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Tolerance of Chemoradiation in Advanced Head and Neck Cancers: Comparison Between Inpatients and Outpatients

  • Virender Suhag
  • B. S. SunitaEmail author
  • Pankaj Vats
  • N. Chakravarty
  • Tejas Pandya
  • Nishant Lohia
Original Article

Abstract

Concurrent chemoradiation (CCRT) is the mainstay of treatment for majority of locally advanced head and neck carcinomas (LAHNC). Addition of chemotherapy to radiotherapy increases the probability of local control and improved disease-free survival but at the cost of acute and delayed toxicities. A retrospective observational study. To compare the tolerance of CCRT and its toxicity profile amongst two groups, first arm (Arm A) being outdoor patients and the second group (Arm B) was hospitalized patients of LAHNC in an oncology centre of a tertiary care hospital. A total of 100 patients were enrolled, 50 in each arm. Overall, the most common site was oropharynx, followed by larynx and hypopharynx. 38 patients in Arm A received full 6 cycles of weekly chemotherapy with Inj Cisplatin infusion. 39 of the hospitalized patients completed 6 cycles of weekly Cisplatin, 04 patients also received 3 weekly Cisplatin. Average duration of treatment was 49.18 days in arm A and 50.92 days in arm B. Incidence of Grade II onwards dysphagia was 48 and 45 (96 and 90%) in Arm A and Arm B respectively; Chi Square value—0.6 (Yate’s corrected); P value—0.43. Grade III oral mucositis was seen in 14% patients in Arm A and 34% patients in Arm B. 3 patients (6%) in Arm A and 14 patients (28%) in Arm B has Grade II and III hematological toxicities and nephrological toxicities. Aspiration pneumonia was seen in 2 patients (4%) in Arm A and in 4 patients (8%) in Arm B, Chi Square value—0.2 (Yate’s corrected) P value—0.67. The incidence of febrile neutropenia was 3 and 10 in Arms A and B (6 and 20%) respectively. The tolerance of CCRT in hospitalized patients is marginally better, with relatively few associated complications as compared to outdoor setting. Every institute should promulgate its own guidelines regarding hospitalization of such patients.

Keywords

Head and neck cancer Chemoradiation Toxicities Outpatient Hospitalization 

Notes

Acknowledgements

The authors will like to thank Lt Col (Dr) Yadu Vir Singh MD (Community Medicine), PGD Epidemiology (PHFI) for his support in editing the manuscript and in providing statistical inputs.

Compliance with Ethical Standards

Conflict of interest

There is no conflict of interest to declare.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. This article does not contain any studies with animals performed by any of the authors.

Informed Consent

All patients were treated by the standard of care as per international guidelines and written informed consent was taken from all participants.

