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The authors undertook a retrospective study on local tumor control, survival and complications of conventional irradiation compared with accelereted hyperfractionated irradiation in women with selected head and neck tumor sites.

Methods:

One hundred eight consecutive women who were treated with radiation alone for cure during 1974-1988 were analyzed. Patients were excluded who had T1 tumors of the vocal cord and those who were treated with brachytherapy implants. Fifty-nine patients were treated with conventional fractionation once daily (QD) during 1974-1988 with a median dose 2.1 grays (Gy) per fraction up to a total median dose of 69 Gy in a median overall time of 54 days. Forty-nine patients were treated with accelerated hyperfractionation twice daily (BID) during 1987-1998 at a median dose of 1.6 Gy per fraction BID, with an interfraction interval of 4-6 hours, for a total median dose of 66 Gy in 35 days. Patients were not randomized into the QD or the BID group.

Results:

The 7-year actuarial local control (LC) rates for T1-T2 in QD treated and BID treated patients were 79 and 87 percentage, respectively (P=not significant [NS]. For T3-T4 tumors, the LC rates at 7 years were 59 percentage and 56 percentage for the QD and BID groups, respectively (P=NS). A Cox regression analysis for LC showed that the significant variables were T classification and overall time. Schedule (QD or BID), total dose, dose per fraction, and patient age were not significant variables. For the QD and BID groups, the 7-year actuarial cause specific survival rates for patients with Stage I-II disease were 100 percentage and 65 percentage respectively (P=0.004), and for patients with Stages III-IVA, IVB disease, the rates were 39 percentage and 56 percentage, (P=NS), respectively. Acute morbidity was higher with the BID schedule In the BID group, 8 percent of patients required tube or parenteral feeding, and 0 percent of patients in the QD group required such feeding (P=0.04). The 5-year actuarial probability of Grade 3-5 late effects was 4 per cent for the BID group and 0 per cent for the QD group (P=NS).

Conclusions:

This study suggests that accelerated hyperfractionated irradiation for women with advanced carcinoma of the head and neck does not provide significantly better local tumor control or cause specific disease free survival compared with conventional fractionation. Women with these malignancies appear to have a better prognosis compared with men