%) and 23(27%) patients respectively. 16 (17%) had tube dependence and nine (9.6%) had aspiration pneumonia. D60, V50 and V60 along with site , node positivity and weight loss were found to be significantly associated with severe late toxicity. Conclusion: Oropharyngeal cancers, node positivity and weight loss were found to have significant grade III and above toxicities including tube dependency. Dose to larynx showed association with severe late toxicities, though dose to constrictors could not.
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Acknowledgment
The authors would like to acknowledges the support provided Dr. Karthickeyan Duraisamy, Academy for Public Health, Calicut, Kerala, India and Dr. Jaya Prasad Tripathy The Union South East Asia Office, International Union Against Tuberculosis and Lung Disease, New Delhi, India. This research was supported through an operational research course, that was jointly developed and run by Academy for Public Health, Kozhikode, Kerala, India; Malabar Cancer Centre (MCC), Thalassery, Kerala, India. The authors thank the staff of Malabar Cancer Centre in the process of data collection for their unreserved assistance. The authors also thank the patients with cancer registered in MCC whose participation in the study made this research possible. This course is under the umbrella of the World Health Organization (WHO-TDR) SORT-IT (structured operational research and training initiative) programme for capacity building in low- and middle-income countries.
References
- International Agency for Research on Cancer. GLOBOCAN 2012; Estimated Cancer Incidence, Mortality and Prevalence Worldwide in 2012- India Fact Sheet. France: IARC; 2012. Available from: http://www.globocan.iarc.fr/Pages/fact_sheets_population.aspx#. [Last accessed on 2016 Jun 18].
- Mishra A, Meherotra R. Head and neck cancer: Global burden and regional trends in India. Asian Pac J Cancer Prev 2014;15:537-50.
- Forastiere AA, Goepfert H, Maor M, Pajak TF, Weber R, Morrison W, et al. Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med 2003;349:2091-8.
- Weidner N, Semple JP, Welch WR, Folkman J. Induction chemotherapy plus radiation compared with surgery plus radiation in patients with advanced laryngeal cancer. N Engl J Med 1991;324:1685-90.
- Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ, Karlsson U, et al. Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol 2004;15:383-8.
- Smith RV, Kotz T, Beitler JJ, Wadler S. Long-term swallowing problems after organ preservation therapy with concomitant radiation therapy and intravenous hydroxyurea: Initial results. Arch Otolaryngol Head Neck Surg 2000;126:384-9.
- Forastiere AA, Zhang Q, Weber RS, Maor MH, Goepfert H, Pajak TF, et al. Long-term results of RTOG 91-11: A comparison of three nonsurgical treatment strategies to preserve the larynx in patients with locally advanced larynx cancer. J Clin Oncol 2013;31:845-52.
- Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D'Cruz AK, Dinshaw KA, et al. Radical radiotherapy with concurrent weekly cisplatin in loco-regionally advanced squamous cell carcinoma of the head and neck: A single-institution experience. Head Neck Oncol 2009;1:17.
- Kang MH, Kang JH, Song HN, Jeong BK, Chai GY, Kang K, et al. Concurrent chemoradiation with low-dose weekly cisplatin in locally advanced stage IV head and neck squamous cell carcinoma. Cancer Res Treat 2015;47:441-7.
- Staton J, Robbins KT, Newman L, Samant S, Sebelik M, Vieira F, et al. Factors predictive of poor functional outcome after chemoradiation for advanced laryngeal cancer. Otolaryngol Head Neck Surg 2002;127:43-7.
- Kies MS, Haraf DJ, Rosen F, Stenson K, List M, Brockstein B, et al. Concomitant infusional paclitaxel and fluorouracil, oral hydroxyurea, and hyperfractionated radiation for locally advanced squamous head and neck cancer. J Clin Oncol 2001;19:1961-9.
- Ackerstaff AH, Tan IB, Rasch CR, Balm AJ, Keus RB, Schornagel JH, et al. Quality-of-life assessment after supradose selective intra-arterial cisplatin and concomitant radiation (RADPLAT) for inoperable stage IV head and neck squamous cell carcinoma. Arch Otolaryngol Head Neck Surg 2002;128:1185-90.
- Samant S, Kumar P, Wan J, Hanchett C, Vieira F, Murry T, et al. Concomitant radiation therapy and targeted cisplatin chemotherapy for the treatment of advanced pyriform sinus carcinoma: Disease control and preservation of organ function. Head Neck 1999;21:595-601.
- Mose S, Class R, Weber HW, Oszvald A, Rahn A, Brady LW, et al. Combined radiotherapy and gemcitabine. Evaluation of clinical data based on experimental knowledge. Strahlenther Onkol 2002;178:59-70.
- Lavertu P, Adelstein DJ, Saxton JP, Secic M, Eliachar I, Strome M, et al. Aggressive concurrent chemoradiotherapy for squamous cell head and neck cancer: An 8-year single-institution experience. Arch Otolaryngol Head Neck Surg 1999;125:142-8.
- Adelstein DJ, Saxton JP, Lavertu P, Rybicki LA, Esclamado RM, Wood BG, et al. Maximizing local control and organ preservation in stage IV squamous cell head and neck cancer with hyperfractionated radiation and concurrent chemotherapy. J Clin Oncol 2002;20:1405-10.
- Nguyen-Tan PF, Zhang Q, Ang KK, Weber RS, Rosenthal DI, Soulieres D, et al. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the radiation therapy oncology group 0129 trial: Long-term report of efficacy and toxicity. J Clin Oncol 2014;32:3858-66.
- Nguyen-Tan PF, Zhang Q, Ang KK, et al. Randomized phase III trial to test accelerated versus standard fractionation in combination with concurrent cisplatin for head and neck carcinomas in the radiation therapy oncology group 0129 trial: Long-term report of efficacy and toxicity. J Clini Oncol 2014;32:3858-66.