Comparative Study of Weekly and Three Weekly Chemoradiation Regimen in Advanced Head and Neck Cancer at Silchar Medical College

Majority of head and neck cancer cases present in an advanced stage and at sites where resection is not easy or it is impossible. For such cases, definitive chemoradiation is the solution. Cisplatin-based chemoradiation is the most common modality in chemoradiation in head and neck cancer world. There is a debate regarding the schedule of regimen whether weekly or three weekly regimens. With this in mind, we aim to compare the response, compliance, and toxicities of weekly low-dose cisplatin regimen and three weekly high-dose cisplatin regimen in our study. MATERIALS& METHODS 41 patients were eligible for the prospective study in the department of ENT, Silchar Medical College.24 in arm A (weekly based regimen) and 17 in arm B (three weekly based regimen) were studied for response to chemoradiation, compliance of treatment and their toxicities. The patients were divided into two arms, Arm A i. e. Cisplatin 30mg/kg body weight in one day given weekly for 6 cycles and Arm B i. e. Cisplatin 100mg/kg body weight in two days given three weekly for 3 cycles. Radiations were delivered in a fraction of 2Gy per day for 5 days per week for 6-7 weeks amounting to a total range of 60-70 Gy in both arms. RESULTS& OBSERVATIONS 70.73 % of total patients showed a complete response.75 % of weekly regimen and 64.7 % of three weekly regimens showed a complete response.79.2 %, 64.7 % of cases of weekly and three weekly regimens respectively completed their treatment. Mucositis was the most common toxicity in both arms involving all the patients. Grade III toxicities are more in arm B (64.7 %) than in arm A (41.6 %). Anemia, leucopenia, and vomiting are more in arm B than in arm A. Leucopenia in arm B is more esp. grade III and its statistically significant. CONCLUSION Toxicities are more in three weekly regimens than weekly regimen. Response and compliance are more in weekly regimen than three weekly regimens. Hence it can be concluded that weekly low-dose cisplatin regimen is superior to three weekly high-dose cisplatin regimen.