References

  1. 1.
    Bandyopadhyay A, Senapati S, Samanta DR, Mohanty S, Das PK (2015) Concurrent cisplatin-based chemotherapy versus radiotherapy alone as adjuvant therapy for squamous cell carcinoma of the oral cavity bearing high-risk features. Clin Cancer Invest J 4:610–616CrossRefGoogle Scholar
  2. 2.
    Wissinger E, Griebsch I, Lungershausen J, Foster T, Pashos CL (2014) The economic burden of head and neck cancer: a systematic literature review. Pharmacoeconomics 32(9):865–882CrossRefGoogle Scholar
  3. 3.
    Madani AH, Dikshit M, Bhaduri D (2012) Risk for oral cancer associated to smoking, smokeless and oral dip products. Indian J Public Health 56:57–60CrossRefGoogle Scholar
  4. 4.
    Lango MN (2009) Multimodal treatment for head and neck cancer. Surg Clin N Am 89(1):43–52CrossRefGoogle Scholar
  5. 5.
    Nair LM, Kumar RR, Thomachan KC, Rafi M, George PS et al (2017) Phase IIb trial comparing two concurrent cisplatin schedules in locally advancedhead and neck cancer. South Asian J Cancer 6(2):64–68PubMedPubMedCentralGoogle Scholar
  6. 6.
    Givens DJ, Karnell LH, Gupta AK, Clamon GH, Pagedar NA et al (2009) Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 135(12):1209–1217. doi: 10.1001/archoto.2009.174 CrossRefPubMedGoogle Scholar
  7. 7.
    Mishra A, Meherotra R (2014) Head and neck cancer: global burden and regional trends in India. Asian Pac J Cancer Prev 15(2):537–550CrossRefGoogle Scholar
  8. 8.
    National Cancer Institute. Common toxicity criteria (NCI-CTC) v4.0. https://evs.nci.nih.gov/ftp1/CTCAE/CTCAE_4.03_2010-06-14_QuickReference_5x7.pdf
  9. 9.
    Ghosh S, Rao PB, Kumar PR, Manam S (2015) Concurrent chemoradiation with weekly cisplatin for the treatment of head and neck cancers: an institutional study on acute toxicity and response to treatment. Asian Pac J Cancer Prev 16(16):7331–7335CrossRefGoogle Scholar
  10. 10.
    Chaturvedi P (2009) Head and neck surgery. J Can Res Ther 5:143CrossRefGoogle Scholar
  11. 11.
    Kulkarni MR (2013) Head and neck cancer burden in India. Int J Head Neck Surg 4(1):29–35CrossRefGoogle Scholar
  12. 12.
    Adelstein DJ, Li Y, Adams GL et al (2003) An intergroup phase III comparison of standard radiation therapy and two schedules of concurrent chemoradiotherapy in patients with unresectable squamous cell head and neck cancer. J Clin Oncol 21:92–98. doi: 10.1200/JCO.2003.01.008 CrossRefPubMedGoogle Scholar
  13. 13.
    Al-Sarraf M, LeBlanc M, Giri PG et al (1998) Chemoradiotherapy versus radiotherapy in patients with advanced nasopharyngeal cancer: phase III randomized intergroup study 0099. J Clin Oncol 16:1310–1317CrossRefGoogle Scholar
  14. 14.
    Kanotra SP, Kanotra S, Gupta A, Paul J (2011) Chemoradiation in advanced head and neck cancers: a comparison of two radiosensitizers, paclitaxel and cisplatin. Indian J Otolaryngol Head Neck Surg 63(3):229–236CrossRefGoogle Scholar
  15. 15.
    Fan KY, Gogineni H, Zaboli D, Lake S, Zahurak ML et al (2012) Comparison of acute toxicities in two primary chemoradiation regimens in the treatment of advanced head and neck squamous cell carcinoma. Ann Surg Oncol 19(6):1980–1987. doi: 10.1245/s10434-012-2219-4 CrossRefPubMedPubMedCentralGoogle Scholar
  16. 16.
    Epstein JB, Klasser GD (2006) Emerging approaches for prophylaxis and management of oropharyngeal mucositis in cancer therapy. Expert Opin Emerg Drugs 11(2):353–373CrossRefGoogle Scholar
  17. 17.
    Bhide SA, Newbold KL, Harrington KJ, Nutting CM (1013) Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers. Br J Radiol 2012(85):487–494Google Scholar
  18. 18.
    Ling DC, Kabolizadeh P, Heron DE, Ohr JP, Wang H et al (2015) Incidence of hospitalization in patients with head and neck cancer treated with intensity-modulated radiation therapy. Head Neck 37(12):1750–1755. doi: 10.1002/hed.23821 CrossRefPubMedGoogle Scholar
  19. 19.
    Givens DJ, Karnell LH, Gupta AK, Clamon GH, Pagedar NA et al (2009) Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer. Arch Otolaryngol Head Neck Surg 135(12):1209–1217. doi: 10.1001/archoto.2009.174 CrossRefPubMedGoogle Scholar
  20. 20.
    Nguyen NP, Moltz CC, Frank C, Vos P, Smith HJ et al (2004) Dysphagia following chemoradiation for locally advanced head and neck cancer. Ann Oncol 15(3):383–388CrossRefGoogle Scholar
  21. 21.
    Talwar B, Donnelly R, Skelly R, Donaldson M (2016) Nutritional management in head and neck cancer: United Kingdom national multidisciplinary guidelines. J Laryngol Otol 130(S2):S32–S40CrossRefGoogle Scholar
