Absence of cervical radiation myelitis after hyperfractionated radiation therapy with and without concurrent chemotherapy for locally advanced, unresectable, nonmetastatic squamous cell carcinoma of the head and neck

Purpose: To evaluate the risk of developing radiation myelitis after a cerv ical spinal cord dose of 50.6 Gy given via 1.1 Gy b.i.d. fractionation duri ng a prospective, randomised trial of hyperfractionated radiation therapy ( HFX RT) to a total dose of 77 Gy given in 70 fractions of 1.1 Gy b.i.d., wi th and without concurrent low-dose, daily cisplatin (CDDP) for head and nec k cancer. Methods: Of 130 patients with locally advanced, unresectable, non metastatic squamous cell carcinoma of the head and neck (SCC H&N) who enter ed a prospective, randomised trial, 101 patients received 50.6 Gy to a port ion of their spinal cord and survived > I year following the beginning of t herapy. Forty-five patients were treated with HFX RT alone and fifty-six pa tients also received CDDP. Results: None of these 101 patients developed ce rvical radiation myelitis. Therefore, it was not possible to investigate th e influence of potentially contributing factors on the occurrence of radiat ion myelitis, such as interfraction interval, cord length, and administrati on of concurrent CDDP. Conclusions: Given the increasing number of studies with both altered fractionated regimens and concurrent radio-chemotherapy i n SCC H&N, new studies with more patients are needed to gain better insight into the risks of developing cervical radiation myelitis.