Hyperfractionated chemoradiation with carbogen breathing, with or without erythropoietin: A stepwise developed treatment schedule for advanced head-and-neck cancer

Purpose: To investigate the influence of carbogen breathing on chemoradiati on and the effects of erythropoietin on transfusions, Methods and Materials: From March 1996 to April 2000, 42 (4 Stage III and 3 8 Stage IV) patients with head and neck cancer were treated with a twice-a- day hyperfractionated schedule, Each fraction consisted of 5 mg/m(2) of car boplatin plus 115 cGy with carbogen breathing. Treatment was given 5 days p er week up to total doses of 350 mg/m(2) of carboplatin plus 8050 cGy in 7 weeks, Anemia was treated either by transfusion or by erythropoietin. Results: Forty-one patients tolerated the treatment as scheduled, All patie nts tolerated the planned radiation dose. Five transfusions were given in t he first group, but no transfusion was needed in the erythropoietin group. Local toxicities remained at the level expected with irradiation alone. Che motherapy toxicity was moderate. Forty-two complete responses were achieved . At two years actuarial local control, cause-specific survival and overall survival are respectively 85%, 69%. and 68%. At four years estimated proba bilities of local control, cause-specific survival and overall survival are also 85%, 69%, and 68%. Conclusions: These results compare favorably with those of most reported st udies. The addition of carbogen breathing appears to improve the results of chemoradiation alone. Erythropoietin therapy avoided transfusions. (C) 200 1 Elsevier Science Inc.