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Aim: To determine whether hyperfractionated radiotherapy with concurrent cisplatin improves outcome in advanced hypopharyngeal cancers. Methodology: From 2012 to 2014, twenty three patients diagnosed with squamous cell carcinoma of hypopharynx (Stg III-7, Stg IVA-14, and Stg IVB-2) were assigned to receive total dose of 75.9 Gy in 66 fractions @ 1.15 Gy/fraction, twice daily with inter-fraction interval of 6 hours, 5 days/week, over 45 days. Spinal cord shielding was done at 50.6 Gy in 44 fractions. Concurrent chemotherapy was delivered with cisplatin 40 mg/m2 once weekly. The tumor response was assessed at 6 weeks and 3 months after the completion of treatment. Results: All the recruited 23 patients completed the planned treatment. The complete response at 6 weeks and 3 months post treatment for primary and node was observed in 16/23 and 18/23, 13/23 and 16/23patients respectively. The grade I and II toxicities encountered during the treatment were mucositis (16 patients), radiation dermatitis (20 patients), neutropenia (9 patients), and leucopenia (18 patients). Grade 3 reactions seen were mucositis (6 patients), neutropenia (3 patients), leucopenia (2 patients), skin (2 patients) and none of the patients had grade IV reactions. The nutrition was maintained with feeding nasogastric tubes and parentral infusion though out the treatment. The median follow up was 18 months with a median overall survival of 24 months and median disease free survival was 18 months without any statistical significance. Conclusion: Hyperfractionated radiotherapy combined with concurrent weekly cisplatin treatment for locally advanced hypopharyngeal cancers can be considered with rigorous monitoring and management of the toxicities.

Aim: To determine whether hyperfractionated radiotherapy with concurrent cisplatin improves outcome in advanced hypopharyngeal cancers. Methodology: From 2012 to 2014, twenty three patients diagnosed with squamous cell carcinoma of hypopharynx (Stg III-7, Stg IVA-14, and Stg IVB-2) were assigned to receive total dose of 75.9 Gy in 66 fractions @ 1.15 Gy/fraction, twice daily with inter-fraction interval of 6 hours, 5 days/week, over 45 days. Spinal cord shielding was done at 50.6 Gy in 44 fractions. Concurrent chemotherapy was delivered with cisplatin 40 mg/m2 once weekly. The tumor response was assessed at 6 weeks and 3 months after the completion of treatment. Results: All the recruited 23 patients completed the planned treatment. The complete response at 6 weeks and 3 months post treatment for primary and node was observed in 16/23 and 18/23, 13/23 and 16/23patients respectively. The grade I and II toxicities encountered during the treatment were mucositis (16 patients), radiation dermatitis (20 patients), neutropenia (9 patients), and leucopenia (18 patients). Grade 3 reactions seen were mucositis (6 patients), neutropenia (3 patients), leucopenia (2 patients), skin (2 patients) and none of the patients had grade IV reactions. The nutrition was maintained with feeding nasogastric tubes and parentral infusion though out the treatment. The median follow up was 18 months with a median overall survival of 24 months and median disease free survival was 18 months without any statistical significance. Conclusion: Hyperfractionated radiotherapy combined with concurrent weekly cisplatin treatment for locally advanced hypopharyngeal cancers can be considered with rigorous monitoring and management of the toxicities.

Radiotherapy combined with three weekly 100 mg/m2 of cisplatin is the accepted standard of care in head and neck squamous cell carcinoma. However, this regimen is associated with severe toxicities with devastating effects on patients. Alternative protocols like weekly 40 mg/m2 have been used in an attempt to reduce toxicities. The main objective of the present study is to identify the dose intensities and toxicities of weekly cisplatin in patients treated in a tertiary centre over a 12 month period. Included patients had squamous cell carcinoma arising in the oral cavity, oropharynx, larynx, or hypopharynx. Patients were excluded if they had nasopharyngeal squamous cell carcinoma, distant metastasis or if they had prior treatment for head and neck cancer excluding neck dissection. During the study period, 52 patients met the inclusion criteria and their data were retrospectively obtained from the patients' database of St James hospital, Dublin. The median age of the study cohort was 54 years (range 33-73). Of the patients, 40 (76.9 %) were male and 12 (20.1 %) were female. The primary tumour sites were as follows: oral cavity and oropharynx in 38 (73 %), larynx in 10 (19 %), and hypopharynx in 4 (8 %). In total, 33 (63.5 %) patients had stage IV disease, while 19 (36.5 %) had stage III disease. Treatment was definitive in 35 (67 %) patients and adjuvant in 17 (35 %). Full-dose radiotherapy was achieved in 50 (96 %) patients. Only 22 (42.3 %) patients completed the intended six cycles of chemotherapy. Cumulative dose of 200 mg/m2 or more was reached in 37 (71 %) patients. The acute adverse effects included grades 3 and 4 mucositis, which occurred in 22 (43.3 %) and 6 patients (12 %), respectively. Grade 3 and 4 neutropenia occurred in six (11.5 %) and three (5.7 %) patients, respectively. The only other haematological toxicity was grade 3 anaemia in 20 (38.4 %) patients. There was no grade 3 or 4 renal toxicity among the study cohort, although grade 2 was observed in