Accelerated hypo fractionated radiation therapy with low dose cisplatin in oral tongue cancer using intensity modulated radiation therapy with simultaneous integrated boost: A prospective study

Background: Achieving local control of locally advanced head-and-neck cancers remains a primary challenge. Standard treatment includes surgery followed by radiotherapy or concurrent chemoradiation, with conventional fractionation delivering 66-70 Gy over six weeks. Recent advancements have renewed interest in hypofractionation, necessitating an evaluation of its acute and late toxicities. Objectives: The primary objective was to evaluate the treatment completion rate and the incidence of acute toxicity. The secondary objective was to assess the clinical response rate eight weeks after treatment completion. Materials and Methods: This prospective study was conducted in the Department of Radiation Oncology, Cancer Institute (WIA) from January to December 2021. We included patients with unresectable Stage III/IV squamous cell carcinoma of the oral tongue. Treatment involved hypo fractionated radiation therapy (HYPO RT) using intensity-modulated radiotherapy with a simultaneous integrated boost (IMRT-SIB), delivering 55 Gy and 44-48 Gy in 20 fractions to the tumor and subclinical areas, respectively, with weekly cisplatin. Results: We included 10 patients in the study. All patients (10/10) completed planned radiation therapy, with 90% (9/10) receiving four cycles of weekly cisplatin. No Grade 4 toxicity was observed. Grade 3 mucositis and dysphagia occurred in 5/10 (50%) and 2/10 (20%) patients, respectively. Nasogastric feeding was required in 2/10 (20%), and 1/10 (10%) developed chemo-induced neutropenia and thrombocytopenia. The complete response rate at eight weeks was 70% (7/10). Conclusion: The study demonstrated that accelerated HYPO RT using IMRT-SIB with concurrent low-dose cisplatin is well-tolerated, with acceptable acute toxicity. Further research with larger cohorts and longer follow-ups is warranted to validate these findings and assess long-term outcomes.