The use of a concomitant electron boost (field in the field technique) in large cervical node metastases over a shortened period

Primary radiotherapy of squamous cell carcinoma of the oropharynx and pharyngolarynx: tentative multivariate modelling system to predict the radiocurability of neck nodes

In a series of 1251 cases of squamous cell carcinomas of oropharynx and pharyngolarynx with clinically positive neck and treated primarily by radiation therapy a determinate group of 798 cases remained eligible for a multivariate analysis of the prognostic factors related to the regional outcome. Node size (p less than 0.0001), node fixity (p = 0.016) and T stage (p = 0.02) were the significant pretreatment factors independently predictive of neck node control. when regarding the treatment modalities in this determinate group of patients who received tumor doses of at least 55 Gy, only the treatment duration was found to be predictive (p = 0.002). Based on these factors, a multivariate model was constructed and tested by estimating the product-limit survival of the various groups of patients. The predictive accuracy of the equation was assessed by the log-rank test significance levels. The model may help to select, in many clinical situations, the appropriate approach of the management of metastatic neck disease, either by definitive radiation therapy or by combined modalities.

A method of radiation treatment for advanced neck node metastases

Thirty-one advanced cervical node metastases (staged N3 according the U.I.C.C. system; 4 N2A, 27N3A according the A.J.C. system) were treated using a particular schedule consisting in two courses: in the first, only the palpable tumor was irradiated with several low energy beams (3.3 mm Al HVL), using as X ray tube operated at 60 kV; in the second course, the whole lymphatic area was treated with 60 Co and conventional fractionation. Palpable disease received 7500 to 10,500 cGy in a overall time of 45-55 days. The local control rate was 87%, without any severe complication. The four (13%) failures were all related to the lowest dose levels.

Regional outcome in oropharyngeal and pharyngolaryngeal cancer treated with high dose per fraction radiotherapy. Analysis of neck disease response in 1646 cases

Out of a series of 1666 consecutive patients with squamous cell carcinoma of oropharynx and pharyngolarynx, 1646 were evaluable at a 3-year interval following radical radiation therapy. The actuarial 3-year nodal control rate using the AJC classification was: N0 98%, N1 90%, N2 88%, N3 71% when the primary was controlled. The regional outcome is influenced by clinical features such as nodal size, multiplicity and fixity. Cervical recurrence frequency is higher for pharyngolaryngeal carcinoma than for oropharyngeal cancer. The impact of the treatment planning on regional control is discussed. Due to the of concomitant boosting of nodes, cervical metastases were treated according to a type of accelerated fractionation schedule with weekly doses of 12-15 Gy for a total of 70-85 Gy in 75% of the cases. Clear-cut dose control relationships are demonstrated for nodes larger than 3 cm in diameter. Overboosting residual cervical disease fails to yield a better nodal control. Comparative analysis is established between results obtained with this high dose per fraction radiotherapy schedule, conventional regimens of irradiation and other new approaches, combining chemical and physical agents. Therapeutic implications are also derived to define adequate field coverage.