Continuous accelerated 7-days-a-week radiotherapy for head-and-neck cancer: long-term results of phase III clinical trial.

Abstract

PURPOSE:

To update 5-year results of a previously published study on special 7-days-a-week fractionation continuous accelerated irradiation (CAIR) for head-and-neck cancer patients.

METHODS AND MATERIALS:

One hundred patients with squamous cell carcinoma of head and neck in Stage T(2-4)N(0-1)M(0) were randomized between two definitive radiation treatments: accelerated fractionation 7 days a week including weekends (CAIR) and conventional 5 days a week (control). Hence the overall treatment time was 2 weeks shorter in CAIR.

RESULTS:

Five-year local tumor control was 75% in the CAIR group and 33% in the control arm (p < 0.00004). Tumor-cure benefit corresponded with significant improvement in disease-free survival and overall survival rates. Confluent mucositis was the main acute toxicity, with the incidence significantly higher in CAIR patients than in control (respectively, 94% vs. 53%). When 2.0-Gy fractions were used, radiation necrosis developed in 5 patients (22%) in the CAIR group as a consequential late effect (CLE), but when fraction size was reduced to 1.8 Gy no more CLE occurred. Actuarial 5-year morbidity-free survival rate was similar for both treatments.

CONCLUSIONS:

Selected head-and-neck cancer patients could be treated very effectively with 7-days-a-week radiation schedule with no compromise of total dose and with slight 10% reduction of fraction dose (2 Gy-1.8 Gy), which article gives 1 week reduction of overall treatment time compared with standard 70 Gy in 35 fractions over 47-49 days. Although this report is based on the relatively small group of patients, its results have encouraged us to use CAIR fractionation in a standard radiation treatment for moderately advanced head-and-neck cancer patients.

• Authors: Krzysztof Skladowski, Boguslaw Maciejewski, Maria Golen, Rafal Tarnawski, Krzysztof Slosarek, Rafal Suwinski, Mariusz Sygula, Andrzej Wygoda
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 66 Issue 3 Pg. 706-13 (Nov 01 2006) ISSN: 0360-3016 [Print] United States
• PMID: 17011446 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)

Topics

• Adult
• Aged
• Carcinoma, Squamous Cell (radiotherapy, secondary)
• Disease-Free Survival
• Dose Fractionation, Radiation
• Female
• Head and Neck Neoplasms (pathology, radiotherapy)
• Humans
• Lymphatic Metastasis
• Middle Aged
• Proportional Hazards Models
• Radiation Injuries (complications)
• Salvage Therapy
• Stomatitis (etiology)
• Time Factors