gms | German Medical Science

Purpose: To compare the long term survival results and late sequelae of two different treatment regimens in the multimodality treatment of advanced, inoperable head and neck cancer.

Material and methods: From 7/1992 to 6/2003, 196 patients (median age: 57 years) with inoperable H&N tumors were treated according to 2 different protocols: 112 patients received RCT (70.2 Gy in 39 fractions, cisplatin/5-FU), and 84 patients accelerated radiotherapy (CBT: 72 Gy in 41 fractions; 6 weeks). Choice of treatment was done according to patients’ preference or contraindications against chemotherapy. Survival (OS/DSS) and freedom from progression (FFP) were calculated (median follow-up 45 months). Known and suspected prognostic factors were analyzed for their influence. Late sequelae were investigated by standardized prospective documentation during follow up and completed by additional telephone calls.

Results: 3 year OS (RCT/CBT) amounted to 37.4%/28.6%, 5 year OS to 26.4%/21.4%. The difference was not significant (p=0.2484). 3 year FFP (RCT/CBT) amounted to 40.0%/33.4%, 5 year FFP to 30.5%/24.3% (p=0.5209). General condition (p<0.0001) and hemoglobin (p=0.0009) had a significant influence on survival. Grade III/IV late sequelae occurred in the following percentages (RCT/CBT): skin (8.2%/4.6%;p=0.503); mucosa (4.1%/0.0%;p=0.101); xerostomia (6.8%/2.1%;p=.0472); laryngitis (1.4%/0.0%;p=0.281); lymphedema (1.4%/2.2%;p=0.475).

Conclusions: With both treatment schemes, long term tumor control and survival could be achieved in about 20-30%. We could not show a superiority of radiochemotherapy over accelerated radiotherapy alone. The predominant late sequelae were skin fibrosis, mucosal atrophy and xerostomia.