321 Hyperfractionated (HF) and accelerated (AF) radiotherapy (RT) in head and neck cancers: Facts from trials, impact on standard practice

From 1978 to 1995, 2165 patients (pts) were entered in trials of HF or AF RT. Two randomized trials in head and neck cancers accrued 867 pts: Protocol 22791 (356 pts, 1980–87) compared CF (70 Gy/35–40 fr/7–8 wks) to HF (80.5 Gy/70 fr/7 wks) in T2–T3, N0-N1 oropharyngeal carcinoma. Locoregional control (LRC) was higher (P = 0.01) in HF versus CF. At 5 years, 56% of the pts are LRC free with HF versus 38% with CF. There was no difference in late normal tissue damage between the two treatment modalites. Protocol 22851 (511 pts, 1985–95) compared AF (72 Gy/5) fr/5 wks) to CF (70 Gy/35 fr/7 wks) in T2 T3 T4 head and neck cancers (hypopharynx excluded). Acute and late toxicity were increased in the AF arm. A better local control (P = 0.01) and progression free survival (P = 0.004) were achieved in the AF arm. These two trials show evidence of the major improvement brought by schemes based upon new radiological concepts. At 5 years, a 61% LRC is observed with AF versus 47% with AF. The progression free survival data suggest that the improvement in LRC contributed to a decrease in distant metastases in the AF arm. From 1978 to 1995, 2165 patients (pts) were entered in trials of HF or AF RT. Two randomized trials in head and neck cancers accrued 867 pts: Protocol 22791 (356 pts, 1980–87) compared CF (70 Gy/35–40 fr/7–8 wks) to HF (80.5 Gy/70 fr/7 wks) in T2–T3, N0-N1 oropharyngeal carcinoma. Locoregional control (LRC) was higher (P = 0.01) in HF versus CF. At 5 years, 56% of the pts are LRC free with HF versus 38% with CF. There was no difference in late normal tissue damage between the two treatment modalites. Protocol 22851 (511 pts, 1985–95) compared AF (72 Gy/5) fr/5 wks) to CF (70 Gy/35 fr/7 wks) in T2 T3 T4 head and neck cancers (hypopharynx excluded). Acute and late toxicity were increased in the AF arm. A better local control (P = 0.01) and progression free survival (P = 0.004) were achieved in the AF arm. These two trials show evidence of the major improvement brought by schemes based upon new radiological concepts. At 5 years, a 61% LRC is observed with AF versus 47% with AF. The progression free survival data suggest that the improvement in LRC contributed to a decrease in distant metastases in the AF arm.