PRIMARY SITE AS PREDICTIVE FACTOR OF LOCAL-CONTROL IN ADVANCED HEAD AND NECK TUMORS TREATED BY CONCOMITANT BOOST ACCELERATED RADIOTHERAPY

Aims and background:The purpose of this phase II study was to assess the efficacy and toxicity of an accelerated radiotheraphy schedule with the concomitant boost technique in the management of patients with advanced head and neck squamous cell carcinomas (HN-SCC) of various primary sites. Methods: From May 1989 to December 1992 45 patients were scheduled to receive a total dose of 75 Gy in 40 fractions over 40 days. The boost encompassing the macroscopic disease was given as a second daily dose during the last 2 weeks of the basic treatment. Results: Severe mucositis was recorded in 27 (60%) patients. Late side effect occurred in 2. As regards local control the primary tumor site was the most significant prognostic factor: at a median follow-up of 24 months (range 12-52 months) the actuarial local control rate was 79%, 48% and 15% for oronasopharyngeal, laryngohypo-pharyngeal and oral cavity primary sites, respectively (p=0.004). Conclusions: This high dose concomitant boost regimen appears feasible in advanced HN-SCC. However, our results indicate the primary tumor site as a major prognostic factor even with an accelerated treatment schedule.