World J Oncol

World Journal of Oncology, ISSN 1920-4531 print, 1920-454X online, Open Access

Article copyright, the authors; Journal compilation copyright, World J Oncol and Elmer Press Inc

Journal website http://www.wjon.org

Original Article

Volume 8, Number 1, February 2017, pages 7-14

Comparative Evaluation of Three Palliative Radiotherapy Schedules in Locally Advanced Head and Neck Cancer

Figure 1. Locally advanced head and neck cancer comparison of three palliative radiotherapy schedules on overall quality of life (n = 90). P values for group I = 0.4, group II = 0.7, group III = 0.6 (not significant).

Figure 2. Locally advanced head and neck cancer comparison of three palliative radiotherapy schedules on locoregional control at the end of treatment (percentage). P values for overall response rate of group I = 0.5, group II = 0.6, group III = 0.3 (not significant).

Figure 3. Kaplan-Meir survival curve showing overall survival for all the groups (in months along the x-axis).

**Table 1.** Patient Characteristics
	Group I (Quad Shot)	Group II (Christie)	Group III (conventional)
Age, years
Range	35 - 85	28 - 77	30 - 72
Median	56	51	56
Gender, n (%)
M	26 (86.7%)	27 (90.0%)	24 (80.0%)
F	4 (13.3%)	3 (10.0%)	6 (20.0%)
Native place, n (%)
Rural	22 (73.3%)	24 (80.0%)	25 (83.3%)
Urban	8 (26.7%)	6 (20.0%)	5 (16.7%)
KPS, n (%)
80	27 (90.0%)	28 (93.3%)	28 (93.3%)
90	3 (10.0%)	2 (6.7%)	2 (6.7%)
Site, n (%)
Base of tongue	10 (33.3%)	11 (36.6%)	9 (30.0%)
Tonsil	7 (23.3%)	8 (26.7%)	4 (13.3%)
Hypopharynx	3 (10.0%)	5 (16.7%)	2 (6.7%)
Larynx	2 (6.7%)	3 (10.0%)	8 (22.7%)
Vallecula	2 (6.7%)	0 (0.0%)	2 (6.7%)
Soft palate/ uvula	2 (6.7%)	0 (0.0%)	1 (3.3%)
Buccal mucosa	0 (0.0%)	0 (0.0%)	1 (3.3%)
Retromolar trigone	1 (3.3%)	0 (0.0%)	1 (3.3%)
Floor of mouth	0 (0.0%)	1 (3.3%)	2 (6.7%)
Anterior tongue	3 (10.0%)	2 (6.7%)	0 (0.0%)
Smoking, n (%)
Yes	24 (80.0%)	25 (83.3%)	23 (76.7%)
No	6 (20.0%)	5 (16.7%)	7 (23.3%)
Tobacco chewing, n (%)
Yes	12 (40.0%)	13 (43.3%)	11 (36.7%)
No	18 (60.0%)	17 (56.7%)	19 (63.3%)
Histopathological distribution, n (%)
WDSCC	1 (3.3%)	6 (20.0%)	2 (6.7%)
MDSCC	23 (76.7%)	21 (70.0%)	23 (76.7%)
PDSCC	2 (6.7%)	1 (3.3%)	2 (6.7%)
SCC(NOS)	4 (13.3%)	2 (6.7%)	3 (10.0%)
Stage, n (%)
III	4 (13.3%)	3 (10.0%)	3 (10.0%)
IV	26 (86.7%)	27 (90.0%)	27 (90.0%)

Table 1. Patient Characteristics

Group I (Quad Shot)

Group II (Christie)

Group III (conventional)

Age, years

Range

35 - 85

28 - 77

30 - 72

Median

Gender, n (%)

26 (86.7%)

27 (90.0%)

24 (80.0%)

4 (13.3%)

3 (10.0%)

6 (20.0%)

Native place, n (%)

Rural

22 (73.3%)

24 (80.0%)

25 (83.3%)

Urban

8 (26.7%)

6 (20.0%)

5 (16.7%)

KPS, n (%)

27 (90.0%)

28 (93.3%)

3 (10.0%)

2 (6.7%)

Site, n (%)

Base of tongue

10 (33.3%)

11 (36.6%)

9 (30.0%)

Tonsil

7 (23.3%)

8 (26.7%)

4 (13.3%)

Hypopharynx

3 (10.0%)

5 (16.7%)

2 (6.7%)

Larynx

2 (6.7%)

3 (10.0%)

8 (22.7%)

Vallecula

2 (6.7%)

0 (0.0%)

2 (6.7%)

Soft palate/ uvula

2 (6.7%)

0 (0.0%)

1 (3.3%)

Buccal mucosa

0 (0.0%)

1 (3.3%)

Retromolar trigone

1 (3.3%)

0 (0.0%)

1 (3.3%)

Floor of mouth

0 (0.0%)

1 (3.3%)

2 (6.7%)

Anterior tongue

3 (10.0%)

2 (6.7%)

0 (0.0%)

Smoking, n (%)

Yes

24 (80.0%)

25 (83.3%)

23 (76.7%)

6 (20.0%)

5 (16.7%)

