HEXASHOT: A Short Course Palliative Radiation Therapy of 21Gy in 6 Fractions Over 3 Days in Locally Advanced, Un-Resectable Head and Neck Cancers

Author(s): Subhrajit Das, Vikas Yadav, Jaspreet Kaur, Rajiv Sharma, Rajashekhar CHT.

Background: Head and neck cancer is one of the most common malignancies in developing countries like India with males being the most implicated ones. 60-80% patients present in advanced stage compared to 40% in developed nations. Most of such locally advanced head and neck cancer patients need some form of urgent palliation and palliative radiation therapy is an effective way in mitigating these cases. This pilot study of palliative radiation therapy using 3 days schedule of total 6 fractions (HEXASHOT) was performed to evaluate the response rates, toxicities and quality of life post treatment in these patients. Materials and Methods: Fifty six patients with locally advanced (Stage IVA-IVB), un-resectable, squamous cell carcinoma of head and neck region were recruited under this study. Radiation therapy was delivered by Co60 teletherapy machine. Response rates and quality of life were assessed at 1 and 3 months post treatment, and toxicities at baseline and 1 month using appropriate standard tools. Results: Median age of these 56 patients (51 male and 5 female) in the study was 57 years. Post completion of radiation therapy Response rateswere statistically significant in patients, with 16.1% patients showing a partial response and 75.0% remaining with stable disease after 1 month. At 3 months, 19.6% had a partial response and 62.5% maintained stable disease. Two patients undergone radical conversion to upto 66Gy total dose, after 1 month in view of near complete response. There was a statistically significant improvement in quality of life and other presenting symptoms post treatment. Only four patients reported Grade 2 oral mucositis at 1 month post treatment with no evidence of xerostomia, dysphagia and hematological toxicities post treatment. Conclusion: In developing countries like India with busy, government hospital settings with long dates of radiation therapy and excessive patient load, “HEXASHOT” is an effective palliative radiation therapy schedule providing optimum symptom relief with minimal toxicities within a short period of 3 days, thus mitigating logistics issues.