title: Late local treatment morbidity after accelerated radiotherapy or alternating chemoradiotherapy for advanced head and neck carcinoma.
abstract: BACKGROUND
  To report local long-term morbidity after concomitant boost radiotherapy (AFRT) or alternating chemoradiotherapy (CTRT), we analyzed the toxicity data recorded in 168 patients with advanced head and neck squamous cell carcinoma treated at our institution within phase II-III studies.
  
  
  METHODS
  All patients enrolled in three consecutive phase II-III studies and followed for a minimum of three months after the end of treatment were included in the present analysis. Local late reactions were scored prospectively. The actuarial incidence of grade 2 or more (2-4) late local toxicity according to RTOG/EORTC was taken as endpoint. The median follow-up is 32.0 months (range, 3.3-138.1 months). For living patients the minimum and median follow-up are 12.1 and 69.3 months, respectively.
  
  
  RESULTS
  The five-year actuarial incidence of grade 2+ and grade 3+ toxicity are 56.7 +/- 5% and 21 +/- 4%, respectively. At multivariate analysis, acute mucositis grade, complementary surgery, primary site and performance status proved to be independent predictive factors of grade 2+ late toxicity with P values of <0.001, 0.009, 0.022 and 0.033, respectively. No effect was found for treatment itself on the incidence of late toxicity, although patients treated with accelerated radiotherapy had a higher probability of confluent mucositis than patients treated with alternating chemoradiotherapy (68% vs 32%, P <0.01).
  
  
  CONCLUSIONS
  A substantial proportion of surviving patients develops late complications, although severe irreversible reactions occur in a minority of patients. Acute local toxicity can be used to predict local late toxicity that arises within five years of the end of treatment.
authors.affiliation: Department of Radiation Oncology, National Institute for Cancer Research, Genoa, ltaly. gisangui@utmb.edu
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Sanguineti
authors.forename: Maria Pia
authors.initials: MP
authors.lastname: Sormani
authors.forename: Marco
authors.initials: M
authors.lastname: Benasso
authors.forename: Renzo
authors.initials: R
authors.lastname: Corvò
authors.forename: Franca
authors.initials: F
authors.lastname: Foppiano
authors.forename: Isabella
authors.initials: I
authors.lastname: Ricci
authors.forename: Michela
authors.initials: M
authors.lastname: Marcenaro
authors.forename: Riccardo
authors.initials: R
authors.lastname: Rosso
authors.forename: Vito
authors.initials: V
authors.lastname: Vitale
mesh_terms: D000970:Antineoplastic Agents / Q000009:adverse effects*; D002294:Carcinoma, Squamous Cell / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D006258:Head and Neck Neoplasms / Q000628:therapy*; D006801:Humans; D008297:Male; D015999:Multivariate Analysis; D011878:Radiotherapy / Q000009:adverse effects*; D011879:Radiotherapy Dosage
chemical_list: D000970:Antineoplastic Agents