BIWEEKLY DOSE-ESCALATION IN CURATIVE ACCELERATED HYPERFRACTIONATION FOR ADVANCED HEAD AND NECK-CANCER - A FEASIBILITY STUDY

Purpose: To study the feasibility of a dose-escalated accelerated hype rfractionation schedule for patients with advanced head and neck cance r. Materials and Methods: Twenty-nine previously untreated patients wi th advanced squamous cell carcinoma were treated with the following bi weekly dose-escalated accelerated hyperfraction schedule: during the f irst 2 weeks 1.2 Gy twice a daily (bid) up to 24 Gy, thereafter during the next following 2 weeks 1.4 Gy bid to 28 Gy in 20 fractions, and t hereafter 22.4 Gy bid fractions during 11/2 weeks. Thus, the the total dose was 74.4 Gy in 54 fractions given in 51/2 weeks. Results: The pl anned total dose was given within the planned time to 19 (66%) patient s. For seven patients the treatment time was prolonged with 1 to 6 day s because of department closure for holidays or machine-down days, and in three cases the treatment time was prolonged more than 8 weeks. Wh en the tumor responses were evaluated at 3 months after given radiothe rapy, 27 (93%) patients showed complete tumor clearance, 1 patient had a recidual focus, and 1 patient showed progressive disease. The ultim ate 1-, 2-, and 3-year local control rates were: 87, 71, and 60%. Four patients had a salvage laryngectomy. The 1-, 2-, and 3-year survival rates for all patients were as follows: 96, 81, and 73%. All patients developed confluent mucositis, 15 patients were hospitalized for nutri tional support, and 11 patients had moist desquamation. However, all a cute reactions healed completely, and no serious late complications we re observed. Conclusions: This is a safe and effective treatment sched ule for patients with advanced head and neck cancer. (C) 1997 Elsevier Science Inc.