FEASIBILITY AND OUTCOME OF A PROGRESSIVELY ACCELERATED CONCOMITANT BOOST RADIOTHERAPY SCHEDULE FOR HEAD AND NECK CARCINOMAS

Purpose: To evaluate toxicity and treatment outcome in patients with h ead and neck carcinomas treated with a modified bifractionated concomi tant boost radiotherapy schedule. Methods and Materials: Eighty-five p atients were treated from February 1991 to October 1995. According to clinical TN stage 23 tumors were T1, 33 T2, 20 T3, 9 T4, 44 N0, and 41 N1-N3. The primary tumor was located in the oral cavity in 6 patients , oropharynx in 36, larynx in 19, hypopharynx in 17, and nasopharynx i n 7. The basic treatment delivered 50.4 Gy in 28 fractions, once a day , to the primary site and both sides of the neck. During the last 3.5 weeks, a boost to the initial gross disease was delivered in 13 fracti ons of 1.5 Gy each as a second daily fraction in a progressively accel erated schedule (total dose 69.9 Gy). Eighteen patients had a uni- or bilateral neck dissection, and 2 an adenectomy before radiotherapy. Th e median follow-up for the surviving patients was 28 months (range: 3- 61 months). Results: All the patients completed the planned radiothera py schedule. According to the RTOG scoring system, 57 patients (67%) p resented with Grade 3-4 acute toxicity. Grade 3 dysphagia was observed in 20 patients (23.5%). Three patients died during the 3 months follo wing the treatment. Among 73 patients evaluable for late effects, five developed Grade 3-4 complications. At 3 years actuarial loco-regional control was 67% and overall survival was 62%. Conclusions: Although l onger follow-up is needed to evaluate the definitive results, we concl ude that this particular concomitant boost schedule is feasible and ap pears to be effective. While acute toxicity was greater than in monofr actionated schedules, it was manageable, provided that supportive care measures were implemented in a timely fashion. (C) 1997 Elsevier Scie nce Inc.