Higher Toxicity Rates Following Hypofractionated Radiotherapy in Early Glottic Cancer Patients

Abstract

Context: Toxicity from radiation therapy for laryngeal squamous cell carcinoma includes dysphagia, mucositis, laryngeal edema, weight loss and pain. Hypofractionation (HF) regimens shorten the overall treatment time to lower the risk for accelerated repopulation of tumor cells following initiation of radiotherapy (RT) demonstrated improved overall survival and locoregional control. Objective: To examine the early toxicity of HF to the larynx, compared with standard fractionated (SF) RT. Methods: Retrospective analysis of 127 laryngeal SCC patients who were treated with RT; Early glottic cancer (50%) received hypofractionation (2.25Gy/fr, 63Gy) only to the glottis while advanced stage disease (50%) received standard fractionation (2Gy/fr, 70Gy) to the glottis and to bilateral neck, with or without concurrent chemotherapy (CRT). Results: Patients in HF group consumed significantly higher dosages of both Fentanyl (15 mg versus 8 mg) and Oxycodone (2.9 mg versus 2.1) due to increased pain and discomfort (P<0.05). Patients in HF group who were treated with Dexamethasone boluses demonstrated a significantly lower weight loss compared to HF patients not treated with steroids, and even promoted weight gain in some (p<0.005). Patients with advanced-stage cancer who were treated with CRT suffered from greater toxicity, compared to RT alone, leading to higher rates of dehydration events and weight loss. Conclusions: HF-treated patients tend to consume significantly higher doses of opioids than patients treated with SF, representing higher levels of pain. Treatment regimens for patients undergoing HF should include proper pain management, and when possible, steroids.