Comparative study of quality of life, toxicity in weekly cisplatin vs three weekly cisplatin along with radiation in locally advanced head and neck malignancies

Aim: This was a prospective two arm comparative study of quality of life, toxicity and response in patients of locally advanced head and neck cancers treated with concurrent chemoradiation with either three weekly or weekly Cisplatin. Materials and methods: The study was performed during 18 months period, 50 patients of locally advanced head and neck cancer were divided into two arms of 25 patients each. All the patients received conventional radiotherapy on linear accelerator with 6MV photons for a total dose of 66Gy, 2Gy per fraction for 33 fractions. Patients in Arm A received concurrent chemotherapy with three weekly Cisplatin at a dose of 100mg/m2 on day 1, 22 and 43. Patients in Arm B received concurrent chemotherapy with Cisplatin at a dose of 40mg/m2 given weekly. Results: All the patients completed the planned radiotherapy treatment except one patient in Arm A who died during RT. The mean cumulative dose was slightly higher in the weekly arm. RT delay and omission of chemotherapy was more common in the three weekly arm. Compliance to treatment was marginally better in the weekly arm. Response to chemoradiation was slightly better in arm B which was not statistically significant. Acute toxicities were slightly higher in the three weekly arm compared to the weekly arm but statistically insignificant. QOL scores were poorer for patients in the three weekly arm. Patients in the weekly arm reached baseline QOL scores compared to the three weekly arm. Conclusion: Patients who are nutritionally compromised and economically backward, radical radiation with weekly concurrent Cisplatin is a viable and an effective treatment option

A comparative study of neoadjuvant chronomodulated folfox and radiotherapy vs. Conventional folfox and radiotherapy in locally advanced carcinoma rectum

Aim: This study was undertaken to determine and compare the efficacy and toxicity of chronomodulated FOLFOX + radiotherapy to conventional FOLFOX + radiotherapy in the neoadjuvant setting of locally advanced rectal cancer. Materials and methods: A total of 44 patients were randomly assigned to the two arms with 24 in chronomodulated arm (Arm A) and 20 in conventional arm (Arm B).Four cycles of FOLFOX chemotherapy followed by radiotherapy were given to18 patients in Arm A and all the 20 patients in Arm B completed the treatment. All the patients were evaluated for surgery. Tumor down staging and toxicity profile were compared. Results: tumor down staging and sphincter preservation rates were similar in both the arms. Incidence of grade-III and grade-IV stomatitis, diarrhea and paresthesia was more in Arm B than in Arm A. Nausea was the most common symptom in both the treatment arms.83% patients in Arm A and 86% patients in Arm B experienced nausea at some point during the treatment. Diarrhea was more common in Arm B with 15 % patients experiencing grade 3-4 diarrhea when compared to 5.55% in Arm A. Stomatitis was more common in Arm B with 10% patients experiencing grade 3-4 toxicity as compared to 5.5% in Arm A. It was observed with increased frequency in Arm B with 7(20%) patients experiencing grade 3 sensory neuropathy compared to 2(11.1%) in Arm A. The incidence of hematological toxicities was similar in both arms with only grade 1 and 2 neutropenia occurring in both the arms. The incidence of leucopenia was greater in the conventional arm (Arm B).Conclusions: we conclude that the administration of Chronomodulated FOLFOX followed by radiotherapy has a better toxicity profile and hence better tolerance and similar tumor down staging when compared to conventional FOLFOX and radiotherapy in the neoadjuvant treatment of locally advanced carcinoma rectum