A comparison of outcomes with ′Christie Regimen′ and pure accelerated radiotherapy versus conventional radiation in locally advanced squamous cell carcinoma of head and neck: A randomized controlled study

Context and Aim: Radiotherapy is alternative to concurrent chemoradiation or surgery for locally advanced squamous cell carcinoma of head and neck (LAHNSCC) due to comorbid conditions. The aim of this study was to compare efficacy and toxicity among hypofractionated, pure accelerated and conventional radiotherapy schedules. Settings and Design: Interventional randomized controlled study. Materials and Methods: Between May 2008 and May 2012, 132 LAHNSCC patients, AJCC stages III to IVB, creatinine clearance <60 ml/min, age more than 50 years, comorbidities like uncontrolled diabetes, cardiac disease, ECOG 3 and 4, or combination of these were randomized into three arms: Arm A, "Christie Regimen", 50 Gray (Gy) in 16 fractions, 3.125 Gy per fraction over 3 weeks; Arm B, 66 Gy in 33 fractions in 6 fractions per week in 5.5 weeks; and Arm C, 66 Gy in 33 fractions, 5 fractions per week, in 6.5 weeks. The endpoints of the study were overall response (ORR = complete response + partial response), diseasefree survival (DFS), toxicities, and overall survival (OS). Statistical Analysis Used: All statistical tests were done using ANOVA. OS and DFS were calculated using KaplanMeier analysis. Result: ORRs were comparable in all arms, P value = 0.401. DFS were in favor of altered radiation, P value = 0.034. Acute Grade 3 cutaneous toxicity (P value = 0.018) and mucositis (P value = 0.011) were high with altered fractionation. Chronic grade 2 and 3 toxicities were higher in altered fractionations. Conclusion: There was no difference in the ORR between three arms but DFS was in favor of altered fractionation arms with manageable toxicity. Both altered fractionation had short overall treatment time which is radiobiologically superior and is beneficial for centers like ours where the patient load is much higher than the facility available.