Abstract
We report the 20-year experience of a single institution about accelerated hyperfractionation (AHF). We retrospectively analyzed the efficacy, and early and late toxicity associated with AHF in a series of patients with head and neck cancers. Between 1985 and 2002, 359 patients were treated with radical AHF. Primary sites were: larynx 237, nasopharynx 50, oropharynx 34, and hypopharynx 38. The AHF schedule was as follows: total dose 60-63 Gy, delivered in 40 fractions during 4 weeks. All cases were treated with twice-daily fractions. The 5-year actuarial loco-regional control rate was 98%, 85%, and 73% in stage I, II, and III-IV glottic laryngeal cancer, respectively. The 5-year actuarial loco-regional control rate was 80%, 69%, and 50% in stage I-II, III and IV oropharyngeal cancer, and 75%, 100%, and 40% in stage I-II, III and IV hypopharyngeal cancer, respectively. These data with AHF were superior to conventional radiotherapy. However, there was no therapeutic gain in nasopharyngeal cancer. Acute mucosal morbidity was significantly more frequent with AHF, but was transient and tolerable. Late complication rate was similar to conventional radiotherapy. AHF (60-62 Gy/40 fractionations/4 weeks) was a good fractionation regimen for head and neck cancers except for nasopharyngeal cancer.
