Accelerated hyperfractionated irradiation for advanced head and neck cancer: Effect of shortening the median treatment duration by 13 days

Background and Purpose. Optimal treatment duration of altered fractionation schedules in head and neck cancer is still undefined. A retrospective stud y on local tumor control, survival. and complications of accelerated hyperf ractionated irradiation in head and neck cancer was undertaken to investiga te whether there was an advantage in further shortening overall time from 6 .5 weeks. Methods. Four hundred nineteen consecutive male patients treated with radia tion alone for cure 1987-1998 were analyzed. Patients with stage I, or trea ted also with brachytherapy implants or chemotherapy, were excluded. Treatm ent with accelerated hy perfractionation was performed twice daily, at a me dian of 1.6 Gy/fraction, to a total median dose of 68 Gy in 39 days. The pa tient population was divided into two groups: those with less than or equal to 39 days overall treatment time (group A. n = 227: median, 33 days) and those with > 39 days (group B, n = 192; median, 46 days), Group A received a significant median tumor dose reduction of 7% compared with group B. Results. The 7-year actuarial local control (LC) rates were 59% and 48% for groups A and B, respectively (p = .02). The actuarial LC rates for T1-2 pa tients were 79% and 74% at 7 years for groups A and B, respectively (p = NS ). Similarly, for T3-4 patients, they were 47% and 35% (p = .02), respectiv ely. The 7-year actuarial disease-free survival (DFS) rates for groups A an d B were 39% and 26% (p = .01), respectively. For stage II patients, DFS wa s 62% and 60% at 7 years (p = NS) for groups A and B, respectively. And sim ilarly, for stage Ill-IV patients, DFS was 33% and 20% (p = .04), respectiv ely, at 7 years. LC and DFS rates at 7 years for T4 and stage IV patients, respectively, were significantly improved in group A. Cox regression analys es for LC showed that both T stage and overall time were significant progno stic factors. Similarly, UICC clinical stage and overall time were signific ant prognostic factors for DFS. There was no difference in acute morbidity between the two groups: 3% of patients in both groups required tube or pare nteral feeding. The 7-year actuarial probability of RTOG/EORTC grades 3-5 l ate effects was 15% and 13%, respectively, for each group (p = NS). Conclusions. This study. with the limitations of a retrospective study, has shown a significant improvement in local tumor control and disease-free su rvival, in patients treated with shorter overall treatment times (median, 3 3 days) with an accelerated hyperfractionated irradiation schedule compared with those treated with a median duration of 46 days. No significant enhan cement of acute reactions and late morbidity were observed with the shorter schedule. (C) 2001 John Wiley & Sons, Inc.