7 (23.3%)

Tobacco chewing, n (%)

Yes

12 (40.0%)

13 (43.3%)

11 (36.7%)

18 (60.0%)

17 (56.7%)

19 (63.3%)

Histopathological distribution, n (%)

WDSCC

1 (3.3%)

6 (20.0%)

2 (6.7%)

MDSCC

23 (76.7%)

21 (70.0%)

23 (76.7%)

PDSCC

2 (6.7%)

1 (3.3%)

2 (6.7%)

SCC(NOS)

4 (13.3%)

2 (6.7%)

3 (10.0%)

Stage, n (%)

III

4 (13.3%)

3 (10.0%)

26 (86.7%)

27 (90.0%)

**Table 2.** Assessment of Quality of Life in Locally Advanced Head and Neck University of Washington Quality of Life Questionnaire Version 4 (n = 90)
Sr. No.	Symptom	Group I (Quad Shot)	Group II (Christie)	Group III (conventional)
Mean ± standard deviation score for each domain using Wilcoxan signed rank test. *Statistically significant.
1	Pain	50 ± 15.54	100 ± 26.59	0.001*	50 ± 9.48	75 ± 29.16	0.002*	50 ± 13.02	75 ± 26.21	0.001*
2	Appearance	50 ± 13.02	75 ± 16.08	0.000*	50 ± 8.64	75 ± 17.47	0.000*	50 ± 11.37	75 ± 15.99	0.000*
3	Activity	50 ± 18.49	100 ± 22.36	0.000*	50 ± 13.27	75 ± 13.90	0.000*	50 ± 13.13	75 ± 19.35	0.000*
4	Recreation	50 ± 12.60	75 ± 16.61	0.000*	50 ± 11.53	75 ± 14.58	0.000*	50 ± 8.64	75 ± 16.54	0.000*
5	Swallowing	33 ± 28.07	67 ± 27.58	0.076	33 ± 18.08	67 ± 30.12	0.007*	33 ± 22.70	67 ± 27.45	0.021*
6	Chewing	100 ± 28.57	75 ± 25.43	0.763	50 ± 24.51	50 ± 24.91	0.782	100 ± 28.57	75 ± 25.43	0.782
7	Speech	83.5 ± 26.75	100 ± 25.55	0.968	67 ± 16.17	67 ± 18.67	0.705	100 ± 28.30	100 ± 22.62	0.713
8	Shoulder	100 ± 23.1	100 ± 16.99	0.414	100 ± 12.23	100 ± 12.23	1	100 ± 23.51	100 ± 17.00	0.366
9	Taste	100 ± 26.55	67 ± 17.50	0.009*	100 ± 0.00	67 ± 22.32	0.000*	100 ± 21.62	67 ± 24.72	0.001*
10	Saliva	100 ± 0.00	67 ± 17.10	0.000*	100 ± 0.00	67 ± 13.83	0.000*	100 ± 0.00	67 ± 10.76	0.000*
11	Mood	25 ± 23.81	75 ± 31.03	0.001*	25 ± 18.28	75 ± 29.65	0.010*	25 ± 21.51	75 ± 27.61	0.001*
12	Anxiety	33 ± 21.11	67 ± 25.39	0.005*	33 ± 19.05	67 ± 23.92	0.216	33 ± 20.95	67 ± 22.21	0.022*
13	Physical domain score	50 ± 13.22	67 ± 14.63	0.043*	50 ± 8.83	61.33 ± 13.63	0.06	50 ± 13.91	67 ± 12.52	0.002*
14	Social domain score	25 ± 10.17	75 ± 31.95	0.000*	25 ± 0.00	62.5 ± 23.38	0.000*	25 ± 8.64	75 ± 7.45	0.000*
15	HRQOL 7 days	20 ± 10.51	60 ± 22.38	0.000*	20 ± 3.65	40 ± 24.16	0.000*	20 ± 7.43	60 ± 20.44	0.000*
16	Overall QOL	20 ± 10.51	60 ± 23.77	0.000*	20 ± 3.65	40 ± 24.16	0.000*	20 ± 7.43	60 ± 21.87	0.000*

Table 2. Assessment of Quality of Life in Locally Advanced Head and Neck University of Washington Quality of Life Questionnaire Version 4 (n = 90)

Sr. No.

Symptom

Group I (Quad Shot)

Group II (Christie)

Group III (conventional)

Mean ± standard deviation

P value

Mean ± standard deviation

P value

Mean ± standard deviation

P value

Pre-RT

Post-RT

Pre-RT

Post-RT

Pre-RT

Post-RT

Mean ± standard deviation score for each domain using Wilcoxan signed rank test. *Statistically significant.

