Intensity-modulated radiotherapy in locally advanced head-and-neck cancers in elderly patients
Neeraj Jain1, Sakshi Jain2, Ramita Sharma1, Kanchan Sachdeva3, Amandeep Kaur4, Abhimanyu Rakesh1, Deepak Abrol5, Meena Sudan1
1 Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab, India
2 Department of Dentistry, Himachal Institute of Dental Sciences, Paonta Sahib, Himachal Pradesh, India
3 Department of Medical Physics, TMH, Mumbai, Maharashtra, India
4 Department of Medical Physics, GCRI, Ahmedabad, Gujarat, India
5 Department of Radiation Oncology, GMC, Kathua, Jammu and Kashmir, India
Department of Radiation Oncology, Sri Guru Ram Das University of Health Sciences, Amritsar, Punjab
Source of Support: None, Conflict of Interest: None
Introduction: Head and neck cancer is one of the most common malignancies in Indian males. Due to poor socioeconomic status, presentation is usually in advanced stage. Treatment option is limited to radiotherapy with or without chemotherapy. Intensity-modulated radiotherapy (IMRT) provides highly conformal dose distributions creating nonuniform spatial intensity using different segments in the beam. Concomitant chemoradiation is highly toxic in this age group.
Material and Methods: During 2016–2017, 44 patients with locally advanced head-and-neck cancers were treated with a curative intent with IMRT. They were in the age range of 65–75. The median age was 69 years. Thirty five were male and nine were female. Histopathologically, all had squamous cell carcinoma. Stage wise, all were T3N2 or more. The standard technique of IMRT was used with sparing of organs at risk and defining treatment volumes: gross, clinical, and planning. Patients were assessed after 4 weeks of completion of treatment for response and toxicities.
Results: Response vise, 14 patients achieved complete response, 28 patients had partial response, and 2 had stable disease. There was no treatment-related mortality. Six patients had treatment interruptions due to toxicity. Incidence of mucositis was of Grade 1–2 in all patients. No hematological toxicity was seen. Patients having dysphagia during treatment were given nasogastric feed.