  22. 22.
    Zhang Z, Zhu Y, Ling Y, Zhang L, Wan H (2016) Comparative effects of different enteral feeding methods in head and neck cancer patients receiving radiotherapy or chemoradiotherapy: a network meta-analysis. Onco Targets Ther 9:2897–2909. doi: 10.2147/OTT.S101983 CrossRefPubMedPubMedCentralGoogle Scholar
  23. 23.
    Shaw SM, Flowers H, O’Sullivan B, Hope A, Liu LW et al (2015) The effect of prophylactic percutaneous endoscopic gastrostomy (PEG) tube placement on swallowing and swallow-related outcomes in patients undergoing radiotherapy for head and neck cancer: a systematic review. Dysphagia 30(2):152–175. doi: 10.1007/s00455-014-9592-z CrossRefPubMedGoogle Scholar
  24. 24.
    Mekhail TM, Adelstein DJ, Rybicki LA, Larto MA, Saxton JP, Lavertu P (2001) Enteral nutrition during the treatment of head and neck carcinoma: is a percutaneous endoscopic gastrostomy tube preferable to a nasogastric tube? Cancer 91(9):1785–1790CrossRefGoogle Scholar
  25. 25.
    Nguyen NP, Smith HJ, Dutta S, Alfieri A, North D et al (2007) Aspiration occurence during chemoradiation for head and neck cancer. Anticancer Res 27:1669–1672PubMedGoogle Scholar
  26. 26.
    Xu B, Boero IJ, Hwang L, Le QT, Moiseenko V et al (2015) Aspiration pneumonia after concurrent chemoradiotherapy for head-and-neck cancer. Cancer 121(8):1303–1311CrossRefGoogle Scholar
  27. 27.
    Lakshmaiah KC, Sirsath NT, Subramanyam JR, Babu K, Govind BK et al (2013) Aspiration in head and neck cancer patients: a single centre experience of clinical profile, bacterial isolates and antibiotic sensitivity pattern. Indian J Otolaryngol Head Neck Surg 65(1):144–149CrossRefGoogle Scholar
  28. 28.
    Madan R, Kairo AK, Sharma A, Roy S, Singh S et al (2015) Aspiration pneumonia related deaths in head and neck cancer patients: a retrospective analysis of risk factors from a tertiary care centre in North India. J Laryngol Otol 129(7):710–714. doi: 10.1017/S0022215115001450 CrossRefPubMedGoogle Scholar
  29. 29.
    Ang KK, Harris J, Wheeler R, Weber R, Rosenthal DI et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363(1):24–35. doi: 10.1056/NEJMoa0912217 CrossRefPubMedPubMedCentralGoogle Scholar
  30. 30.
    Pignon JP, le Maître A, Bourhis J, MACH-NC Collaborative Group (2007) Meta-analyses of chemotherapy in head and neck cancer (MACH-NC): an update. Int J Radiat Oncol Biol Phys 69(2):S112–S114CrossRefGoogle Scholar
  31. 31.
    Pignon JP, Baujat B, Bourhis J (2005) Individual patient data meta-analyses in head and neck carcinoma: what have we learnt? Cancer Radiother 9:31–36CrossRefGoogle Scholar
  32. 32.
    Gupta PK, Lal P, Bajpai R, Goel A, Yadav R et al (2016) Long term results of comparison of concurrent low-dose daily cisplatin versus the standard weekly cisplatin with six fractions per week radiotherapy in locally advanced head neck cancer. South Asian J Cancer 5(2):80–84CrossRefGoogle Scholar
  33. 33.
    Kose F, Besen A, Sumbul T, Sezer A, Karadeniz C et al (2011) Weekly cisplatin versus standard three-weekly cisplatin in concurrent chemoradiotherapy of head and neck cancer: the Baskent University experience. Asian Pac J Cancer Prev 12(5):1185–1188PubMedGoogle Scholar
  34. 34.
    Rawat S, Srivastava H, Ahlawat P, Pal M, Gupta G et al (2016) Weekly versus three-weekly cisplatin-based concurrent chemoradiotherapy as definitive treatment in head and neck cancer- where do we stand? Gulf J Oncol 1(21):6–11Google Scholar
  35. 35.
    Gupta T, Agarwal JP, Ghosh-Laskar S, Parikh PM, D’Cruz AK et al (2009) 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 15(1):17. doi: 10.1186/1758-3284-1-17 CrossRefGoogle Scholar
  36. 36.
    Dimri K, Pandey AK, Trehan R, Rai B, Kumar A (2013) Conventional radiotherapy with concurrent weekly cisplatin in locally advanced head and neck cancers of squamous cell origin—a single institution experience. Asian Pac J Cancer Prev 14(11):6883–6888CrossRefGoogle Scholar

Copyright information

© Association of Otolaryngologists of India 2017

Authors and Affiliations

  • Virender Suhag
    • 1
  • B. S. Sunita
    • 2
    Email author
  • Pankaj Vats
    • 1
  • N. Chakravarty
    • 1
  • Tejas Pandya
    • 1
  • Nishant Lohia
    • 1
  1. 1.Department of Radiation OncologyArmy Hospital (R&R)DelhiIndia
  2. 2.Department of PathologyArmy Hospital (R&R)DelhiIndia

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