Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival

T Rupasinghe; D C Silva; J Balawardena; K Perera; D Gunasekera; S Weerasinghe; N Jeyakumaran; P Abeysinghe; T Skandarajah; A Choudhury; N Joseph

doi:10.1016/j.clon.2021.09.017

Curative-Intent Radiotherapy for Squamous Cell Carcinoma of the Head and Neck in Sri Lanka: The Impact of Radiotherapy Technique on Survival

Clin Oncol (R Coll Radiol). 2021 Dec;33(12):765-772. doi: 10.1016/j.clon.2021.09.017. Epub 2021 Oct 9.

Authors

Affiliations

¹ National Cancer Institute, Maharagama, Sri Lanka; Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka.
² Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka.
³ Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka; General Sir John Kotalawela Defence University, Kandawala, Sri Lanka.
⁴ The Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK; The Christie NHS Foundation Trust, Manchester, UK.
⁵ Sri Lanka Cancer Research Group, Sri Lanka College of Oncologists, Mahargama, Sri Lanka; Teaching Hospital, Batticaloa, Sri Lanka. Electronic address: nuradh@gmail.com.

PMID: 34642066
DOI: 10.1016/j.clon.2021.09.017

Abstract

Aims: We conducted a retrospective analysis of patients with squamous cell carcinoma of the head and neck (SCCHN) treated with curative-intent radiotherapy at the National Cancer Institute of Sri Lanka to determine the impact of the treatment technique on disease-free survival (DFS).

Materials and methods: SCCHN patients treated with radical radiotherapy or adjuvant postoperative radiotherapy from 2016 to 2017 were included in the study. Data on the following variables were collected by reviewing clinical and radiotherapy treatment records: age, gender, tumour site, stage, time to delivery of radiotherapy, use of neoadjuvant chemotherapy, use of concurrent radiosensitising chemotherapy and treatment technique. DFS, defined as the time to death, tumour recurrence or loss to follow-up, was the primary end point and outcomes were compared between patients treated with intensity-modulated radiotherapy (IMRT) in linear accelerators and those treated with conventional radiotherapy in cobalt teletherapy units. Univariate and multivariate analyses were carried out on known prognostic variables.

Results: In total, 408 patients were included in the study, with 138 (34%) being treated with IMRT in the linear accelerator. More than 75% of patients were of stage III or IV at diagnosis. The 2-year DFS of the whole cohort was 25% (95% confidence interval 21-30%). Patients treated with IMRT in the linear accelerator had a superior DFS in comparison with those treated with conventional radiotherapy in the cobalt teletherapy units (P < 0.001, hazard ratio 0.64, 95% confidence interval 0.5-0.82). Higher stage, cobalt treatment and use of neoadjuvant chemotherapy were adversely associated with DFS on multivariate analysis.

Conclusion: A large proportion of patients with SCCHN treated with curative-intent radiotherapy in Sri Lanka had locally advanced disease and DFS was superior in patients treated with IMRT in the linear accelerator.

Keywords: Head and neck cancer; intensity-modulated radiotherapy; radiotherapy.

MeSH terms

Disease-Free Survival
Head and Neck Neoplasms* / radiotherapy
Humans
Neoplasm Recurrence, Local
Radiotherapy, Intensity-Modulated*
Retrospective Studies
Squamous Cell Carcinoma of Head and Neck
Sri Lanka