Split-Course radiotherapy: A nonideal treatment in a nonideal patient
Background: Radical chemoradiation is the standard of care for locally advanced head-and-neck cancer. However, patients with pretreatment poor risk features exhibit a poor tolerance to these rigorous regimens and are then usually prescribed short-course palliative radiotherapy which provides symptom...
| Main Authors: | , , , |
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| Format: | Article |
| Language: | English |
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Wolters Kluwer Medknow Publications
2018-01-01
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| Series: | Journal of Head & Neck Physicians and Surgeons |
| Subjects: | |
| Online Access: | http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=1;spage=43;epage=47;aulast=Thakur |
| _version_ | 1811207985676943360 |
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| author | Pragyat Thakur Bhavana Rai Sushmita Ghoshal Rohit Mahajan |
| author_facet | Pragyat Thakur Bhavana Rai Sushmita Ghoshal Rohit Mahajan |
| author_sort | Pragyat Thakur |
| collection | DOAJ |
| description | Background: Radical chemoradiation is the standard of care for locally advanced head-and-neck cancer. However, patients with pretreatment poor risk features exhibit a poor tolerance to these rigorous regimens and are then usually prescribed short-course palliative radiotherapy which provides symptomatic relief; however, survival outcomes are poor. However, a proportion of these patients may tolerate higher dose of radiation with planned treatment break which in turn may translate into improved locoregional control. Materials and Methods: Patients with histologically confirmed nonmetastatic locally advanced squamous cell carcinoma of oropharynx with poor risk features, treated with split-course radiotherapy were included in this retrospective study. A dose of 35 Gy in 15# 3 weeks was initially prescribed. After planned treatment break of 2 weeks, an additional dose of 25 Gy in 10# 2 weeks was delivered. A weekly assessment of radiation reactions was performed during the treatment course, and response to the treatment was assessed clinically at 8 weeks after treatment completion and on subsequent follow-up. Survival analysis was done at median follow-up. Results: Of the 117 eligible patients, 14 (11.9%) had Stage III (with poor Karnofsky Performance Score) and 103 (88.1%) had Stage IV disease. Toxicity was observed as Grade I 80/117 (68.4%), Grade II 20/117 (17.1%), and Grade III as 17/117 (14.5%). A complete clinical response was observed in 45.3% patients at first follow-up. Patients had a median follow-up of 20 months (range 0–62 months). Median progression-free survival and overall survival were 12 and 16 months, respectively. Conclusions: This regimen can be delivered effectively and has an acceptable toxicity profile. It can be used as a treatment option in patients with poor risk pretreatment features. |
| first_indexed | 2024-04-12T04:12:52Z |
| format | Article |
| id | doaj.art-47f372144b4e4efb995a6db803ee10ed |
| institution | Directory Open Access Journal |
| issn | 2347-8128 2347-8128 |
| language | English |
| last_indexed | 2024-04-12T04:12:52Z |
| publishDate | 2018-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Head & Neck Physicians and Surgeons |
| spelling | doaj.art-47f372144b4e4efb995a6db803ee10ed2022-12-22T03:48:27ZengWolters Kluwer Medknow PublicationsJournal of Head & Neck Physicians and Surgeons2347-81282347-81282018-01-0161434710.4103/jhnps.jhnps_33_16Split-Course radiotherapy: A nonideal treatment in a nonideal patientPragyat ThakurBhavana RaiSushmita GhoshalRohit MahajanBackground: Radical chemoradiation is the standard of care for locally advanced head-and-neck cancer. However, patients with pretreatment poor risk features exhibit a poor tolerance to these rigorous regimens and are then usually prescribed short-course palliative radiotherapy which provides symptomatic relief; however, survival outcomes are poor. However, a proportion of these patients may tolerate higher dose of radiation with planned treatment break which in turn may translate into improved locoregional control. Materials and Methods: Patients with histologically confirmed nonmetastatic locally advanced squamous cell carcinoma of oropharynx with poor risk features, treated with split-course radiotherapy were included in this retrospective study. A dose of 35 Gy in 15# 3 weeks was initially prescribed. After planned treatment break of 2 weeks, an additional dose of 25 Gy in 10# 2 weeks was delivered. A weekly assessment of radiation reactions was performed during the treatment course, and response to the treatment was assessed clinically at 8 weeks after treatment completion and on subsequent follow-up. Survival analysis was done at median follow-up. Results: Of the 117 eligible patients, 14 (11.9%) had Stage III (with poor Karnofsky Performance Score) and 103 (88.1%) had Stage IV disease. Toxicity was observed as Grade I 80/117 (68.4%), Grade II 20/117 (17.1%), and Grade III as 17/117 (14.5%). A complete clinical response was observed in 45.3% patients at first follow-up. Patients had a median follow-up of 20 months (range 0–62 months). Median progression-free survival and overall survival were 12 and 16 months, respectively. Conclusions: This regimen can be delivered effectively and has an acceptable toxicity profile. It can be used as a treatment option in patients with poor risk pretreatment features.http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=1;spage=43;epage=47;aulast=ThakurCarcinoma oropharynxoverall survivalprogression-free survivalsplit-course radiotherapytoxicity |
| spellingShingle | Pragyat Thakur Bhavana Rai Sushmita Ghoshal Rohit Mahajan Split-Course radiotherapy: A nonideal treatment in a nonideal patient Journal of Head & Neck Physicians and Surgeons Carcinoma oropharynx overall survival progression-free survival split-course radiotherapy toxicity |
| title | Split-Course radiotherapy: A nonideal treatment in a nonideal patient |
| title_full | Split-Course radiotherapy: A nonideal treatment in a nonideal patient |
| title_fullStr | Split-Course radiotherapy: A nonideal treatment in a nonideal patient |
| title_full_unstemmed | Split-Course radiotherapy: A nonideal treatment in a nonideal patient |
| title_short | Split-Course radiotherapy: A nonideal treatment in a nonideal patient |
| title_sort | split course radiotherapy a nonideal treatment in a nonideal patient |
| topic | Carcinoma oropharynx overall survival progression-free survival split-course radiotherapy toxicity |
| url | http://www.jhnps.org/article.asp?issn=2347-8128;year=2018;volume=6;issue=1;spage=43;epage=47;aulast=Thakur |
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