Comparative Evaluation of Palliative Radiotherapy with Chemotherapy vs.Palliative Radiotherapy Alone in Locally Advanced Head and Neck Cancer

Background: The aim of the study was to evaluate and compare the efficacy, tolerability and toxicity of two palliative radiotherapy (RT) schedules in locally advanced head and neck carcinoma (LAHNC), i.e., Quad Shot schedule with chemotherapy and Quad Shot schedule alone. Methods: The patients were randomly divided into two groups of 30 each. Group I patients were planned for 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles. All these patients also received paclitaxel 60 mg/m2 intravenous. Group II patients received 14.8 Gy in 4 fractions over 2 days every 3 weeks for three cycles alone. All these patients in Group I and II received total radiation dose of 44.4 Gy. Results: At the end of treatment, complete tumor response (CR) in Group I was better than Group II (40% vs. 36.7%). Disease status (tumor+node) at the end of treatment in terms of complete response was 36.7% vs. 0% (11/30 and 0/30) in Group I and II. Disease status at 6 months of follow up was noted as follows: complete tumor response in Group I and II was 23.3% (7/30) vs. 10% (3/30) (p=0.012). Complete nodal response was 35.7% (10/28) in Group I and 6.67% (02/30) in Group II (p= 0.538). Overall, no evidence of disease was observed in 16.7% (5/30) in Group I and 3.3% (1/30) in Group II respectively (p<0.001). Conclusion: This palliative schedule has been shown to provide good tumor response and palliation of symptoms. The toxicity profile remains low with the addition of paclitaxel. Further investigation is warranted in a larger trial. Palliation of symptoms resulted in improved quality of life for these group of patients