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Volume 4, Number 2, 1999

Escalated hyperfractionation in radiotherapy for head and neck cancer - 5-year results

Wygoda A, Składowski K, Mucha A, Sąsiadek W, Pilecki B, Zajusz A, Maciejewski B.

Summary:

Purpose: To evaluate 5-year results of escalated hyperfractionation schedule in aspect of local tumour control
(LTC) and late radiation toxicity.
Materiał and methods: Forty eight patients with squamous celi carcinoma of oral cavity (34 pts), oropharynx (11
pts) and larynx (3) in stage T1-4NO-1 have been treated at Centre of Oncology in Gliwice, between the years
1988-92. There were four patients with T1 primary tumour, 27 with T2, 11 with T3 and 2 with T4; in 4 patients the
tumour stage remains unknown (TX). Ali the patients were treated by radiation therapy alone, using the technique
of two opposed parallel fields and hyperfractionation with escalation of the dose per fraction during the second
part of the treatment schedule. The total dose ranged between 62,2 and 74 Gy. The median follow-up was 62
months.
Results: Despite of the relative high proportion of complete local regressions (75%), the 5-year LTC rate of 54%
was noted in the whole group of patients. Stage-related LTC rates were as follows: 100% for TX tumours, 50% for T1, 55% for T2, 45% for T3 and 0% for T4. Acute radiation reactions were more intensive than those usually
obsen/ed during conventional radiotherapy; all patients experienced a confluent mucositis and two waves of
acute mucosal reaction because of treatment gap were observed during the radiation course. Severe late
radiation toxicity (grade IV) was noted in two patients (4%).
Conclusions: Long-term tumour control results of escalated hyperfractionation radiotherapy may suggest that
there is no benefit of a such regimen. However, in the majority of patients the treatment course differed markedly
from protocol assumptions.

Signature: Rep Pract Oncol Radiother, 1999; 4(2) : 39-44


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