Introduction:

       Head and neck cancer is the 6^th leading cancer by incidence world-wide; in which vast majority are squamous cell carcinoma of upper aero digestive tract. Oral cavity, larynx and oropharynx cancer comprises almost 90%. Major modality of treatment is surgery, chemotherapy, radiotherapy or combination of three. Alteration in immune, inflammatory and angiogenetic responses within the micro environment of upper aero digestive tract Carcinoma has a role in tumor aggressiveness and response to chemo radiation. â€¢There is an association between pre-treatment haematological inflammatory markers and outcome & side effects of treatment.  Inflammation has been proposed as a potential mechanism for fatigue in head and neck ca patients who receives radiation; through inhibitory effect on dopaminergic circuits in basal ganglia by inflammatory mediators; fatigue was significantly correlated with mucositis. Pre-treatment Total leucocyte count, Neutrophil /Lymphocyte ratio, Erythrocyte sedimentation rate, C reactive protein are useful biomarkers to predict treatment outcome and select a subgroup of patients in need of more aggressive treatment approach.

Rationale of the study:

        Disease progression in cancer is dependent on complex interaction between tumor and host inflammatory response.  The purpose of this study is:

1.    To study the usefulness of hematological inflammatory markers in predicting short term treatment outcome and occurrence of adverse effects.

2.    The impact of pre and post nutritional status of patients who receive chemoradiation for locally advanced cancer of upper aerodigestive tract on short term treatment outcome and toxicity

Research Hypothesis:

   1. Systemic inflammatory markers are objective and sensitive marker of radiation induced mucositis and for predicting the short term disease outcome .

  2. Treatment the outcome is positively correlated with nutritional status of patients with locally advanced upper aerodigestive tract carcinoma.

Aim of the study:

1.    To evaluate the association of serum inflammatory mediators for predicting clinical response and toxicity after chemoradiation.  

2.    To  analyse the association between nutritional status and short term treatment outcome in patients with locally advanced upper aerodigestive tract carcinoma undergoing chemoradiation.

Objectives:

1.      To detect association between haematological inflammatory markers and acute toxicity and short term treatment response by assessing the markers(Erythrocyte sedimentation rate, C reactive protein, Total leucocyte count, Neutrophil Lymphocyte ratio)before ,during and after treatment.

2.      To assess nutritional  status of  upper aero digestive tract cancer patients treated with chemoradiation on short term treatment outcome by comparing weight, Body mass index, Mid upper arm circumference(MUAC),Triceps skin fold thickness(TSFT ) and S.Albumin before, during and after treatment.

Study group:

Patients with locally advanced biopsy proven upper aero digestive tract Carcinoma planned for definitive chemoradiation.

Study Protocol:

1.    Patients with locally advanced upper aero digestive tract Carcinoma planned for definitive chemoradiation(EBRT to a dose of 60 to 70 Grey + cisplatin 40 mg/m2 or carboplatin) will be evaluated with;

2.    Pretreatment anthropometric and laboratory parameters and repeat on 3rd week, at the end,6 wks and 3 months after chemoradiation

3.    These patients will be clinically evaluated for mucositis based on WHO grading

4.    Response is accessed by radiological imaging modality at 3 months post-treatment