Comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers

Background: Head and neck cancers are the most common malignancy among males in India. Carcinoma of buccal mucosa is the most common cancer among head and neck cancers due to high rate of tobacco chewing habit. Aim and objectives: To study the comparison of acute toxicities and response of standard chemo radiation versus hyper fractionated radiotherapy in head and neck cancers. Materials and methods: It was a prospective study of acute toxicity and response in patients diagnosed with head and neck malignancy. Patients with oral cavity site, previously untreated locally advanced III, IV-A and IV -B, age of 20-60 years. Results: Primary tumor site of the patients included in the both CRT arm and HFRT was not significant (P=0.755). Majority of patients included were T3 (44% in CRT arm and 46.7% in HFRT arm) and T2 (24% in CRT arm and 26.7% in HFRT arm) lesions. The tumors with respect to T stage, the difference between two arms was not statistically significant (P = 0.988). Most of the patients presented with N1 (44% of CRT arm and 40% of HFRT arm) and N2 (28% of CRT arm and 26.7% of HFRT arm) stage. With respect to nodal (N) stage at presentation, CRT arm and HFRT arm were comparable (P=0.987). In HFRT arm, 7 (46.7%) patients were presented in stage III and 8 (53.3%) patients were in stage IV. With respect to TNM stage, CRT arm and HFRT arm were comparable (P=0.87). Radiotherapy treatment compared in both CRT Arm and HFRT arms was not statistically significant (P=0.493). In CRT arm Grade 2 toxicity: 13/22 (59%) patients developed skin toxicity, 12/22 (55%) patients developed mucous membrane toxicity, 15/22 (68%) patients developed nausea, 8/22 (36%) patients developed vomiting, 10/22 (45%) salivary gland toxicity. Grade 3 toxicity: 2/22 (9%) patients developed skin toxicity, 10/22 (45%) patients developed mucous membrane toxicity, 5/22 (23%) patients developed nausea, 6/22 (27%) patients developed vomiting. Conclusion: Standard chemo radiation is better than HFRT in Head and Neck (oral cavity) cancers because of less toxicity, less mean overall treatment time, less number of treatment breaks and better response.