Paclitaxel Based CCRT Is an Acceptable Alternative for Cisplatin Based CCRT in the Treatment of Locally Advanced (Stage IVA) Head Neck Carcinoma

Abstract

Introduction: Head neck carcinoma is the sixth most common cancer in the world. Concurrent chemo radiation became standard protocol for patients with locally advanced squamous cell carcinoma of head neck where curable surgery is not feasible. Study Design and Objective: This quasiexperimental study done to compare the treatment response and acute toxicities with the treatment of low dose weekly Paclitaxel with radiation versus weekly Cisplatin with radiation therapy for histologically proven Stage- IVA squamous cell carcinoma of head neck. Methods: All the patients were divided in two groups. Arm-A, 45 number patients received injection Paclitaxel 40 mg/m2, i/v in 1 hr. infusion weekly for 6 weeks and in Arm- B, 45 number patients received injection Cisplatin 30 mg/m2, i/v in 2 hrs infusion weekly for 6 weeks. All patients received 66 Gray (Gy) radiation at the rate of 2 Gy/day, 5 fractions in a week for 6.5 weeks. Results: In this study about 65.55% patients were smoker. Most common sub site was larynx (41.46%) followed by oral cavity (25.00%) The most common presenting features were cervical lymphadenopathy (100.00%) followed by pain (70.00%), sore throat (43.33%) and hoarseness of voice (41.11%). Complete response showed in the patients of Arm-A, 73.33% among the smoker and 66.67% in non-smoker, whereas 72.41% in smoker and 62.50% in non-smoker showed complete response in the patients of Arm-B. Common toxicities related to treatment were mucosities, skin reaction, vomiting, nausea, weight loss, anaemia, leucopcnia, thrombocytopenia and diarrhoea. The toxicities in Arm-A were more than that of Arm-B, but were manageable. Conclusion: In this study it is evident, the concurrent chemo radiotherapy with weekly Paclitaxel is suitable alternative when Cisplatin cannot be given safely.