Abstract
OBJECTIVE: To study the natural course of disease in patients of advanced squamous cell carcinoma of head and neck (SCCHN) admitted in a rural tertiary hospital and to formulate an acceptable protocol of management and their prognosis. STUDY DESIGN: A 5-year retrospective analysis of patients of advanced SCCHN attended in the department of Radiotherapy and admitted at department of ENT at B. S. Medical College, Bankura, West Bengal were analyzed for the present study. SETTING: B. S. Medical College, Bankura at West Bengal, which is a rural medical college and act as tertiary referral, center for three district of West Bengal namely Midnapur, Purulia, Bankura, part of Burdwan and adjoining area of Jharkhand state. PATIENTS: We investigated 100 patients in our hospital who presented with advanced and in-operable stage of SCCHN. ELIGIBILITY CRITERIA: Biopsy proved cases of SCCHN in stage III, stage IVA and stage IVB which is surgically unresectable and without any past history of radiotherapy and chemotherapy were included in this study. KEY DEMOGRAPHIC FEATURES: Eighty-nine men and 11 female with advanced SCCHN were included in this study. Their median age was 48 years (36-78 years) with a median weight of 44 kg and median Karnofsky score 70. INTERVENTIONS: Different types of palliative surgical intervention like Ryles' tube insertion (16%), feeding jejunostomy (11%), tracheostomy (60%) and arterial ligation (2%) was done to relieve the symptoms. Forty-three patients received chemoradiation and 22 patients received only radiotherapy. Best supportive care was provided to 35 patients. OUTCOME: Twenty-nine percent of patients had partial response in terms of disease control and none had complete response. CONCLUSION: Symptomatic relief of respiratory obstruction, dysphagia and pain constitute the mainstay of treatment in the present study. A short course of radiotherapy is found to be effective in control of symptoms and helps to improve the quality-of-life. Complete response to therapy in advanced head and neck squamous cell carcinoma with a poor nutritional status is very difficult to achieve.