Hala Mohamed El-Shenshawy MD, PhD, Presenter: Nothing to Disclose

Aza Abdel Naby MD, PhD, Abstract Co-Author: Nothing to Disclose

Aly Tawfeek MD,PHD, Abstract Co-Author: Nothing to Disclose

Amal Fouad MD,PHD, Abstract Co-Author: Nothing to Disclose

Rasha Hamdy MSC, Abstract Co-Author: Nothing to Disclose

Radiotherapy is often the primary treatment of locally advanced squamous cell head and neck cancer, but the optimal fractionation schedule has been controversial. The aim of this study was to examine whether, after preceeding induction chemotherapy, hyperfractionated radiotherapy (HFRT) is superior to conventional fractionated radiotherapy (CFRT).

Patients with locally advanced squamous cell head and neck cancer were treated with 3 cycles of cisplatin (100 mg/m2 D1) and 5-fluorouracil (1000 mg/m2 D1-4), repeated every 3 weeks. Then patients were randomized to receive either CFRT at 2 Gy / fraction / day, 5 day / week to 65- 70 Gy / 33- 35 fractions / 7 weeks or HFRT at 1.2 Gy / fraction, twice daily with a 6-h interfraction interval, 5 days / week to 76.8 Gy / 64 fractions / 7 weeks. Of the 60 patients entered, only 53 patients were evaluable for outcomes. The primary end points were local control and progression- free survival.

Chemotherapy was well tolerated, the overall response rate after induction chemotherapy was 73.6%, including 13.2% complete response rate. After completion of RT, patients treared with HFRT had an overall response rate of 96.2% vs 77.8% in CFRT (P= 0.037) and complete response rate of 65.4% in HFRT vs 40.7% in CFRT (P=0.013). After a median follow- up of 23 months, overall survival was 57.7% in HFRT vs 44.4% in CFRT (P= 0.068). The 2- year progression- free survival was 44% in HFRT vs 23.8% in CFRT (P=0.028). The 2- year locoregional control was significantly higher in HFRT (58.8%) than those with CFRT (36.4%) (P=0.021). The incidence of local recurrence rate was 41.2% in HFRT vs 63.6% in CFRT (P=0.019). However, the incidence of distance metastases was 7.7% in HFRT vs 11.1% in CFRT (P=0.439).

After induction chemotherapy, hyperfractionated radiotherapy is more efficaceous than conventional fractionated radiotherapy in locally advanced squamous cell head and neck cancer. Acute but not late effects are increased, but it is tolerable and manageable

After induction chemotherapy, hyperfractionated radiotherapy is more efficaceous than conventional fractionated radiotherapy in locally advanced squamous cell head and neck cancer.

El-Shenshawy, H, Naby, A, Tawfeek, A, Fouad, A, Hamdy, R, Conventional versus Hyperfractionated Radiotherapy in Locally Advanced Head and Neck Cancer.  Radiological Society of North America 2007 Scientific Assembly and Annual Meeting, November 25 - November 30, 2007 ,Chicago IL. http://archive.rsna.org/2007/5015980.html