POSTOPERATIVE ACCELERATED RADIOTHERAPY IN HIGH-RISK SQUAMOUS-CELL CARCINOMA OF THE HEAD AND NECK - LONG-TERM RESULTS OF A PROSPECTIVE TRIAL

Background. For patients treated with combination resection and postop erative radiotherapy, the interval between surgery and completion of r adiotherapy represents an opportunity for tumor repopulation and treat ment failure. A prospective trial to test the feasibility and efficacy of accelerated postoperative radiotherapy was concluded in August of 1990. Methods. Thirty-two patients with high-risk pathologic findings were treated with 63 Gy in 35 fractions of 1.8 Gy over 5.2 weeks using a modified concomitant-boost technique. Results. Acute mucosal and sk in reactions were increased but tolerable. At a median follow-up of 6 years, the crude in-field recurrence rate for the entire group was 10/ 32 (31%), with 0/10 (0%) recurrences in patients commencing accelerate d radiotherapy within 4 weeks of surgery and 10/22 (45%) recurrences i n patients with a delay of more than 4 weeks (p = .006). The rate of l ate complications appears similar to that seen with conventional radio therapy, with possibly a higher rate of ''consequential''-type late ef fects. Conclusions. This pilot study suggests that prompt application of accelerated postoperative radiotherapy significantly improves local -regional control and supports the concept of rapid tumor repopulation in the postoperative setting, Various strategies to overcome tumor re population are discussed. (C) 1998 John Wiley & Sons, Inc.