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Postoperative accelerated radiotherapy in high‐risk squamous cell carcinoma of the head and neck: Long‐term results of a prospective trial
Author(s) -
Trotti Andy,
Klotch Douglas,
Endicott James,
Ridley Marion,
Cantor Alan
Publication year - 1998
Publication title -
head and neck
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.012
H-Index - 127
eISSN - 1097-0347
pISSN - 1043-3074
DOI - 10.1002/(sici)1097-0347(199803)20:2<119::aid-hed4>3.0.co;2-5
Subject(s) - medicine , radiation therapy , surgery , repopulation , concomitant , prospective cohort study , head and neck , basal cell , head and neck cancer , stem cell , haematopoiesis , biology , genetics
Background For patients treated with combination resection and postoperative radiotherapy, the interval between surgery and completion of radiotherapy represents an opportunity for tumor repopulation and treatment failure. A prospective trial to test the feasibility and efficacy of accelerated postoperative radiotherapy was concluded in August of 1990. Methods Thirty‐two patients with high‐risk pathologic findings were treated with 63 Gy in 35 fractions of 1.8 Gy over 5.2 weeks using a modified concomitant‐boost technique. Results Acute mucosal and skin reactions were increased but tolerable. At a median follow‐up of 6 years, the crude in‐field recurrence rate for the entire group was 10/32 (31%), with 0/10 (0%) recurrences in patients commencing accelerated radiotherapy within 4 weeks of surgery and 10/22 (45%) recurrences in patients with a delay of more than 4 weeks ( p = .006). The rate of late complications appears similar to that seen with conventional radiotherapy, with possibly a higher rate of “consequential”‐type late effects. Conclusions This pilot study suggests that prompt application of accelerated postoperative radiotherapy significantly improves local‐regional control and supports the concept of rapid tumor repopulation in the postoperative setting. Various strategies to overcome tumor repopulation are discussed. © 1998 John Wiley & Sons, Inc. Head Neck 20: 119–123, 1998.