Radiation side effects and determinants of head and neck cancers at ORCI, Dar es salaam, Tanzania

Abstract

The vast majority of HNC are squamous cell carcinoma . Throughout the past two decades the efforts to improve the efficacy of treatment for locally advanced HNSCC have led to increased use of multimodality approaches combining surgery, radiotherapy , and chemotherapy Most studies use chemotherapy as a treatment modality for HNSCC fail to stratify age in looking at outcome. Currently, available studies looking at outcomes with regards to patient age give little to no data about specific chemotherapeutic agents or radiation techniques and dosing. Given that less than 2% of HNSCC patients are enrolled in clinical trials worldwide, only future enrollment of all patients into clinical trials can give us knowledge about the role of treatment modality and outcome regarding patient age.(1) Xerostomia is one of the most prevalent late side effects of radiation for head and neck malignancies, and patients cite it as the major cause of decreased quality of life. The degree of xerostomia has been reported to depend on the radiation dose and volume of salivary gland irradiated. However, radiation of young patients has specific implications given their potential lifespan. As patients survive longer after radiation treatment for HNC, the long-term consequences of this treatment become more significant. Objectives To evaluate the radiation side effects and determinants among HNC patients at ORCI for the past two years attendig follow up clinic at ORCI hospital between May and September 2012. Also to determine the most prevalent cause of radiation of side effect. Methodology This was a Cross Sectional Descriptive Study.Setting was at ORCI involved 72 consented subjects. Characteristics of the type of radiation side effects and determinants was noted and documented in the request form. Collected data was analyzed using SPSS V15. For the continuous data mean and standard deviation will be considered while for the categorical is by number and percent. The association between radiation side effects and determinants was established using chi square. Budget The whole process from data collection to report submission will cost 1,515,000 Tanzanian shillings. Results A total of 72 patients were included in the study with majority being >65 years of age. SCC was the leading histological type seen in these patients.The study showed that 61.1% of the patients included in the study were not staged. Mucositis was seen as the commonest radiation side effect reported in 50% of the patients. CRT was not associated with increase in radiation side effect compared to EBRT alone. The APPA field technique that was given in most patients resulted in more radiation side effect compare to three separate field technique which was given to some few patients. Conclusion and Recommendations Successful treatment of HNSCC needs planned combination of different treament modalities to achieve local tumor control with minimal radiation side effect.The use of new generation machines increase radiation dose to the target and minimizes doses to critical organs. Oral hygiene and adequate nutrition during RT coarse can be helpful in minimizing radiation side effect in absence of anti-mucositic agents.