Elective lower neck irradiation: 5000 cGy/25 fractions versus 4050 cGy/15 fractions

This is an analysis of 171 patients treated with irradiation alone for squamous cell carcinoma of the head and neck who received elective radiation therapy to the clinically negative low neck. All patients have a minimum follow-up of 2 years and 63% have had at least 5 years of follow-up. Patients were excluded from this analysis if they developed recurrent disease at the primary site or in the upper neck. The majority of patients, 162/171, were treated with one of 2 dose-fractionation protocols: 5000 cGy/25 fractions (5 fractions per week for 5 weeks) and 4050 cGy/15 fractions (5 fractions per week for 3 weeks). Patients were subdivided into four risk groups based on the estimated likelihood of subclinical disease in the neck. There was no difference in the rate of the neck disease control between these 2 dose-fractionation protocols. We conclude that 5000 cGy/25 fractions and 4050 cGy/15 fractions are equally effective in sterilizing occult neck disease.