Sujatha, V (2012) A single arm Phase II prospective study to assess the feasibility, tolerance and efficacy of Low dose Radiotherapy with Neoadjuvant Chemotherapy in locally advanced head and neck carcinoma. Masters thesis, Christian Medical College, Vellore.
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Abstract
Purpose: Neoadjuvant chemotherapy plays an ever increasing role in the management of locally advanced head and neck carcinomas. The addition of low dose fractionated radiotherapy can act as a chemopotentiator and lead to increased effectiveness of chemotherapy. The feasibility, tolerance and efficacy of adding low dose radiotherapy to neoadjuvant chemotherapy has been explored in this phase II study. Materials and methods: Newly diagnosed patients withcarcinomas of head and neck region with locally advanced stages were treated with 2 cycles of neoadjuvant chemotherapy with Inj Paclitaxel (175mg/m2) and Inj Carboplatin (AUC 5). Low dose fractionated radiotherapy of 80 cGy per fraction was delivered to the gross tumour on days 1 and 2 of each cycle of chemotherapy. Disease status was assessed clinically before each cycle of chemotherapy. CT imaging of the head and neck was done at baseline and again after completing induction therapy. Feasibility and tolerance of radical chemoradiotherapy following induction therapy was assessed by weekly clinical assessment. Results: A total of 14 patients were enrolled in the trial. Of these, 12 patients (85%) completed the full course of 2 cycles of neoadjuvant chemotherapy with low dose radiotherapy. There was one death and one case of disease progression during induction therapy. Among the 9 patients who completed full course of induction therapy, CT imaging and response evaluation showed partial response in 5 patients (45%) and stable disease was seen in 6 patients (55%). Radical radiotherapy following induction therapy was reasonably well tolerated. Concurrent chemotherapy with radical radiotherapy was not well tolerated with none of the patients completing the full planned course of chemotherapy. Conclusions: There was one treatment related death due to neutropenia; all the other patients tolerated induction therapy with Paclitaxel and Carboplatin with low dose radiotherapy reasonably well. All patients tolerated radical radiotherapy following neoadjuvant chemotherapy with low dose radiotherapy reasonably well. Response rate seen was 45%, which is lesser than that reported by major studies. This could be due to small number of patients in the study. Patients did not tolerate the full planned course of concurrent chemotherapy. All patients received the full dose of radiotherapy planned. Hence, addition of low dose fractionated radiotherapy to neoadjuvant chemotherapy is a clinically viable option for locally advanced inoperable head and neck cancer which needs to be evaluated in the setting of controlled clinical trial.
| Item Type: | Thesis (Masters) |
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| Additional Information: | reg.No.20103752 |
| Uncontrolled Keywords: | low dose radiotherapy, ultrafractionation, neoadjuvant chemotherapy, head and neck carcinoma. |
| Subjects: | MEDICAL > Radio Therapy |
| Depositing User: | Subramani R |
| Date Deposited: | 14 Sep 2020 03:47 |
| Last Modified: | 14 Sep 2020 03:47 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/13129 |
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