ELAPSED RADIATION-THERAPY TREATMENT TIME AS A PREDICTOR OF SURVIVAL IN PATIENTS WITH ADVANCED HEAD AND NECK-CANCER WHO RECEIVE CHEMOTHERAPYAND RADIATION-THERAPY

PURPOSE: To determine whether elapsed radiation therapy treatment time relates to survival in patients with head and neck cancer treated seq uentially with chemotherapy and radiation therapy. MATERIALS AND METHO DS: From 1981 to 1988, 76 adult patients with bulky stage II-IV head a nd neck cancer received induction chemotherapy (fluorouracil and cispl atin). Those with a complete or partial response (n = 46) received ful l-dose definitive radiation therapy (range, 64.0-77.5 Gy; median, 70 G y). Those with less than a partial response (n = 21) undervent surgery and postoperative radiation therapy (n = 15), palliative radiation th erapy (n = 4), or palliative chemotherapy (n = 2). Nine patients refus ed to undergo radiation therapy after induction chemotherapy. RESULTS: The 5-year overall survival rates were as follows: 32% in all patient s, 38% in patients who underwent chemotherapy and radiation therapy, a nd 27% in patients who underwent chemotherapy, surgery, and radiation therapy. The number of days between radiation therapy treatments was h ighly predictive of overall survival. In the groups with treatments le ss than 55 days apart, 56-65 days apart, and more than 66 days apart, the 5-year survival rates were 56%, 46%, and 15%, respectively (P .02) . CONCLUSION The time between radiation therapy treatments is strongly predictive of survival in patients undergoing sequential chemotherapy and radiation therapy. The use of induction chemotherapy does not neg ate the need to avoid treatment interruptions during definitive radiat ion therapy.