title: Accelerated radiotherapy in locally advanced head-neck carcinomas: are concomitant boost and chemotherapy feasible in the routine outpatient-based radiotherapy clinic?
abstract: OBJECTIVE
  Accelerated radiotherapy and concurrent chemoradiotherapy is an effective treatment modality in locally advanced head and neck carcinomas. In this study, we examined the efficacy and feasibility of concomitant boost radiotherapy and chemotherapy in the routine outpatient- based radiotherapy clinic.
  
  
  METHODS
  Between January 1993 and December 2000, only 51 out of 127 eligible patients were deemed suitable to receive concomitant boost radiotherapy and/or chemotherapy. Their median age was 60 years (range 17-83 years). The histological diagnosis was squamous-cell carcinoma in 38 (75%) patients, undifferentiated nasopharyngeal carcinomas (WHO type III) in 10 (20%) patients and other histology in 3 (5%) patients. The concomitant boost regimen consisted of 70 Gy in 6 weeks (1.8 Gy/fraction/day, 5 days/week, to the clinical target volume (CTV), and 1.6 Gy/fraction/day to the gross tumor volume (GTV) as a second-daily treatment for the last 2 weeks). The concomitant chemotherapy regimen consisted of cisplatin 100 mg/m(2) given every 3 weeks for 3 courses, and the neoadjuvant regimen of cisplatin 100 mg/m(2) plus epirubicin 100mg/m(2), every 3 weeks for 3 courses.
  
  
  RESULTS
  Only 55% of patients completed the treatment exactly as planned, with 82% completing treatment within acceptable limits. The median radiotherapy duration was 45 days (40-95 days). In univariate analysis, patients with better performance status (p=0.002) or nasopharyngeal carcinomas (p=0.043) had a significantly better compliance to treatment. In multivariate analysis only nasopharyngeal site was a significant predictor of compliance (p=0.019). The maximum acute reaction was grade 3 mucositis in 24 (49%) patients. No grade 4 acute or late reactions were seen. Complete and overall response rates were 51% and 75.5%, respectively. Patients with nasopharyngeal cancer and good treatment compliance had a better response rate (p=0.009 and 0.01, respectively). The median follow-up period of surviving patients was 28 months (range 6-58 months). The 3-year progression-free survival rate was 39%.
  
  
  CONCLUSIONS
  In the routine outpatient-based setting we found that this intensive treatment schedule can only be given to a limited and highly selected group of patients.
authors.affiliation: Dokuz Eylül Head and Neck Carcinomas Group, Izmir, Turkey; Department of Radiation Oncology, Dokuz Eylül Medical School, Izmir, Turkey. fadime.akman@deu.edu.tr
authors.forename: F
authors.initials: F
authors.lastname: Akman
authors.forename: M
authors.initials: M
authors.lastname: Sen
authors.forename: T
authors.initials: T
authors.lastname: Erdag
authors.forename: O
authors.initials: O
authors.lastname: Cetinayak
authors.forename: F
authors.initials: F
authors.lastname: Eyiler