Multiple fractions in the treatment of head and neck cancer.

Fifty-eight cases of head and neck cancer received hyperfractionated accelerated radiotherapy, with treatment three times daily to 47.5-54 Gy over 12-20 days. A total of 69% had a complete response within 3 months, and the actuarial survival was 52% at 1 year, 41% at 2 years, 43% at 3 years and 38% at 4 years. Acute reactions were rather more pronounced (31%) and late necrosis (15%) was more than would be expected with conventional fractionation. It is suggested that multiple fractions carried out by a small centre, are feasible and will reduce hospital stay.

Hyperfractionated accelerated radiotherapy for carcinoma of the oesophagus.

We report on 48 patients with carcinoma of the oesophagus treated by hyperfractionated accelerated radiotherapy. The patients, aged 46 to 93 years, were considered suitable for radiotherapy on their performance status irrespective of the presence of metastases. The radiotherapy was given three times a day over 2 weeks with a minimum of 3 h between treatments. The treatment was well tolerated acutely and to date there have been no unacceptable long-term side-effects. Dysphagia was improved in 39 (81.2%) patients. Product-limit survival was 35.7%, 18.5% and 12.3% at 1, 2 and 3 years. We conclude that this regime is feasible within the normal working day, well tolerated, effective and the shorter overall treatment duration desirable.

Final report of the general clinical results of the British Institute of Radiology fractionation study of 3F/wk versus 5F/wk in radiotherapy of carcinoma of the laryngo-pharynx.

The 10 year follow-up of a clinical trial involving the comparison of 3F/wk versus 5F/wk in radiotherapy of squamous cell carcinoma of the larynx and hypopharynx has now been completed. The trial involved an intake of 734 patients between 1966 and 1975. The classification of all patients has been revised to conform with the latest TNM publication. A reduction in total dose was made for 3F/wk compared with 5F/wk. This varied between 13% and 11% in centres treating over 3 weeks and 6 weeks, respectively. No statistically significant differences have been found between the two arms (3F/wk versus 5F/wk) of the trial in any of the main group analyses. A number of sub-group analyses relating to survival, tumour-free and laryngectomy-free rates and to the comparison of acute or late normal-tissue radiation damage have also been performed. No differences have been found that could be considered to be statistically significant in relation to the particular sub-group. Previous interim reports suggested minor differences in sub-group analyses between the 3F/wk and 5F/wk regimes in this trial; these have diminished now that the full follow-up data are available. This trial has provided evidence on which clinicians may base their choice between either a 3F/wk fractionation regime or a conventional 5F/wk treatment protocol in the treatment of carcinoma of the laryngo-pharynx.

Seventh interim progress report of the british institute of radiology fractionation study of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx.

A fresh analysis of the data entered into the multicentre BIR fractionation trial of 3F/week versus 5F/week in radiotherapy of the laryngopharynx has been undertaken. Completed records of the 732 patients initially entered into the trial have now risen from 687 at the last report to 706. The data have been analysed in a manner similar to that adopted previously so as to measure the effects of the two regimes on both tumour and normal tissues, and some additional analyses have now also been made. There have been some modifications in the results in the various sub-groups which may be due to an inadequate number of patients having been followed up for long enough at the time of the previous analyses. More data for late radiation damage to normal tissues and new radiobiological findings have suggested possible explanations for the differences which have emerged between the two groups. The apparent differences between the sub-groups containing patients with highly localized tumours, which were reported in our previous report, are now less marked and not statistically significant.

Sixth interim progress report of the British Institute of Radiology fractionation study of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx.

The results are reported of the multicentre BIR fractionation trial of 3F/week versus 5F/week in radiotherapy of the laryngo-pharynx. 687 patient records have been analysed with respect to survival rates, recurrence-free rates and laryngectomy-free rates. For the group as a whole these analyses show no difference between the two fractionation regimes. Analysis of the sub-group which had early disease confined to the vocal cords does, however, show a better recurrence-free and laryngectomy-free rate for those patients treated with 5F/week, though the survival rate for the two groups remains similar. Acute and late normal tissue reactions are reported for up to six years after treatment. It appears that treatment with 3F/week can be given safely to patients with advanced disease. The differences between the two treatment groups who had early disease of the vocal cords are discussed, but until more data become available in the future the problems raised cannot be resolved.

Radiation-induced fibrosarcoma.

Six cases of fibrosarcoma arising in previously irradiated tissues are reported, out of a total of 220 cases of fibrosarcoma treated at Mount Vernon Hospital during the last 23 years.This rare occurrence may follow at any interval from 3 to 38 years after irradiation, usually after high dosage. Four of our six cases are known to have died of the disease.The literature regarding radiation-induced fibrosarcoma is reviewed and it is suggested that adequate excision or amputation may be curative, if undertaken early enough.