TMSS Medical College Journal

Background: Locally advanced inoperable squamous cell carcinoma of the head and neck (SCCHN) region requires intensive treatment approaches such as chemoradiation. The optimal strategy, whether concurrent or sequential chemoradiation, remains unclear in terms of balancing efficacy and toxicity. Objective: This study aimed to compare the acute toxicities of concurrent chemoradiation (CRT) and sequential chemoradiation in patients with locally advanced inoperable SCCHN. Material and Methods : A quasi-experimental study was conducted in the Department of Radiotherapy, Rajshahi Medical College Hospital, from June 2019 to May 2020 for locally advanced inoperable SCCHN. Patients receiving concurrent chemoradiation (CRT) in Arm A (n=30) with weekly cisplatin 30 mg/m2 and radiotherapy 60 Gy were compared to those receiving sequential chemoradiation in Arm B (n=30) with paclitaxel 175 mg/m2 and cisplatin 75 mg/m2 3 weekly for 3 cycles followed by radiotherapy after 3 weeks with the same dose. Acute toxicities were assessed using Common Terminology Criteria for Adverse Events (CTCAE) version 5.0. Results: A total of 60 patients were included, with 30 in cach arm. The incidence of grade ITI-IV mucositis was lower in the sequential chemoradiation arm compared to the concurrent arm (20% vs. 31.1%). Similarly, the incidence of grade ILIV dysphagia was lower in the sequential arm (14.3% vs. 24.4%). There were no significant differences in the incidence of xerostomia, dermatitis, or hematological toxicities between the two arms Conclusions: Sequential chemoradiation may be associated with lower rates of severe mucositis and dysphagia compared to concurrent chemoradiation in locally advanced inoperable SCCHN.

Locally advanced inoperable squamous cell carcinoma of the head and neck (SCCHN) represents a significant challenge in oncology due to its aggressive nature and limited treatment options.! Chemoradiation, the concurrent administration of chemotherapy and radiotherapy, has emerged as a standard treatment approach for these patients, offering improved locoregional control and survival outcomes compared to radiotherapy alone.” However, whether concurrent or sequential, the optimal sequencing of chemotherapy and radiotherapy remains a topic of debate among clinicians and researchers. The choice between concurrent chemoradiation (CRT) and sequential chemoradiation in locally advanced inoperable SCCHN is influenced by several factors, including treatment efficacy, toxicity profile, and patient tolerance. While concurrent chemoradiation has demonstrated superior outcomes in terms of locoregional control and survival, it is also associated with increased acute and long-term toxicities, such as mucositis, dysphagia, Xerostomia, dermatitis, and | hematological toxicities.”