Presenter: J. Bourhis Presenter's Affiliation: Institut Gustave Roussy, Villejuif, France Type of Session: Plenary
There is some clinical evidence that radiation therapy administered over a shorter period of time offers better tumor control by decreasing the ability of cancer cells to repair themselves from radiation-induced damage.
Combined chemotherapy and radiation therapy regimens are also used in the treatment of advanced cancers.
It is unclear as to if one of these approaches is superior.
Patients with advanced stage squamous cell cancer of the head and neck were randomized to receive either modified fractionated radiotherapy (RT) or concomitant radio-chemotherapy (RT-CT)
109 patients were randomized between very accelerated RT (62-64 Gy/3weeks) and moderately accelerated RT (62-64 Gy/5 weeks) + CDDP 100 mg/m2 Days 1, 16 and 32 and 5FU 1g/m2/day, days 1 to 5 and 31 to 35.
In the RT-CT arm, 2 additional cycles of CDDP-5FU were given whenever possible, 28 days and 56 days after the local treatment.
90% of patients had T4 tumors or N3 nodal disease.
The majority of patients had oropharynx cancer.
There was a 96% incidence of grade 3/4 mucositis in the Accelerated Group, versus 81% in the RT-CT Group.
For both groups, there was only about 30% locaregional control.
There was no significant difference between groups in terms of survival or incidence of distant metastases.
Accelerated radiotherapy is no better than chemoirradiation in terms of locoregional control, distant metastases, or overall survival.
Local control of advanced head and neck cancers is necassary before improvements in survival can be achieved.
Accordingly, the development of other chemotherapeutic and biologic therapies are needed.
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