title: Uninterrupted moderately accelerated radiotherapy in the treatment of unresectable/advanced head and neck cancer: one institution's experience and a comparative review.
abstract: Conventional radiotherapy alone in treatment of unresectable or locally advanced head and neck cancer has poor results. To improve outcome without significant increase in acute and late morbidity, we began a moderately accelerated hyperfractionation radiation therapy protocol without breaks for treatment of unresectable/advanced head and neck malignancies. From August 1984 to June 1995, 48 patients with unresectable or advanced carcinoma of the head and neck were treated using a protocol of accelerated hyperfractionation radiation therapy at Kaiser Permanente Medical Center, Los Angeles. Patients were treated twice a day using 150 cGy per fraction, 4 days per week, to a final dose of 60 Gy. Two patients were excluded from this analysis because they did not complete treatment. With a median follow-up of 33 months, 31 (67%) patients have had disease recurrence, 30 (65%) of whom had a locoregional component to their failures. At the last follow-up, 12 patients (26%) were alive with no evidence of disease, 30 patients had died of disease, and 4 had died of intercurrent disease without recurrence. Nine (19%) patients required treatment interruptions averaging 8 days in duration. This accelerated regimen resulted in outcomes similar to those with conventional radiotherapy, most likely because of a conservative total dose. Further refinement of fractionation schedules with potential incorporation of chemotherapy must be investigated.
authors.affiliation: Kaiser Permanente Medical Center Los Angeles, California, USA.
authors.forename: M
authors.initials: M
authors.lastname: Dowlatshahi
authors.forename: S
authors.initials: S
authors.lastname: Iganej
authors.forename: A
authors.initials: A
authors.lastname: Ciabatone
authors.forename: A
authors.initials: A
authors.lastname: Peddada
authors.forename: M
authors.initials: M
authors.lastname: Miller
authors.forename: M
authors.initials: M
authors.lastname: Tome
authors.forename: A
authors.initials: A
authors.lastname: Rao
authors.forename: M
authors.initials: M
authors.lastname: Ryoo
authors.forename: G
authors.initials: G
authors.lastname: Becker
authors.forename: M
authors.initials: M
authors.lastname: McNicoll
authors.forename: T
authors.initials: T
authors.lastname: Morgan
authors.forename: J
authors.initials: J
authors.lastname: Ryoo
authors.forename: R
authors.initials: R
authors.lastname: Kagan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018572:Disease-Free Survival; D019583:Dose Fractionation, Radiation; D004307:Dose-Response Relationship, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local; D011879:Radiotherapy Dosage; D012189:Retrospective Studies