Alternate-day hypofractionated radiotherapy for radical treatment of head & neck cancer during the COVID-19 pandemic: A single institute experience

ABSTRACT

Background: Managing head and neck squamous cell carcinoma (HNSCC) requires a prolonged course of concurrent chemoradiotherapy and other supportive care measures. Such a multidisciplinary approach was significantly hampered during the emergence of the COVID-19 pandemic which necessitated divergence of health resources towards treating the infected patients thereby compromising cancer care. Therefore, we adopted an alternate-day hypofractionated radiotherapy (ADH RT) schedule, aiming to decrease patients' hospital visits daily without compromising the oncological outcomes. This study assesses the response and toxicity of the ADH RT schedule in HNSCC patients. Method(s) Retrospective analysis of all histopathologically proven HNSCC patients treated with ADH RT regimen during April - October 2020 in our institute. Hypofractionation dose schedule 63Gy/21 fractions, 3Gy/fraction was delivered on alternate days without concurrent chemotherapy after patients' consent. Weekly radiation toxicity assessment and post-radiotherapy response assessment by CECT face and neck at 3 and 6 months. Result(s) A total of 26 patients were planned for ADH RT. Most (96%) of them were males with a median age of 60 years and ECOG PS <=2. The most common tumor site was the oropharynx (58%), the stage was IVA (54%) followed by stage IVB (27%). 93% of patients had a history of tobacco smoking. Only 23 patients completed the treatment and were included in the final assessment. Mucositis and dermatitis grade 1, 2 and 3 was observed in 44%, 52%, 4% and 78%, 18%, and 4% patients, respectively. At three months of follow-up, 5 patients were lost to follow-up and 4 patients expired due to COVID/disease-related complications. Complete response (CR) was observed in 10 patients (71.4%) and partial response in 4 patients. At 6 months, CR was observed in 7 (64.5%) patients. Conclusion(s) Most of the patients were able to tolerate and complete treatment. At analysis, around half of the patients either expired or were lost to follow-up which is the major limitation of this study. Among the available patients, a good response was observed. The practical applicability of this regimen needs to be tested further with a larger sample size and longer follow-up. Legal entity responsible for the study The authors. Funding(s) Has not received any funding. Disclosure All authors have declared no conflicts of interest. Copyright © 2022