Hyperfractionated Accelerated Radiotherapy versus Conventional Fractionation Both Combined with Chemotherapy in Patients with Locally Advanced Head and Neck Carcinomas: A Retrospective Analysis of a Monoinstitutional Series

• Published in: Oncology Vol. 76; no. 6; pp. 405 - 412
• Main Authors: WELZ, Hanna, POTTGEN, Christoph, STUSCHKE, Martin, JAWAD, Jehad Abu, WIERLEMANN, Arne, WITTIG, Andrea, STÜBEN, Georg, BUDACH, Volker, LEHNERDT, Goetz, JAHNK, Klaus, SACK, Horst
• Format: Journal Article
• Language: English
• Published: Basel Karger 01.01.2009
• Subjects: Aged; Antineoplastic Combined Chemotherapy Protocols - therapeutic use; Biological and medical sciences; Carcinoma - drug therapy; Carcinoma - radiotherapy; Combined Modality Therapy - methods; Dose Fractionation; Female; Fluorouracil - administration & dosage; Head and Neck Neoplasms - drug therapy; Head and Neck Neoplasms - radiotherapy; Humans; Male; Medical sciences; Middle Aged; Mitomycin - administration & dosage; Otorhinolaryngology (head neck, general aspects and miscellaneous); Otorhinolaryngology. Stomatology; Regression Analysis; Retrospective Studies; Treatment Outcome; Tumors; Antineoplastic agent; 5-Fluorouracil; Cancerology; ENT disease; Mitomycin C; Head and neck carcinoma; Accelerated radiotherapy; Fluorouracil; Human; Drug combination; Fractionation; Mitomycin; Enzyme; Fluoropyrimidine derivatives; Transferases; Enzyme inhibitor; Malignant tumor; Thymidylate synthase; Radiotherapy; Retrospective; Concomitant chemotherapy; Hyperfractionation; Alkylating agent; Chemotherapy; Treatment; Antimetabolic; Methyltransferases; Pyrimidine derivatives; Head and neck cancer; Combined treatment; Locally advanced stage; Comparative study; Cancer
• ISSN: 0030-2414; 1423-0232
• DOI: 10.1159/000215927

Hyperfractionated accelerated radiotherapy (HART) has been combined with chemotherapy (CC) for locally advanced head and neck cancer, but no data from randomized trials are available for a comparison with conventionally fractionated radiotherapy (CFRT) and CC. This monoinstitutional retrospective study compares the results of both treatment schedules: 315 patients with locally advanced carcinoma (UICC stage III and IV) of the oral cavity and the orohypopharynx were treated from January 1990 to March 2006 with a radiochemotherapy combination based on mitomycin C and fluorouracil (HART-CC: 203 patients, CFRT-CC: 112 patients, total dose: 70-72 Gy) with curative intent. Two- and 4-year survival was 60 and 42 (HART-CC) and 59 and 42% (CFRT-CC; p = 0.82, log-rank test), respectively. Using multivariate Cox regression, pretreatment hemoglobin level, N stage, tumor site but not the year of treatment, gender and T stage were significant prognosticators for survival. For locoregional control, only N stage was significant. The prognostic value of these pretreatment factors did not variate with the fractionation schedule used. In combination with CC, there was no trend towards an improved efficacy of HART in comparison with CFRT.