Correlation of 3DCRT and Open Field Treatment Techniques in Advanced Head and Neck Cancer Patients Treated by Chemoradiation

Multimodality treatment is required for the management of head and neck cancer. Functional impairment and toxicities associated with surgery and radiation accentuate the need to develop innovative therapeutic strategies in the management of these patients to improve survival and reduce toxicity. In this study, we have compared treatment effects in patients of advanced head and neck squamous cell cancer treated by open field and 3DCRT treatment planning techniques. This study aims to evaluate open field and 3DCRT treatment planning techniques in advanced head and neck squamous cell cancer patients managed by chemoradiation in the scenario of limited resources. In this analytical study, 40 histologically proven unresectable advanced squamous cell carcinoma patients of oropharynx and larynx were allocated in two groups to receive 70 Gy in 35 fractions in 7 weeks with concurrent cisplatinum35 mg/m2 weekly either with open-field technique or three dimensional conformal radiotherapy (3DCRT) by ElektaSynergy linear accelerator. Target volume coverage and dose received by organ at risk (OARs) were compared. Clinical outcome in terms of response and toxicities is also evaluated in this study. Plans with best possible coverage of the target volume were obtained. No significant difference was found in the dose received by the spinal cord; however, it was possible to prevent higher dose to brain stem with 3DCRTin node negative patients of oropharynx cancer and larynx cancer. Skin toxicities were significantly lower in 3DCRT arm. In low resource settings with increased burden of locally advanced disease, both open-field and 3DCRT treatment techniques are comparable in terms of target coverage, OARs preservation, toxicity and treatment response.