title: Accelerated radiotherapy, carbogen and nicotinamide (ARCON) in locally advanced head and neck cancer: a feasibility study.
abstract: OBJECTIVE
  ARCON (Accelerated Radiotherapy, CarbOgen, Nicotinamide) achieves a large therapeutic gain in rodents. A phase I/II study was therefore undertaken to determine its feasibility in patients with locally advanced head and neck cancer.
  
  
  METHODS
  The accelerated regime CHART was used in 35 patients given carbogen and/or nicotinamide with 11 small volume fractions. Eight patients received carbogen, 12 received nicotinamide and 15 were treated with ARCON. Treatment compliance, side-effects and acute mucositis were monitored in all cases.
  
  
  RESULTS
  All patients underwent CHART as intended. In the 23 patients receiving carbogen, two failed to complete treatment. Compliance with nicotinamide was much lower. Out of 25 patients, only 52% received 10-11 doses of the 80 mg/kg/day of the drug. The most common side-effect was nausea and vomiting, which responded to standard anti-emetics in almost half of the patients. Historical comparisons with the CHART head and neck trials indicate that there was no increase in the severity of acute mucositis in any of these patients. Although the observation period is not sufficiently long to be definitive (median 20 months) there is no evidence of an increase in late normal tissue reactions.
  
  
  CONCLUSIONS
  ARCON using CHART as the radiotherapy protocol is feasible in patients with advanced head and neck cancer. However, we are concerned about the low compliance rate in our patients, which is far lower than that reported elsewhere. The implications are discussed together with identifying strategies for increasing compliance.
authors.affiliation: Marie Curie Research Wing, Mount Vernon Hospital, Northwood, Middlesex, UK.
authors.forename: M I
authors.initials: MI
authors.lastname: Saunders
authors.forename: P J
authors.initials: PJ
authors.lastname: Hoskin
authors.forename: K
authors.initials: K
authors.lastname: Pigott
authors.forename: M E
authors.initials: ME
authors.lastname: Powell
authors.forename: K
authors.initials: K
authors.lastname: Goodchild
authors.forename: S
authors.initials: S
authors.lastname: Dische
authors.forename: J
authors.initials: J
authors.lastname: Denekamp
authors.forename: M R
authors.initials: MR
authors.lastname: Stratford
authors.forename: M F
authors.initials: MF
authors.lastname: Dennis
authors.forename: A M
authors.initials: AM
authors.lastname: Rojas
mesh_terms: D000284:Administration, Oral; D000336:Aerosols; D000932:Antiemetics / Q000627:therapeutic use; D002245:Carbon Dioxide / Q000008:administration & dosage* / Q000009:adverse effects; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005240:Feasibility Studies; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008787:Metoclopramide / Q000627:therapeutic use; D009325:Nausea / Q000139:chemically induced / Q000188:drug therapy; D009536:Niacinamide / Q000008:administration & dosage* / Q000009:adverse effects; D010100:Oxygen / Q000008:administration & dosage* / Q000009:adverse effects; D011838:Radiation-Sensitizing Agents / Q000008:administration & dosage* / Q000009:adverse effects; D011882:Radiotherapy, High-Energy; D014839:Vomiting / Q000139:chemically induced / Q000188:drug therapy
chemical_list: D000336:Aerosols; D000932:Antiemetics; D011838:Radiation-Sensitizing Agents; D002245:Carbon Dioxide; D009536:Niacinamide; C011700:carbogen; D008787:Metoclopramide; D010100:Oxygen