Prospective Study on Hypofractionated Intensity Modulated Radiation Therapy(using VMAT Technique) with Concurrent Chemotherapy in Locally Advanced Laryngeal and Hypopharyngeal Squamous Cell Cancers

Radiotherapy, in combination with chemotherapy is the mainstay of treatment for locally advanced laryngeal and hypopharyngeal cancers, as radical surgery is associated with high morbidity and functional compromise. The development of Intensity Modulated Radiation Therapy (IMRT) has resulted in improved dose distributions, with smaller volumes of normal tissues receiving high doses; which provides the opportunity of increasing the dose per fraction. Volumetric modulated arc therapy (VMAT) is a novel technique of delivering IMRT that reduces treatment delivery time and offers good conformity. Chemotherapy induced radio sensitization can also be considered as a method of biologic dose escalation. In this study, 44 patients will be selected based on their stage, general condition, other inclusion and exclusion criteria. The selected patients will be simulated by CT simulator. After CT simulation, contouring of the tumor and critical structures will be done. Patient will receive 55 Gy/20# to PTV 55, 50 Gy/20# to PTV 50 and 46 Gy/20# to PTV 46. Along with this, they will receive concurrent chemotherapy with injection cisplatin. First 3 follow-up visits will be at 2 weeks, 4 weeks and 6 weeks after completion of treatment. Thereafter, the follow up to continue monthly once for the first 6 months and at 3 monthly intervals for the rest of the study period. In each follow-up, patient will undergo a complete head and neck examination and will be assessed clinically for response and toxicities. Investigations will be done accordingly. CECT neck will be done 3 months post treatment to assess the tumor response and will be correlated clinically. Response will be assessed using RECIST version 1.1. Acute and late toxicities will be assessed and graded as per CTCAE version 5.0.

In this study, 44 patients recruited till closure of recruitment and planned hypofractionated IMRT using VMAT technique (55 Gy in 20#) plus 3 weekly Cisplatin 100 mg/sqm. Among them, 43 patients (97.7%) received full course of treatment and 1 patient (2.3%) did not complete (discontinued after 2# radiotherapy) the treatment.