Adding dose escalation to accelerated hyperfractionation for head and neck cancer: 76 Gy in 5 weeks

Abstract

Summary Twenty-two patients with head and neck cancer have been treated on a pilot protocol that incorporates dose escalation with accelerated hyperfractionation during a 5-week radiotherapy schedule. Twelve patients were treated with definitive radiotherapy alone and the remaining 10 patients were treated postoperatively. The definitive radiotherapy schedule delivers a cumulative dose of 76 Gy in 5 weeks. The acute tolerance of the postoperative regimen has been superb, whereas the acute treatment reactions in the definitive group are more potent. This is largely due to the fact that larger mucosal volumes were treated in the primary radiotherapy patients, in whom confluent mucositis manifests late in week 3. Complete tumor regression has been observed in 10 of 12 (83%) definitive patients, including 3 patients with N3 neck disease. Two of 12 patients (17%) experienced prolonged painful mucositis (12 and 14 weeks), suggesting that 76 Gy over 32 elapsed days tests the capacity of the acute reacting tissues to recover fully. The radiobiological rationale for this schedule is discussed.