Pain

50 ± 15.54

100 ± 26.59

0.001*

50 ± 9.48

75 ± 29.16

0.002*

50 ± 13.02

75 ± 26.21

0.001*

Appearance

50 ± 13.02

75 ± 16.08

0.000*

50 ± 8.64

75 ± 17.47

0.000*

50 ± 11.37

75 ± 15.99

0.000*

Activity

50 ± 18.49

100 ± 22.36

0.000*

50 ± 13.27

75 ± 13.90

0.000*

50 ± 13.13

75 ± 19.35

0.000*

Recreation

50 ± 12.60

75 ± 16.61

0.000*

50 ± 11.53

75 ± 14.58

0.000*

50 ± 8.64

75 ± 16.54

0.000*

Swallowing

33 ± 28.07

67 ± 27.58

0.076

33 ± 18.08

67 ± 30.12

0.007*

33 ± 22.70

67 ± 27.45

0.021*

Chewing

100 ± 28.57

75 ± 25.43

0.763

50 ± 24.51

50 ± 24.91

0.782

100 ± 28.57

75 ± 25.43

0.782

Speech

83.5 ± 26.75

100 ± 25.55

0.968

67 ± 16.17

67 ± 18.67

0.705

100 ± 28.30

100 ± 22.62

0.713

Shoulder

100 ± 23.1

100 ± 16.99

0.414

100 ± 12.23

100 ± 23.51

100 ± 17.00

0.366

Taste

100 ± 26.55

67 ± 17.50

0.009*

100 ± 0.00

67 ± 22.32

0.000*

100 ± 21.62

67 ± 24.72

0.001*

Saliva

100 ± 0.00

67 ± 17.10

0.000*

100 ± 0.00

67 ± 13.83

0.000*

100 ± 0.00

67 ± 10.76

0.000*

Mood

25 ± 23.81

75 ± 31.03

0.001*

25 ± 18.28

75 ± 29.65

0.010*

25 ± 21.51

75 ± 27.61

0.001*

Anxiety

33 ± 21.11

67 ± 25.39

0.005*

33 ± 19.05

67 ± 23.92

0.216

33 ± 20.95

67 ± 22.21

0.022*

Physical domain score

50 ± 13.22

67 ± 14.63

0.043*

50 ± 8.83

61.33 ± 13.63

0.06

50 ± 13.91

67 ± 12.52

0.002*

Social domain score

25 ± 10.17

75 ± 31.95

0.000*

25 ± 0.00

62.5 ± 23.38

0.000*

25 ± 8.64

75 ± 7.45

0.000*

HRQOL 7 days

20 ± 10.51

60 ± 22.38

0.000*

20 ± 3.65

40 ± 24.16

0.000*

20 ± 7.43

60 ± 20.44

0.000*

Overall QOL

20 ± 10.51

60 ± 23.77

0.000*

20 ± 3.65

40 ± 24.16

0.000*

20 ± 7.43

60 ± 21.87

0.000*

**Table 3.** Pattern of Failure at Last Follow-Up
Group	Stage	NED	Primary site failure	Nodal failure	Both primary and nodal failure
Group I Quad shot	III	0/4 (0.00%)	3/4 (75.00%)	2/4 (50.00%)	1/4 (25.00%)
IV	6/26 (23.07%)	17/26 (65.38%)	16/26 (61.54%)	13/26 (50.00%)
Total	6/30 (2.00%)	20/30 (66.67%)	18/30 (60.00%)	14/30 (46.67%)
Group II Christie	III	2/3 (66.67%)	1/3 (33.33%)	0/3 (0.00%)	0/3 (0.00%)
IV	6/27 (22.22%)	20/27 (74.07%)	18/27 (66.67%)	17/27 (62.96%)
Total	8/30 (26.67%)	21/30 (70.00%)	18/30 (60.00%)	17/30 (56.67%)
Group III conventional	III	0/3 (0.00%)	3/3 (100.00%)	2/3 (66.67%)	2/3 (66.67%)
IV	4/27 (14.81%)	21/27 (77.77%)	15/27 (55.55%)	14/27 (51.85%)
Total	4/30 (13.33%)	24/30 (80.00%)	17/30 (56.67%)	16/30 (53.33%)
All groups	18/90 (20.0%)	65/90 (72.22%)	53/90 (58.89%)	47/90 (52.22%)

Table 3. Pattern of Failure at Last Follow-Up

Group

Stage

NED

Primary site failure

Nodal failure

Both primary and nodal failure

Group I Quad shot

III

0/4 (0.00%)

3/4 (75.00%)

2/4 (50.00%)

1/4 (25.00%)

6/26 (23.07%)

17/26 (65.38%)

16/26 (61.54%)

13/26 (50.00%)

Total

6/30 (2.00%)

20/30 (66.67%)

18/30 (60.00%)

14/30 (46.67%)

Group II Christie

III

2/3 (66.67%)

1/3 (33.33%)

0/3 (0.00%)

6/27 (22.22%)

20/27 (74.07%)

18/27 (66.67%)

17/27 (62.96%)

Total

8/30 (26.67%)

21/30 (70.00%)

18/30 (60.00%)

17/30 (56.67%)

Group III conventional

III

0/3 (0.00%)

3/3 (100.00%)

2/3 (66.67%)

4/27 (14.81%)

21/27 (77.77%)

15/27 (55.55%)

14/27 (51.85%)

Total

4/30 (13.33%)

24/30 (80.00%)

17/30 (56.67%)

16/30 (53.33%)

All groups

18/90 (20.0%)

65/90 (72.22%)

53/90 (58.89%)

47/90 (52.22%)