OBJECTIVES : To document and assess the following parameters

1. Acute toxicites : mucositis, dermatitis, dysphagia, voice changes, and xerostomia

2. Clinical response rate : changes in gross tumor volume and changes in nodal volume

3.dose volumetric parameters : dose to parotid gland and dose to spinal cord 

all patients will undergo CT simulation and treatment planning by IMRT initially, and will be reviewed weekly basis while RT is going on for grading acute toxicities. 

During the course of treatment patient will undergo rescan and replanning around 23 fractions and dose volume changes are compared with initial scan for gross tumor volume, nodal volume, dose to parotid gland and dose to spinal cord 

During the time period between March 2021 to December 2022, after histopathological confirmation 64 patients were recruited into the study after screening and excluding the patients based on exclusion criteria. Pre-treatment evaluation done in all patients before starting RT. Planning CT was taken with Siemens AS 20 CT simulator and the images were transferred to the MONACO treatment planning systems. All the patients were treated with Elekta synergy linear accelerator (Elekta, Stockholm) with IMRT. In 64 patients, 43 patients received 66Gy and 21 patients received 70Gy. After 22# all patients underwent re CT simulation and replanning

·       The Mean GTV-P volume is 59.03cc in Initial plan and 41.24cc in the Replan with a mean reduction of 30.4%.

·       Mean GTV-N is 48.98cc in initial plan and 31.09cc in Replan with mean reduction of 36.2%.

·       We achieved reduced volume of tumour was calculated to be at the rate of 1.11% per day.

·       The mean reduction in the Dmax Spinal Cord dose, Dmean Right Parotid and Dmean Left Parotid 3.4%, 6.3% and 4.5% respectively. The Above values were found to be statistically significant

·       V95% is more than 95% and v107% is less than 2% in both initial and replans.

The observed acute radiation induced toxicities in our studies were mucositis, dermatitis, dysphagia, xerostomia and voice changes. Most of the patients had grade 2 and grade 3 acute toxicities. Maximal grading in acute toxicities; Mucositis is Grade 2-38/64 (59.37%), Dermatitis is Grade 2-46/64 (71.87%), Dysphagia is Grade 2-37/64 (57.8%), Voice changes is grade 2-29/64 (57.8%), Xerostomia Grade 1 is 50/64 (78.1%). No one experienced grade 3, grade 4 xerostomia. There were no deaths during the course of treatment.

All 64 patients underwent response evaluation in 8-10weeks after the completion of treatment. In those 56.25% patients had complete response, 32.81% patients had partial response, 7.81% patients had progressive disease and 3.12% patients had stable disease.