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.