Fast neutron teletherapy in advanced epidermoid head and neck cancer. A review

An extensive review of clinical studies employing fast neutron teletherapy for advanced epidermoid carcinomas of the head and neck is presented. Head and neck tumors have represented an excellent study site because of their accessibility to physical examination for measurement of tumor response, and because early neutron beams have had poor depth dose characteristics, making the treatment of more deeply seated tumors technically difficult. A summary of the major trials comparing neutron and mixed-beam (combination neutron and photon) therapy with conventional therapy indicates no conclusive evidence of improvement in local control or survival rates for the experimental arms. Exceptions to this are the Hammersmith experience and the slightly higher lymph node control rates seen in two studies. An evaluation of toxicity indicates that with the new generation of cyclotrons, complication rates may approach parity with those of photon linear accelerators.