Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer

Details

Serval ID
serval:BIB_7EE7B9C7AC71
Type
Article: article from journal or magazin.
Collection
Publications
Institution
Title
Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer
Journal
Radiotherapy and Oncology
Author(s)
Zouhair  A., Azria  D., Pasche  P., Stupp  R., Chevalier  J., Betz  M., Mirimanoff  R. O., Ozsahin  M.
ISSN
0167-8140 (Print)
Publication state
Published
Issued date
02/2004
Volume
70
Number
2
Pages
183-8
Notes
Comparative Study
Journal Article --- Old month value: Feb
Abstract
BACKGROUND AND PURPOSE: To assess the feasibility and efficacy of accelerated 66-Gy postoperative radiotherapy (PORT) using a single-fraction regimen from Mondays to Thursdays and a concomitant boost on Friday afternoon sessions in patients with locally advanced head and neck cancer (LAHNC). PATIENTS AND METHODS: Between December 1997 and June 2002, 89 consecutive patients with pT1-pT4 and/or pN0-pN3 LAHNC were included. PORT was indicated in patients with positive surgical margins, T4 tumors, or extracapsular nodal infiltration. RT consisted of 66 Gy (2 Gy/fr) in 5 weeks and 3 days. Median follow-up was 21 months (range 2-59). RESULTS: Acute morbidity was acceptable: grade 3 mucositis in 20 (22%) patients, grade 3 dysphagia in 22 (25%) patients, and grade 3 skin erythema in 18 (20%) patients. Median weight loss was 2 kg (range 0-14.5). No grade 4 toxicity was observed. Late effects included grade 3 xerostomia in 6 (7%) patients, and grade 3 edema in 2 (2%) patients. Median time to locoregional relapse was 10 months (range 2-21). Two-year overall, cause-specific, and disease-free survival rates were 70% (95% confidence interval (CI) 59-81), 75% (95% CI 64-86), and 63% (95% CI 52-74), respectively. The 2-year actuarial locoregional control rate was 80% (95% CI 70-90). Distant metastasis probability at 4 years was 38% (95% CI 20-56). Multivariate analysis revealed that pT-classification (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 an accelerated PORT schedule including a once-weekly concomitant boost (six fractions per week) is easily feasible with excellent local control. Acute and late RT-related morbidity is acceptable. Given the disease progression pattern (distant metastases), adjuvant chemotherapy should be considered.
Keywords
Aged Aged, 80 and over Carcinoma, Squamous Cell/mortality/pathology/*radiotherapy/surgery Confidence Intervals Dose-Response Relationship, Radiation Female Follow-Up Studies Head and Neck Neoplasms/mortality/pathology/*radiotherapy/surgery Humans Male Middle Aged Multivariate Analysis Neoplasm Invasiveness/*pathology Neoplasm Staging Postoperative Period Proportional Hazards Models Prospective Studies Radiotherapy Dosage Radiotherapy, Adjuvant Risk Assessment Survival Analysis Treatment Outcome
Pubmed
Web of science
Create date
28/01/2008 8:39
Last modification date
20/08/2019 14:39
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