Treatment of advanced head and neck cancer with accelerated fractionation

Forty-eight patients with locally advanced head and neck cancer have been treated with 1.80 Gy 3 times daily, 4 hours between fractions, 3 days per week (Monday, Wednesday and Friday). At 37.80 Gy, fields were reduced and a final tumor dose of 59.40 Gy in 33 fractions given in three and a half weeks. Fifty-six percent of patients had complete resolution of tumor; the overall local control rate was 52% with an average follow-up of 12.5 months. Actuarial survival was 74% at 12 months and 50% at 24 months. Disease-free survival was 48% at 12 months and 32% at 24 months. Acute complications were common, but late complications were rare, two cases of asymptomatic subcutaneous fibrosis. Radiation therapy with accelerated fractionation shows promise of improving the therapeutic ratio.