Assessing feasibility, compliance and toxicity of concomitant chemo‐radiotherapy in head and neck cancers in the Northern Territory: initial experience and challenges

Comprehensive oncology services have recently been introduced in the Northern Territory ( NT ) enabling delivery of concurrent chemo‐radiotherapy ( CCRT ) in locally advanced head and neck squamous cell carcinoma ( LAHNSC ). The purpose of this study is to assess feasibility, compliance and toxicity of CCRT in remote Australia. Methods Chart review was conducted for all patients >18 years, with biopsy‐proven LAHNSC , receiving curative intent CCRT between January 2010 and September 2012. Results The study population comprised of 26 patients, 20 Caucasian and 6 Indigenous, having a median age of 58 years, with most common sites of involvement being the oropharynx ( n = 16) and the oral cavity ( n = 6). Major risk factors were smoking and alcoholism. Cardiovascular disease, viral hepatitis, latent tuberculosis and strongyloidosis were the major comorbidities. Fifty‐eight per cent ( n = 15) required assisted feeding. All patients received intensity modulated radiotherapy. Systemic therapy comprised of cisplatin or carboplatin/cetuximab. Most common acute (grade 3/4) toxicities were mucositis, dysphagia and dermatological in 54%, 31% and 23% respectively. Complications were infection and gastrostomy insertion related. Hospitalisation occurred in 23%, treatment break >2 days in 38%, with no difference in toxicities between indigenous and nonindigenous patients. Platinum use was associated with greater nausea ( P = 0.003), renal dysfunction ( P = 0.03) and ototoxicity ( P = 0.04) and cetuximab with dermatological reactions ( P = 0.05). At median follow‐up of 16 months, overall survival was 58% with progression‐free survival of 50%. Conclusions We have demonstrated good compliance rates, tolerance and feasibility outcomes. The seeming preponderance of LAHNSC in the NT is cause for concern.