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Hyperfractionation for head and neck cancer.

J T Parsons1, W M Mendenhall, N J Cassisi

  • 1University of Florida College of Medicine, Gainesville 32610.

International Journal of Radiation Oncology, Biology, Physics
|April 1, 1988
PubMed
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Twice-daily radiation therapy improved local control rates for advanced head and neck squamous cell carcinomas compared to once-daily treatment. This approach showed promising survival rates, especially for earlier stages, with acceptable complication rates.

Area of Science:

  • Oncology
  • Radiation Oncology
  • Head and Neck Cancer

Background:

  • Squamous cell carcinomas of the head and neck are often diagnosed at advanced stages.
  • Curative-intent treatment for these cancers requires effective local and regional control.
  • Conventional once-daily irradiation has limitations in achieving optimal outcomes for advanced disease.

Purpose of the Study:

  • To evaluate the efficacy and safety of twice-daily (TD) irradiation for moderately advanced to advanced primary squamous cell carcinomas of the head and neck.
  • To compare the outcomes of TD irradiation with historical control groups treated with once-daily (QD) irradiation.

Main Methods:

  • A cohort of 144 patients with 148 primary squamous cell carcinomas of the head and neck received TD irradiation (120 cGy/fraction) between 1978 and 1984.

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  • Treatment included irradiation alone, with radium needle boost, or preoperative irradiation followed by surgery.
  • Follow-up included assessment of local control, neck control, distant metastases, complications, and survival rates.

    • Main Results:

    • TD irradiation achieved higher local control rates (10-15 percentage points) compared to historical QD treatment.
    • 5-year actuarial survival rates were 59% for Stage III, 37% for Stage IVA, and 23% for Stage IVB.
    • Neck control rates varied by N stage, with 100% for N0 and decreasing rates for higher N stages.
    • Distant metastases developed in 4% of Stage II-III and 18% of Stage IV patients with locoregional control.

    Conclusions:

    • Twice-daily irradiation is an effective treatment modality for advanced head and neck squamous cell carcinomas, yielding improved local control compared to once-daily regimens.
    • The treatment demonstrates favorable survival outcomes, particularly for Stages II and III.
    • Complication rates were acceptable, with those of salvage surgery similar to once-daily treated patients.