Is Locally Advanced Head-Neck Cancer One More Candidate for Accelerated Hypofractionation?

• Published in: Anticancer research Vol. 41; no. 1; pp. 467 - 475
• Main Authors: Koukourakis, Ioannis M, Zygogianni, Anna, Kouloulias, Vassilios, Kyrgias, George, Panteliadou, Marianthi, Nanos, Christos, Abatzoglou, Ioannis, Koukourakis, Michael I
• Format: Journal Article
• Language: English
• Published: Greece International Institute of Anticancer Research 01.01.2021
• Subjects: Adult; Aged; Aged, 80 and over; Cancer; Chemoradiotherapy; Chemotherapy; Combined Modality Therapy; Dose Fractionation, Radiation; Dysphagia; Edema; Female; Fractions; Head & neck cancer; Head and Neck Neoplasms - mortality; Head and Neck Neoplasms - pathology; Head and Neck Neoplasms - radiotherapy; Humans; Kaplan-Meier Estimate; Laryngeal cancer; Male; Middle Aged; Mucositis; Neoplasm Metastasis; Neoplasm Staging; Prognosis; Radiation Dose Hypofractionation; Radiation therapy; Radiotherapy Dosage; Radiotherapy, Intensity-Modulated - adverse effects; Radiotherapy, Intensity-Modulated - methods; Toxicity; Treatment Outcome; Tumors; Young Adult; radiotherapy; acceleration; Locally advanced head-neck cancer; hypofractionation; chemo-radiation
• ISSN: 0250-7005; 1791-7530
• DOI: 10.21873/anticanres.14797

Hypofractionated accelerated radiotherapy (HypoAR) is widely applied for the treatment of early laryngeal cancer. Its role in locally advanced head-neck cancer (LA-HNC) is unexplored. We present results of a prospective trial on 124 patients with LA-HNC, treated with radio-chemotherapy with three different HypoAR fractionations (3.5 Gy/day × 14-15 fractions, 2.7 Gy/day × 20-21 fractions, and 2.5 Gy/day × 21-22 fractions). Protraction of the overall treatment time due to oropharyngeal mucositis was enforced in 18/57 laryngeal, 6/19 nasopharyngeal, and 15/48 cancer patients with other tumors. Regarding late toxicities, laryngeal edema grade 3 was noted in 5/57 patients with laryngeal cancer, while severe dysphagia was noted in 4/124 and tracheoesophageal fistula formation in 1/124 patients. The complete response rates obtained were 73%, 84%, and 67% in patients with laryngeal, nasopharyngeal, and other tumors, respectively. The 3-year locoregional progression-free survival was 58%, 73%, and 55%, respectively. HypoAR chemoradiotherapy is feasible, with acceptable early and late radiotherapy toxicities, response rates and LPFS.