Altered and Conventional Fractionated Radiotherapy in Patients With Head and Neck Cancer
Condition: Head and Neck Cancer
MeSH terms: Head and Neck Neoplasms
Study type: Observational

Summary: 
      The aim of our study was to evaluate the value of two different altered fractionation
      schedules - hyperfractionation and accelerated fractionation with concomitant boost - in
      comparison with conventional fractionation in primary definitive radiotherapy for squamous
      cell carcinomas of the larynx, oropharynx or hypopharynx. The study began and was conducted
      while the only teletherapy unit in our department was the cobalt-60 machine. During that
      period we were expecting the installation of new sophisticated equipment. We assumed that the
      results of this study would be also able to show whether or not it would be rational to use
      the altered fractionation regimens on the new machines.
    

Detailed description: 
      Eligible patients admitted from March 1999 to December 2000 were treated with conventionally
      fractionated radiotherapy. These patients represented the retrospective part of the study.
      Patients admitted between January 2001 and June 2004 were included in the prospective part of
      the study. Following the confirmation of their eligibility, altered fractionation schedule
      assignment was made after stratifying by site of origin (larynx vs oropharynx vs
      hypopharynx), Karnofsky performance score (60%-70% vs 80%-100%), and stage of disease (I and
      II vs III and IV). Patients were randomized to receive radiotherapy delivered using either
      hyperfractionation or accelerated fractionation with concomitant boost as a late accelerating
      component. Exceptions occurred when patients either refused treatment with two daily
      fractions or were not offered twice-a-day irradiation because of lack of machine time.

      Radiotherapy Scheduling and Technique The conventionally fractionated radiotherapy schedule
      was 66-70 Gy in 6½ -7 weeks (one fraction of 2 Gy per day, 5 fractions per week), whereas the
      hyperfractionation treatment schedule was 74.4-79.2 Gy in 6.2-7 weeks (two fractions of 1.2
      Gy per day, 10 fractions per week with interfraction interval of at least 6 hours; Figure 1).
      The treatment schedule in accelerated fractionation using concomitant boost consisted of
      daily fraction of 1.8 Gy, 5 days a week, up to 32.4 Gy including all sites of disease and
      electively irradiated areas of the neck, followed by two daily fractions for the last 11-12
      days. The first daily fraction encompassed all sites of the disease and electively irradiated
      neck nodes using a dose of 1.8 Gy, and the second daily fraction was the concomitant boost
      delivered through reduced fields to encompass the gross disease only, using a fraction of 1.5
      Gy up to total doses of 68.7-72 Gy in 6 weeks (Figure 1). The interval between the two daily
      fractions was at least 6 hours.
    

Observational model: Defined Population
Time perspective: Other
Keywords: Head and neck cancer; Fractionation; Radiotherapy; Conventional fractionation; Hyperfractionation; Accelerated fractionation