SPLIT HYPERFRACTIONATED ACCELERATED RADIATION-THERAPY AND CONCOMITANTCISPLATIN FOR LOCALLY ADVANCED HEAD AND NECK CARCINOMAS - A PRELIMINARY-REPORT

Purpose: The feasibility and activity of an intensive chemoradiotherap eutic scheme for patients with locally advanced squamous cell head and neck cancers were tested in a single institution Phase II pilot study . Methods and Materials: Between January 1990 and February 1992, 40 pa tients were entered into this trial. The treatment protocol consisted of split hyperfractionated accelerated radiation therapy (SHART), 1.6 Gy per fraction given twice per day to a total dose of 64-67.2 Gy for a total of 6 weeks with a 2-week gap, and cisplatin (20 mg/sqm/Days 1 to 5, in continuous perfusion) concomitantly. Results: All of the 40 p atients are evaluable for response and survival. Toxicity was signific ant, but tolerable. A complete tumor response to this treatment was ac hieved by 37 patients (92.5%). With a minimal followup of 22 months (m edian 30 months) there have been 16 local relapses and 19 patients hav e died, 2 without tumor. The projected 2- and 3-year overall survival rates are 64% (confidence interval (CI) 95%, 49-79%) and 47%, respecti vely. The 2-year local control probability has been 56% (CI 95%, 39-73 %). Conclusion: This treatment obtains a high rate of complete respons es with increased acute toxicity but tolerable late effects. Prelimina ry results are encouraging for laryngeal neoplasms. A longer follow-up is needed to evaluate the impact of this treatment on patient surviva l.