Uninterrupted moderately accelerated radiotherapy in the treatment of unresectable/advanced head and neck cancer : one institution's experience and a comparative review

• Published in: American journal of clinical oncology Vol. 23; no. 2; pp. 149 - 154
• Main Authors: DOWLATSHAHI, M, IGANEJ, S, MORGAN, T, RYOO, J, KAGAN, R, CIABATONE, A, PEDDADA, A, MILLER, M, TOME, M, RAO, A, RYOO, M, BECKER, G, MCNICOLL, M
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01-04-2000
• Subjects: Adult; Aged; Aged, 80 and over; Biological and medical sciences; Disease-Free Survival; Dose Fractionation, Radiation; Dose-Response Relationship, Radiation; Female; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Male; Medical sciences; Middle Aged; Miscellaneous; Neoplasm Recurrence, Local; Radiotherapy Dosage; Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects); Retrospective Studies; Human; Rapid technique; Carcinoma; Treatment; Head and neck; ENT disease; Advanced stage; Malignant tumor; Radiotherapy; Fractionated dose
• ISSN: 0277-3732; 1537-453X
• DOI: 10.1097/00000421-200004000-00009

Conventional radiotherapy alone in treatment of unresectable or locally advanced head and neck cancer has poor results. To improve outcome without significant increase in acute and late morbidity, we began a moderately accelerated hyperfractionation radiation therapy protocol without breaks for treatment of unresectable/advanced head and neck malignancies. From August 1984 to June 1995, 48 patients with unresectable or advanced carcinoma of the head and neck were treated using a protocol of accelerated hyperfractionation radiation therapy at Kaiser Permanente Medical Center, Los Angeles. Patients were treated twice a day using 150 cGy per fraction, 4 days per week, to a final dose of 60 Gy. Two patients were excluded from this analysis because they did not complete treatment. With a median follow-up of 33 months, 31 (67%) patients have had disease recurrence, 30 (65%) of whom had a locoregional component to their failures. At the last follow-up, 12 patients (26%) were alive with no evidence of disease, 30 patients had died of disease, and 4 had died of intercurrent disease without recurrence. Nine (19%) patients required treatment interruptions averaging 8 days in duration. This accelerated regimen resulted in outcomes similar to those with conventional radiotherapy, most likely because of a conservative total dose. Further refinement of fractionation schedules with potential incorporation of chemotherapy must be investigated.