Efficacy of adjuvant radiation in early-stage cancers of buccal mucosa: an institutional experience.

PURPOSE: The purpose of this study is to determine if depth of infiltration is the only risk factor that will determine the outcomes in early-stage buccal mucosa patients or do the other minor risk factors have an impact too. METHODS: It is a retrospective analysis of 226 patients with early-stage buccal mucosa cancer who were treated with curative intent from 2010 to 2020. These patients were grouped in two arms, surgery alone (n = 111) and surgery followed by adjuvant radiotherapy (n = 115). Patients were followed up and local and regional recurrences and distant metastasis were recorded. RESULTS: Our results show that addition of radiation to the standard surgery arm improves overall survival and disease-free survival, though the improvement in overall survival was not statistically significant. This improvement was more pronounced in the depth of infiltration > 5 mm and in 5 mm or less depth of infiltration this benefit was not statistically significant. Other factors like perineural invasion, lymphovascular invasion, tumour size, node positive, margin positive were considered for univariate analysis. Although there was a trend towards improvement of OS and DFS, it was not statistically significant as far as these factors are concerned. CONCLUSION: The role of adjuvant radiation in early-stage cancers of buccal mucosa is a crucial tool with definitive DFS benefit and requires more prospective trials to answer the OS benefit.

An experience with simultaneous integrated boost-volumetric-modulated arc therapy in the definitive treatment of head and neck cancer: An Indian data.

Background: There are very few prospective studies comparing simultaneous integrated boost versus sequential boost in the setting of definitive treatment modality of head and neck squamous cell cancer (HNSCC), especially in the Indian scenario. Materials and Methods: We prospectively randomized 50 patients with biopsy-proven squamous cell carcinoma of the oropharynx, hypopharynx, and larynx malignancies, stage T1-3, enlarged node measuring ≤3 cm that are planned for definitive radiotherapy with chemotherapy into either hypo-fractionated simultaneous integrated (Hypo-SIB VMAT) boost arm or conventional (Conv-VMAT) boost arm. Results: Most of the patients were men and aged less than 50 years. Patients with nodal involvement were 76% in Hypo-SIB VMAT and 80% in Conv-VMAT arm. The overall stage group distribution of II, III, and IVA were 16%, 44%, 40%, and 12%, 56%, and 32%, respectively, in both arms. All patients completed the intended treatment in both arms. Overall survival at the end of 2 years was 84% in Hypo-SIB VMAT arm and 80% in the Conv-VMAT arm (P = 0.25); disease-free survival (DFS) was 88% and 72%, respectively (P = 0.12); and locoregional recurrence-free survival (LRFS) was 92% and 84%, respectively (P = 0.38). All the acute and chronic toxicities in both the arms were comparable with no significant difference in any of the toxicities. The average overall treatment time (OTT) in Hypo-SIB VMAT arm is 39.4 days and in Conv-VMAT arm is 50.2 days (P = 0.00001) which is statistically significant. Conclusions: Accelerated Hypo-SIB VMAT has similar response and toxicities as compared to Conv-VMAT in the setting of definitive concurrent chemoradiation of HNSCC patients with the advantage of less OTT, faster treatment delivery, and patient compliance.

Comparison of acute toxicities of two chemotherapy schedules for head and neck cancers.

BACKGROUND: Chemo-radiotherapy has become the standard of care for loco-regionally advanced head and neck cancers. Platinum based regimens are the most effective. Although benefits are proven with chemo-radiation, acute toxicities are markedly increased. The dose and delivery schedules of Cisplatin have ranged from intermittent higher dose [100 mg/m2] every 3 weeks to low dose [6 mg/m2] daily administration. At present there is no data indicating which regimen is superior. PURPOSE: To compare acute toxicities of two chemotherapy schedules for head and neck cancers. MATERIALS AND METHODS: A total of 83 head and neck cancer patients treated with two schedules of concurrent chemo RT were analyzed, retrospectively, for treatment toxicity. In group A [51 patients], chemotherapy [CT] was administered on week 1, 4 and 7 [cisplatin 100 mg/m2] over a period of 2-3 days. In group B [32 patients], CT was delivered weekly [cisplatin 40 mg/m2]. Radiotherapy dose was 7000 cGy in 35 fractions for definitive concurrent chemo-radiation and 6600 cGy in 33 fractions for adjuvant treatment. RESULTS: Group B patients had increased grade III skin and hematological toxicity, where as patients in group A had more pharyngeal toxicity. Treatment interruptions and percentage of weight loss were higher in group B. Weekly CT schedule had higher rate of severe mucositis, which was statistically significant on both univariate [P = 0.005] and multivariate [P = 0.007] analysis. CONCLUSIONS: Three weekly CT is less toxic than weekly. Weekly CT can be made more acceptable by reducing the dose and using feeding tubes for nutrition.