International Journal of Research in Medical Sciences | August 2020 | Vol 8 | Issue 8 Page 2834 International Journal of Research in Medical Sciences Mathew Varghese K et al. Int J Res Med Sci. 2020 Aug;8(8):2834-2838 www.msjonline.org pISSN 2320-6071 | eISSN 2320-6012 Original Research Article Comparison of altered fractionation schedule with concurrent chemo- radiation for squamous cell carcinoma of head and neck Mathew Varghese K. 1 *, Geeta S. Narayanan 2 , Bhaskar Vishwanathan 2 , Shashidhar V. Karpurmath 3 , Soumya Narayanan 4 INTRODUCTION Head and neck squamous cell carcinoma (HNSCC) is a locoregional disease confined to the primary tumor and the regional lymph nodes; distant metastasis is rarely seen at the time of diagnosis. Radiotherapy and surgery are thus the treatment of choice with Radiation therapy (RT) playing a pivotal role in the treatment management of HNSCC, if organ preservation is required. Over the past 2 decades, there have been several major advances in the treatment of cancers of the head and neck. Accelerated RT applied to squamous cell carcinoma of the head and neck yields better loco-regional control than does a conventional schedule with identical dose and fractionation. This is in agreement with several similar but small randomized studies. 1-5 Effective chemotherapeutic agents have been developed for HNSCC and are increasingly used sequentially or concurrently with radiation to treat unresectable cases or to promote organ preservation. 6-9 1 Department of Radiation Oncology, Amala Institute of Medical Sciences, Thrissur-680 555, Kerala, India 2 Department of Radiation Oncology, 3 Department of Medical Oncology, 4 Department of Medical Physics, Vydehi Institute of Medical Sciences, Bengaluru, Karnataka, India Received: 00 June 2020 Accepted: 00 July 2020 *Correspondence: Dr. Mathew Varghese K., E-mail: drmathew@hotmail.com Copyright: © the author(s), publisher and licensee Medip Academy. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-Commercial License, which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited. ABSTRACT Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo- radiation in patients with primary and the nodal disease. Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m 2 ). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed. Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05). When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms. Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided. Keywords: Acute toxicity, Altered fractionation, Concurrent chemo-radiation, Radiotherapy, Squamous cell carcinoma of head and neck DOI: http://dx.doi.org/10.18203/2320-6012.ijrms20203095