HYPERFRACTIONATED-ACCELERATED SIMULTANEOU S RADIOCHEMOTHERAPY OF ADVANCED HYPOPHARYNGEAL CARCINOMAS - SURVIVAL RATES, FUNCTIONAL RESULTS AND QUALITY-OF-LIFE IN A PHASE-II STUDY

Forty-one patients with locally advanced hypopharyngeal carcinomas wer e followed for at least 3 years (median, 60 months) after simultaneous radiochemotherapy. Conventionally fractionated radiotherapy was admin istered as 5x2 Gy/week to a total dose of 30 Gy within 3 weeks. From t he fourth week an accelerated hyperfractionated schedule was used as 2 x1.4 Gy/day five days weekly given exclusively to the first order targ et volume of macroscopic tumor (adding up to a total dose of 72 Gy in six weeks). The second and third order target volumes received convent ional fractionation only to 60 Gy and 50 Gy, respectively. The moderat e acceleration of the concomitant boost scheme in the second half was counterbalanced during the first week by the introduction of a Ei-fluo rouracil bolus of 350 mg/M-2 with 200 mg/M-2 folinic acid and a subseq uent continuous infusion using the same dose each 24 h for 5 days. Add itionally,a Mitomycin-C bolus of 10 mg/M-2 was infused at the fifth da y and on the first day of the sixth week. Six weeks after treatment th e patients were restaged. In cases with residual carcinoma salvage sur gery was performed (11 patients). Late effects of therapy were analyze d according to the Lent-Soma index and life quality according to the E uropean Organisation for Research and Treatment of Cancer-Modul. Late effects of treatment were tolerable and were controlled locally. The 3 -year-survival rate was 39%, with a local-regional recurrence-free con trol rate of 71%. Fifty-two percent of all cases of death were caused by distant metastases, secondary carcinomas or other diseases not rela ted to tumor recurrence. The poor prognosis of hypopharyngeal carcinom as despite acceptable local tumor control may be due to specific biolo gical factors present in affected patients.