Radiation with concurrent late chemotherapy intensification ('chemoboost') for locally advanced head and neck cancer

The aim of this study was to review our experience with a treatment regimen that combined conventionally fractionated radiation therapy (70 Gy over 7 weeks) with chemotherapy (cisplatin and fluorouracil), given concurrently in the last 2 weeks of radiation therapy in patients with previously untreated advanced squamous cell cancer of the head and neck region.Twenty-eight patients, all but two having UICC stage IV disease, were treated at the Peter MacCallum Cancer Institute between November 1995 and April 1998. Planned chemotherapy consisted initially of continuous infusion at 10 mg/m(2) per day of cisplatin and 400 mg/m(2) per day of fluorouracil on days 1-5 of weeks 6 and 7 of a conventionally fractionated course of radiotherapy. After the first 14 patients, the dose of fluorouracil was reduced to 360 mg/m(2) per day because of acute toxicity.36.8 months), with an estimated 50% surviving at 2 years (CI, 29-71%). Sixteen patients (57%) developed confluent mucositis and 11 (39%) developed patchy mucositis. The median duration of mucositis for these 27 patients was 1.5 months. Seventeen patients (61%) required nutritional support for a median duration of 1.4 months. Fourteen patients (50%) had grade three skin reactions, and 12 (43%) had one or more other significant (Grade 3) toxicities, predominantly infective. Grade 3 late toxicity has been observed in three patients to date (three xerostomia, including one with severe depression), and one patient had chronic ulceration of the oral tongue (grade 4). This chemoradiation regimen achieved an excellent complete response rate and good locoregional control at 2 years in patients with a poor initial prognosis. Acute toxicity was significant but manageable. The regimen offers an alternative to surgery and postoperative radiation therapy in locally advanced head and neck cancer.

Phonological fusion in dichotic monitoring

Phonological fusion (e.g., BACK + LACK perceived as BLACK) was examined in a dichotic monitoring task that required subjects to press a button whenever they thought a predesignated target (e.g., BLACK) occurred. Fusion rate was determined from incidental response to fusible pairs in this task. It was found that a voluntary strategy of selective attention to one ear reduced fusion rate. However, fusions could not be entirely eliminated using this strategy. A signal detection analysis indicated that strategy did not involve a response bias shift, although individual differences in fusion rates unimodally distributed) could be partly accounted for by differences in response bias and discriminatory ability. Phenomenological data suggested that a fusible stimulus pair may yield more than one percept on a single presentation, but not necessarily that same percept on repeated presentations. Reaction time data supported the view that phonological fusion involves parallel processing of fusible items in the language-dominant hemisphere.

Phonological fusion in dichotic monitoring

Phonological fusion (e.g., BACK + LACK perceived as BLACK) was examined in a dichotic monitoring task that required subjects to press a button whenever they thought a predesignated target (e.g., BLACK) occurred. Fusion rate was determined from incidental response to fusible pairs in this task. It was found that a voluntary strategy of selective attention to one ear reduced fusion rate. However, fusions could not be entirely eliminated using this strategy. A signal detection analysis indicated that strategy did not involve a response bias shift, although individual differences in fusion rates unimodally distributed) could be partly accounted for by differences in response bias and discriminatory ability. Phenomenological data suggested that a fusible stimulus pair may yield more than one percept on a single presentation, but not necessarily that same percept on repeated presentations. Reaction time data supported the view that phonological fusion involves parallel processing of fusible items in the language-dominant hemisphere.