An original accelerated radiotherapy schedule in stage III to IV head and neck cancers.  Results in a multicenter setting. 
Accelerated radiotherapy delivery has recently been shown to be effective in overcoming repopulation during fractionated radiotherapy.  The therapeutic ratio may be particularly favorable for 5-week regimens.  This study reports the feasibility and results of a particular accelerated schedule in Stage III to IV head and neck carcinomas used in a multicenter setting.  Seventy-four patients with Stage III (26 patients) or IV (48 patients) head and neck carcinomas were treated with a 5-week accelerated schedule (69.6 to 69.8 Gy in 41 to 40 fractions over a period of 35 to 36 days).  Treatment began with 20 Gy in 10 daily fractions to initial involved sites, followed by bi-fractionated radiotherapy (2 x 1.6 Gy to 1.66 Gy/day) to a larger head and neck volume.  Thirty-six (49%) patients received induction chemotherapy (median 3 cycles, range 1 to 4 cycles).  Grade 3 or 4 (RTOG) confluent mucositis was observed in 57 patients (77%) and Grade 3 dysphagia in 33 patients (44%).  Grade 3 or 4 (RTOG-EORTC) late complications were scored in 10.5% of cases.  The 5-year actuarial locoregional control rate was 56% (95% CI: 42 to 71).  The 5-year overall actuarial survival was 32% (95% CI: 18 to 46).  Induction chemotherapy was not associated with a more favorable outcome.  This study demonstrates the feasibility of this schedule in a multicenter setting.  The oncologic results appear similar to those obtained by other accelerated regimens, while the rate of late complications seems acceptable.  Five-week accelerated regimens warrant further evaluation, particularly in conjunction with concomitant chemotherapy, in the framework of prospective trials.