Uninterrupted moderately accelerated radiotherapy in the treatment of unresectable/advanced head and neck cancer - One institution's experience and acomparative review

Conventional radiotherapy alone in treatment of unresectable or locally adv anced head and neck cancer has poor results. To improve outcome without sig nificant increase in acute and late morbidity, we began a moderately accele rated hyperfractionation radiation therapy protocol without breaks for trea tment of unresectable/advanced head and neck malignancies. From August 1984 to June 1995, 48 patients with unresectable or advanced carcinoma of the h ead and neck were treated using a protocol of accelerated hyperfractionatio n radiation therapy at Kaiser Permanente Medical Center, Los Angeles. Patie nts were treated twice a day using 150 cGy per fraction, 4 days per week, t o a final dose of 60 Gy. Two patients were excluded from this analysis beca use they did not complete treatment. With a median follow-up of 33 months, 31 (67%) patients have had disease recurrence, 30 (65%) of whom had a locor egional component to their failures. At the last follow-up, 12 patients (26 %) were alive with no evidence of disease, 30 patients had died of disease, and 4 had died of intercurrent disease without recurrence. Nine (19%) pati ents required treatment interruptions averaging 8 days in duration. This ac celerated regimen resulted in outcomes similar to those with conventional r adiotherapy, most likely because of a conservative total dose. Further refi nement of fractionation schedules with potential incorporation of chemother apy must be investigated.