Accelerated postoperative radiation therapy with weekly concomitant boost in patients with advanced head and neck cancer.


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Accelerated postoperative radiation therapy with weekly concomitant boost in patients with advanced head and neck cancer.
International Journal of Radiation Oncology, Biology, Physics
Zouhair A., Azria D., Pasche P., Coucke P.A., Stupp R., Chevalier J., Mirimanoff R.O., Ozsahin M.
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2, Suppl.1
Purpose/Objective: To assess the feasibility and efficacy of accelerated weekly 6 fractionated 66-Gy postoperative radiation therapy (RT) using a single fraction
regimen from Monday to Thursday and a concomitant boost in the Friday afternoon sessions in patients with advanced head and neck cancer (AHNC).
Materials/Methods: Between December 1997 and June 2002, 89 (male to female ratio: 68/21; median age: 60 years [range: 36-81]) consecutive patients (refusing to
participate or ineligible for the EORTC 22931 study comparing postoperative RT vs. RT plus chemotherapy) with pT1-pT4 and/or pN0-pN3 AHNC (28 oropharynx, 26
oral cavity, 18 hypopharynx, 6 larynx, 5 unknown primary, 4 salivary gland, and 2 paranasal sinus) were included in this prospective study. Postoperative RT was
indicated because surgical margins were not free of tumor (n = 22) or for T4 tumors (n = 4) in 26 (29%) patients; or because of extranodal infiltration with (n = 33) or
without (n = 30) positive surgical margins in 63 (71%) patients. Median interval between surgery and RT was 6 weeks (3-15). RT consisted of 66 Gy (2 Gy/fr) in 5
weeks and 3 days. Median RT duration was 39 days (range: 35-67). Prophylactic percutaneous endoscopic gastrostomy was applied in 26 (29%) patients. Median
follow-up was 21 months (range: 2-59).
Results: All but one patient (not finishing the treatment because of non treatment-related reasons at 56 Gy) received the planned total dose without unplanned
interruption. Acute morbidity was acceptable: grade 3 mucositis in 20 (22%) patients, grade 3 dysphagia in 22 (25%) patients, grade 3 skin erythema in 18 (20%)
patients. Median weight loss of was 2 kg (range: 0-14.5). No grade 4 toxicity was observed. Considering the late effects, grade 0, 1, 2, or 3 xerostomia was observed in
15 (17%), 57 (64%), 11 (12%), and 6 (7%) patients, respectively; grade 0, 1, 2, and 3 edema in 29 (33%), 46 (52%), 12 (13%), and 2 (2%) patients, respectively.
Median time to locoregional relapse was 10 months (range: 2-21); only 4 (4%) local and 9 (10%) regional relapses were observed, and 18 (20%) patients developed
distant metastases (all locally controlled but with regional relapses in 4 cases). The 2-year overall, cause-specific, and disease-free survival rates were 70%, 75%, and
63%, respectively; and 2-year actuarial-local and locoregional control rates were 94% and 80%, respectively. Distant metastasis probabilities at 2 and 4 years were 20% and 38%, respectively. Univariate analyses revealed that pT-stage, 3 or more lymph node metastases, and extranodal extension in 2 or more lymph nodes were Related Articles in ScienceDirect
significant. Multivariate analysis (Cox model) revealed that pT-stage (pT1, 2 vs. pT3, 4) and extranodal extension (0, 1 vs. 2 or more) were the two factors independently
influencing the outcome.
Conclusions: We conclude that reducing the overall treatment time using postoperative accelerated RT by weekly concomitant boost (6 fractions per week) is easily
feasible with excellent local control. Acute and late RT-related morbidity is highly acceptable. Given the disease progression pattern (distant metastases), adjuvant
chemotherapy should be considered.
Create date
19/11/2007 12:27
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20/08/2019 13:09
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