Long-term results of accelerated radiation treatment for advanced head andneck cancer

Background and purpose: This report presents long-term follow-up data from a prospective but unrandomized trial of a continuous 3.5week course of acce lerated radiation treatment (ART) used as primary treatment for patients wi th loco-regionally advanced head and neck cancer. Materials and methods: Ninety-three patients in three centres in New Zealan d and Australia were treated with ART (59.40 Gy in 33 fractions over 24-25 days). Their disease originated from three anatomical regions (oral cavity, 35 patients; pharynx, 31 patients; larynx, 27 patients). Seventy-nine of t hese patients had stage III or IV cancers. Results: Follow-up ranged from 68 to 203 months (median 139 months). Loco-r egional (LR) failure occurred in 52 patients leading to a 10-year actuarial expectation of LR control of 38%. The actuarial expectation of LR control at 10 years was highly dependent on stage and for stage III, IVA and IVB pa tients it was 57 +/- 8.1%, 32 +/- 1.7% and 7 +/- 0.5%, respectively. Multiv ariate analysis could not confirm an independent impact of primary site or histological differentiation on LR failure. Two patients died of acute toxi city of treatment and six patients developed grade 3/4 late complications a ffecting soft tissues only, yielding an actuarial expectation of complicati ons of this severity at 5 years of 9%. No cases of osteoradionecrosis or my elitis were observed. Conclusion: This ART, which has proved easy to use at a number of large and small centres, has produced encouraging long-term LR control at a cost of limited soft tissue morbidity. (C) 1998 Elsevier Science Ireland Ltd. All r ights reserved.