Phase I pilot study on fast neutron teletherapy for advanced carcinomas of the head and neck region. Final report on local control rate and survival

Nasopharyngeal carcinoma in Saudi Arabia: a retrospective study of 166 cases treated with curative intent

A retrospective review was performed of the medical records of 166 adult patients with biopsy-proven carcinomas of the nasopharynx treated with curative intent at King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia. All patients were treated between June 1975 and December 1985 using megavoltage therapy equipment. Most patients presented with advanced nodal disease: 23 patients (13.9%) were N0, 16 patients (9.6%) were N1, 29 patients (17.5%) were N2, and 98 patients (59%) were N3. The overwhelming majority of patients had nonkeratinizing lesions (158/166). At the time of analysis, mean follow-up time was 24.2 months (range 2-108). Actuarial curves are presented for local/regional control as a function of T-stage and N-stage and for survival and time to development of distant metastases as a function of N-stage. At 4 years local/regional control was 70% for T1 lesions, 59% for T2 lesions, 30% for T3 lesions, and 35% for T4 lesions. There was little correlation between local/regional control and N-stage being about 50% at 4 years for all nodal subgroups. Only six patients exhibited an isolated first failure in the regional nodes alone, whereas 60 patients failed initially at the primary site (either alone or in conjunction with a simultaneous nodal failure). The development of distant metastases correlated to some extent with nodal disease ranging from 20% at 4 years for T1/T2 N0 patients to 70% for patients who initially presented with N3 disease. Survival data was more difficult to obtain due to cultural biases in a medically unsophisticated patient population. True survival curves are bounded by calculating actuarial curves in two ways: death as the failure endpoint and death plus lost-with-active-disease as failure endpoints. In terms of the latter curves, at 4 years "survival" ranged from 39% for patients with T1/T2 N0 lesions to 23% for patients with N3 lesions.

Results of fast neutron therapy in advanced head and neck cancer

Eighty-nine patients with advanced head and neck cancer were treated with a fast neutron beam of mean energy 5.6 MeV. The standard tumour dose was 1320 cGyn, gamma in 20 fractions over 4 weeks, but 13 patients with laryngeal cancer received 1200 cGyn, gamma. Complete remission was achieved in 50 patients (56%). Fifteen patients (17%) survived 2 years, 14 of them being symptom-free. Survival correlated with the stage of disease. Encouraging results were obtained for cervical node metastases, oropharynx and salivary gland cancer. In laryngeal and hypopharyngeal cancer, neutron therapy seems to be disadvantageous. The main reason for treatment failure was local recurrence. Two patients died of complications.

Mixed beam radiation therapy for unresectable squamous cell carcinomas of the head and neck: the results of a randomized RTOG study

Three hundred and twenty-two patients with inoperable squamous cell carcinomas of the head and neck were entered on a randomized study comparing "mixed beam" radiation therapy with photon radiation therapy. Patients with histologically proven tumors of T-stage T2, T3, or T4 and any N-stage originating in the oral cavity, oropharynx, supraglottic larynx, or hypopharynx were eligible. One hundred forty-five patients were randomized to photon treatment and 177 were randomized to mixed beam treatment. No significant differences could be demonstrated between the experimental and control groups for primary tumor control or overall survival, although there was an advantage for mixed beam treatment over photon treatment for patients with metastatic cervical adenopathy (69 vs. 55% complete response rate in the nodes, p = .024). It is concluded that mixed beam radiation therapy does not offer a significant advantage over photon radiation therapy for patients with advanced squamous cell carcinomas of the head and neck.