Results of 2 Dimensional Postoperative Radiotherapy Treatment in Carcinoma Buccal Mucosa Patients: A Regional Cancer Centre Experience
Purpose/Objective(s): In India > 1 million new cases of cancer diagnosed every year. 40-50% of these cases are of head and neck cancer because of tobacco overuse. In our institute we have almost 1000-1300 new cases of Carcinoma Buccal Mucosa reported every year. From which 70-75% are surgically operable. For post-operative Radiotherapy treatment, we treat most of our patients by 2 Dimensional conventional treatments. Purpose of this study is to assess toxicity & long term results of postoperative carcinoma buccal mucosa cases treated by 2 Dimensional conventional treatment planning.
Materials/Methods: From January 2009 to January 2012, almost 1980 postoperative cases of Carcinoma Buccal mucosa were referred for radiotherapy treatment. From which 1584 cases were suitable for postoperative 2 Dimensional Conventional planning. In selected cases, 71%, 18%, 11% cases were of Stage IV, III, II (close margin) respectively. Postoperative chemotherapy and radiotherapy was indicated in 475 patients. For all patients Plaster of Paris cast was prepared & X-ray was taken on Simulator machine. Target volume was drawn on x-ray & treatment plan generated on contour drawn with 90-95% isodose line covering the target, with hot spot of +10% on 2D Plato treatment planning system. All patients were treated with unilateral Anterior Posterior Lateral wedge pair technique for buccal mucosa and unilateral lower neck was given in indicated patients. Dose prescribed was 60 Gy/30#, 2Gy/#, 5 days a week, total 6 weeks treatment. Treatment plan verified on day 2 and treatment started. In patients where postoperative chemotherapy and radiotherapy was used, chemotherapy was given Cisplatin 30mg/m2 every weekly for 6 weeks. In most of the patients, treatment break was not required. All patients completed treatment successfully. Patients were assessed for locoregional control, acute & late toxicity and followed up for 3 years for disease free survival and overall survival.
Results: Grade II & III acute mucositis was 82% & 18% respectively in 1109 patients who received only postoperative radiotherapy. For patients who received postoperative radiotherapy and chemotherapy Grade II and Grade III acute mucositis was seen in 75% & 25% respectively and side effects related to Cisplatin were managed conservatively. Almost all patients had Grade II skin reactions. Grade III skin reactions were observed in 8% of patients on post operative radiotherapy alone and 19% of patients on postoperative radiotherapy and chemotherapy but were manageable. All patients tolerated treatment well. For 1584 patients, follow up dropout rate was 20%. None of the patients developed significant late toxicity. As opposite parotid spared, no late complication of xerostomia observed. For 1268 patients, 1-, 2-, 3- year locoregional control rates were 82%, 75%, 68% respectively. Disease free survival rate was 63% (799 patients) & overall survival was almost 55% (697 patients) at median follow up for 40 months.
Conclusion: 2D Conventional Radiotherapy Treatment Planning in our set up has shown very good results with almost 50% survival rates. It is less toxic treatment with fewer complications & less time consuming. It is highly cost effective treatment approach & results are very much encouraging.