Early morbidity after radiotherapy with or without chemotherapy in advanced head and neck cancer. Experience from four nonrandomized studies.
BACKGROUND
Data on early treatment-related morbidity after radiotherapy alone (RT; 217 patients) or combined with chemotherapy (RT + CT; 182 patients) of head and neck squamous cell carcinoma are analyzed.


METHODS
The patients were treated between November 1985 and November 1996 in four Swiss centers that independently introduced combined-modality therapy in selected cases of head and neck cancer. RT schedules varied among the four centers, but within each institution all patients received the same dose-fractionation schedule irrespective of whether they had CT or not. The following early morbidity items were evaluated: skin, mucosa, larynx, salivary glands, dysphagia, weight loss, and toxic death. Toxicity was scored using the EORTC/RTOG scale.


RESULTS
Although considerable variation was noted among the treatment schedules/centers, the main findings are as follows: (1) early morbidity was significantly enhanced after all five RT + CT schedules compared with RT alone; (2) typically, a third of the patients lost > 10% of their body weight during concurrent RT + CT as compared with 10% of the patients receiving RT alone; (3) at 12 weeks, the prevalence of grade 2 morbidity was 25-60% after RT + CT as compared with 4-20% after RT alone.


CONCLUSIONS
A number of early morbidity items were found to be more prevalent and/or more severe after RT + CT than after RT alone.
Bieri
Sabine
S
Department of Radiation Oncology, Regional Hospital of Sion, Switzerland. sabine.bieri@chr.ch
Bentzen
Soeren M
SM
Huguenin
Pia
P
Allal
Abdelkarim S
AS
Cozzi
Luca
L
Landmann
Christine
C
Monney
May
M
Bernier
Jacques
J
D002294:Carcinoma, Squamous Cell / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D003131:Combined Modality Therapy; D019583:Dose Fractionation, Radiation; D006258:Head and Neck Neoplasms / Q000188:drug therapy* / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D009017:Morbidity; D009367:Neoplasm Staging; D011878:Radiotherapy / Q000009:adverse effects* / Q000401:mortality; D011879:Radiotherapy Dosage; D013557:Switzerland; D015431:Weight Loss / Q000528:radiation effects