Hypofractionated versus conventional radiotherapy with or without chemotherapy in head and neck cancer: A comparative study

Background: To investigate tumor response and toxicities in head and neck squamous cell cancer (HNSCC) upon hypofractionated radiotherapy compared with conventional fractionation. Settings and Design: Data from patients with squamous cell cancer of oral cavity, oropharynx, hypopharynx, and larynx (AJCC, 2010 Stage II to IVB); who received hypofractionated (n = 30) or conventionally fractionated (n = 30) radiotherapy, with or without chemotherapy, between January 2010 to June 2011 were retrieved and retrospectively analyzed. Materials and Methods: In conventional arm (Arm A), each patient received 70 Gy at 2 Gy per fraction over 7 weeks, along with concurrent cisplatin (100 mg/m ² ) on days 1, 22, and 43 for locally advanced stage. In hypofractionated arm (Arm B), each patient received 55 Gy at 2.75 Gy per fraction over 4 weeks, along with concurrent cisplatin (100 mg/m ² ) on days 1 and 22 for locally advanced stage. The end points were tumor response, acute and late toxicities, overall survival (OS), and diseases-free survival (DFS). Results: The tumor response distribution was comparable - 24 (80%) patients in arm A and 23 (76%) in arm B achieved a complete response. Significant differences in frequencies of acute grade ≥ 2 skin toxicity, mucositis were found, with higher frequencies in Arm B. Higher frequencies of late grade ≥ 2 dysphagia, laryngeal edema, xerostomia, and confluent mucositis were encountered in Arm B at 6 months from start of chemoradiation. However, OS, DFS, and loco-regional recurrence rates were comparable between the two arms. Conclusions: Hypofractionated radiotherapy can achieve similar tumor response to conventionally fractionated radiotherapy in HNSCC, although with some increase of toxicity.