A dose escalation study of hyperfractionated accelerated radiation delivered with integrated neck surgery (HARDWINS) for the management of advanced head and neck cancer.
OBJECTIVE
To determine toxicity and outcome of radiation dose escalation with hyperfractionated accelerated radiation delivered with neck surgery (HARDWINS) for head and neck cancer.


METHODS
Patients with stage III and IV squamous cell carcinoma of the oropharynx, hypopharynx or larynx were enrolled. Dose levels of 60, 62 and 64Gy were delivered with twice daily fractionation in 40 fractions over 4 weeks. Involved and at-risk nodal regions received microscopic dose (46.5-48Gy) with neck dissection for node positive patients 8 weeks after radiation.


RESULTS
One hundred and sixty-nine patients were enrolled (60Gy n=22, 62Gy n=26, 64Gy n=121). No grade 4 acute toxicity was observed. Incidence of acute grade 3 toxicity was: skin (2%), larynx (6%), pharynx and esophagus (66%) and mucous membrane (75%). Feeding tube dependence was observed in 14% of patients receiving 64Gy. Overall survival, and relapse free rate at 5 years were 65% and 63%, respectively. Local, nodal and distant relapse free rates at 5 years were 77%, 94% and 81% (median follow-up 3.8 years).


CONCLUSIONS
HARDWINS can be delivered without acute grade 4 toxicity but significant grade 3 acute toxicity. A significant proportion of the patients have prolonged swallowing dysfunction. Outcomes suggest this regimen represents an alternative to chemoradiation.
Waldron
John
J
Department of Radiation Oncology, Princess Margaret Hospital and the University of Toronto, Canada. john.waldron@rmp.uhn.on.ca
Warde
Padraig
P
Irish
Jon
J
Pintilie
Melania
M
Sellmann
Susanna
S
Bayley
Andrew
A
Cummings
Bernard
B
Kim
John
J
Liu
Fei-Fei
FF
Payne
David
D
Ringash
Jolie
J
Brown
Dale
D
Freeman
Jeremy
J
Gilbert
Ralph
R
Gullane
Patrick
P
Witterick
Ian
I
O'Sullivan
Brian
B
D000328:Adult; D000368:Aged; D002294:Carcinoma, Squamous Cell / Q000532:radiotherapy* / Q000601:surgery*; D003131:Combined Modality Therapy; D003680:Deglutition Disorders / Q000453:epidemiology; D019583:Dose Fractionation, Radiation; D005260:Female; D006801:Humans; D007822:Laryngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D037981:Neck Dissection; D009364:Neoplasm Recurrence, Local; D009959:Oropharyngeal Neoplasms / Q000532:radiotherapy* / Q000601:surgery*; D011379:Prognosis; D011832:Radiation Injuries / Q000453:epidemiology; D011879:Radiotherapy Dosage; D015996:Survival Rate; D016896:Treatment Outcome