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Continuous hyperfractionated accelerated radiotherapy with/without mitomycin C in head and neck cancers
1Department of Radiotherapy and Radiobiology, University of Vienna, Allgemeines Krankenhaus der Stadt Wien, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Summary
Adding mitomycin C to accelerated radiotherapy significantly improved head and neck cancer control and survival. This combination therapy offers better outcomes than conventional or accelerated radiotherapy alone for advanced head and neck cancers.
Area of Science:
- Oncology
- Radiation Oncology
- Head and Neck Cancer Research
Background:
- Advanced head and neck cancers often require radiation therapy when surgery is not an option.
- Conventional radiotherapy shows limited locoregional tumor control rates in these challenging cases.
- Innovative treatment modifications, including altered fractionation and chemotherapy, are needed.
Purpose of the Study:
- To compare the efficacy of conventional fractionation (CF) with accelerated radiotherapy schedules.
- To evaluate the impact of adding mitomycin C (MMC) to accelerated radiotherapy (V-CHART+MMC).
- To assess locoregional tumor control and overall survival in head and neck cancer patients.
Main Methods:
- Randomized trial of 239 patients with squamous cell head and neck cancers (Oct 1990-Dec 1997).
- Treatment arms: Conventional Fractionation (70 Gy/7 weeks), V-CHART (55.3 Gy/17 days), V-CHART+MMC (55.3 Gy/17 days + MMC).
- Toxicity, locoregional tumor control, and overall survival were assessed.
Main Results:
- Accelerated fractionation (V-CHART) showed similar outcomes to CF when radiotherapy was the sole treatment.
- V-CHART+MMC demonstrated significantly improved locoregional tumor control (48%) compared to CF (31%) and V-CHART (32%).
- Overall survival was also significantly higher with V-CHART+MMC (41%) versus CF (24%) and V-CHART (31%).
- Main toxicity was mucositis (Grade 3-4 in 95% with V-CHART), with 18% Grade 3-4 hematological toxicity from MMC.
Conclusions:
- Shortening radiotherapy overall treatment time to 17 days with a reduced dose (55.3 Gy) yielded results comparable to conventional fractionation.
- The addition of mitomycin C to accelerated fractionated radiotherapy significantly enhanced local tumor control and patient survival.
- V-CHART+MMC represents a promising treatment modification for advanced head and neck cancers.