Gp. Delaney et al., SPLIT-COURSE ACCELERATED THERAPY IN HEAD AND NECK-CANCER - AN ANALYSIS OF TOXICITY, International journal of radiation oncology, biology, physics, 32(3), 1995, pp. 763-768
Citations number
21
Categorie Soggetti
Oncology,"Radiology,Nuclear Medicine & Medical Imaging
Purpose: To retrospectively assess a protocol of split-course accelera
ted radiation therapy (SCAT) for selected head and neck cancers. Metho
ds and Materials: SCAT consisted of 1.8 Gy per fraction administered t
wice daily with a minimum gap between fractions of 6 h. The treatment
protocol prescribed an initial 16 fractions followed by a planned 5 to
12 day break, and then a further 20 to 22 fractions for a total dose
ranging from 64.8 to 72 Gy delivered in 5 to 6 weeks. Results: Twenty-
eight patients received SCAT for histologically confirmed head and nec
k cancer between January 1987 and August 1991. All patients were follo
wed up until December 1, 1993. The mean potential follow-up time was 4
.2 years (range: 2.9-6.2 years). All patients completed the treatment
protocol. Thirteen tumors were laryngeal in origin, eight hypopharynge
al, four paranasal sinus, and three oropharyngeal. There were no Stage
I, three Stage II, nine Stage III, and 12 Stage IV tumors. Four tumor
s were not staged (two paranasal sinus cancers and two surgical recurr
ences). Early and late toxicities were moderate to severe. Confluent m
ucositis was experienced by 27 of the 28 patients (96%). One patient r
equired a prolonged midtreatment break of 24 days. Nine patients (32%)
required narcotic analgesia for pain relief. Eleven patients (39%) re
quired hospitalization for nasogastric feeding or pain control. The me
dian length of hospital stay was 14 days (range 7-98 days). The actuar
ial rate of severe late toxicity at 3 years was 47% (standard error (S
E) = 13%). A complete tumor response was achieved in 86% of patients,
The actuarial local control rate at 3 years was 43% (SE = 11%) and the
actuarial survival rate at 3 years was 25% (SE = 8%). Conclusion: Giv
en the encouraging complete response rate and local control for such a
dvanced tumors, SCAT for locoregionally advanced tumors merits further
investigation. However, because of the significant late toxicity obse
rved, the total dose, interfraction interval, and fractionation techni
que used should be reconsidered.