ACCELERATED FRACTIONATION RADIOTHERAPY AND CONCOMITANT CHEMOTHERAPY IN PATIENTS WITH STAGE-IV INOPERABLE HEAD-AND-NECK-CANCER

Background. Stage IV inoperable head and neck cancer has a a-year mort ality rate of greater than 70% when treated with conventional radiothe rapy. A Phase II study was undertaken to evaluate the effects of conco mitant chemotherapy and accelerated, interrupted, twice-a-day radiothe rapy on tumor response, locoregional control, survival, and morbidity. Methods, Thirty-four patients with Stage IV inoperable squamous cell carcinoma of the head and neck and a minimum follow-up of 36 months we re evaluated. Concomitant chemoradiotherapy was administered during we eks 1, 3, and 5 (with planned breaks during weeks 2 and 4), consisting of cisplatin 60 mg/m(2) on Day 1, continuous 5-day infusion of 5-fluo rouracil, 750 mg/m(2) per day, and radiotherapy, 2 Gy twice a day, mor e than 6 hours apart, followed by 3 days of radiation therapy alone (f inal ''boost'') in week 6, for a total dose of 70 Gy and treatment dur ation of 5 1/2 weeks (38 days). Results. Twenty-seven patients achieve d a clinical complete response (82%). Actuarial locoregional control a t 3 years was 73% and the actuarial 3-year survival probability, inclu ding all deaths, was 38%. All locoregional recurrences were manifested within 12 months. Of the 20 deaths, 12 were tumor related (locoregion al and/or metastatic), 3 were treatment related, and 5 were due to oth er causes. Acute toxicity consisted of grade 3 mucositis and dysphagia and grade 2-3 leukopenia, not requiring treatment interruption or ces sation. Conclusion. Concomitant accelerated radiation therapy and chem otherapy is a feasible treatment approach in this prognostically poor patient population, yielding dramatic tumor responses and impressive l ocoregional control at the cost of somewhat increased acute toxicity. Although serious late complications have not been observed, caution sh ould be exercised in view of the relatively short follow up.