Modern Radiotherapy for a Medieval Malady: An Analysis of Treatment Toxicities for Locally Advanced Head and Neck Cancers

Background: Concurrent chemo-radiation has proven to be beneficial in a majority of patients with locally advanced head and neck cancers. Despite modern techniques of radiation delivery, the trade-off is acute and entails late toxicities for a considerable number of patients. Very few studies have reported the outcomes of these patients. We aimed to prospectively assess and report the toxicities of patients undergoing definitive chemo-radiation by the volumetric modulated arc therapy (VMAT) for the treatment of advanced laryngeal and hypopharyngeal cancer. Method: This prospective observational study was conducted in a single tertiary care center over a period of two years. We recorded acute and late toxicities during and after the treatment of patients with locally advanced laryngeal and hypopharyngeal cancer treated with definitive chemo-radiotherapy using VMAT. Chi square test and Fisher's exact test were used for comparing the significance of outcome parameters with different variables. Results: 28 patients who met the inclusion criteria were taken up for analysis. The median age was 59 years. The median treatment time was 48 days. The mean dose to parotid, superior, and mid constrictors was 32, 45, and 64 Grays (Gy). At completion, 7% of the patients had grade 3 or more dermatitis, 4% had grade 3 or higher mucositis, and no patient had grade 3 or higher xerostomia. Five patients treated for hypopharynx cancer developed strictures. Conclusion: Our results showed that concurrent chemo-radiotherapy using VMAT is a promising method of treatment for advanced laryngeal and hypopharyngeal squamous cell cancer with an acceptable toxicity profile.