Awwad H K, Khafagy Y, Barsoum M, Ezzat S, el-Attar I, Farag H, Akoush H, Meabid H, Zaghloul M S
Radiotherapy Department, University of Cairo, Egypt.
Radiother Oncol. 1992 Dec;25(4):261-6. doi: 10.1016/0167-8140(92)90245-p.
Fifty-six patients with locally advanced head and neck squamous cell carcinoma were subjected to adjuvant radiotherapy after radical surgery with randomisation to either conventional fractionation (CF), comprising 50 Gy/25 F/5 weeks, or to accelerated hyperfractionation (AHF) to a dose of 42 Gy/30 F/11 days (3 F/day), a dose/F of 1.4 Gy and an interfraction interval of 4 h. The in vitro [3H]thymidine labelling index (TLI) was determined as an indicator of tumour proliferation. Early mucosal reactions were somewhat more severe after AHF than after CF and the peak was attained earlier. The actuarial 3-year complication rate was significantly lower in the AHF (64%) than in the CF group (87%). This is probably related to a smaller fraction size and a lower total dose. The overall 3-year disease-free survival amounted to 46 +/- 7%. Sex, the anatomical site, the nodal status, the performance status and TLI have been shown to be significant prognostic factors, but only the latter two proved to be independent covariates. Overall, the type of fractionation did not seem to influence survival. However, AHF seemed to offer higher survival probabilities in fast growing tumours and this attained a significant level for tumours with TLI > 10.4% (Tpot < 4.5 days). However, CF and AHF were associated with similar survival rates in slowly growing tumours. The relative effectiveness of the CF and AHF schedules is predictable on the basis of the linear-quadratic system. In the case of tumour response, a time factor has to be included assuming that accelerated repopulation of microscopic residues occurs from the outset.(ABSTRACT TRUNCATED AT 250 WORDS)
56例局部晚期头颈部鳞状细胞癌患者在根治性手术后接受辅助放疗，随机分为传统分割放疗（CF）组，即50 Gy/25次/5周，或加速超分割放疗（AHF）组，剂量为42 Gy/30次/11天（每天3次），每次剂量1.4 Gy，两次照射间隔4小时。测定体外[3H]胸腺嘧啶核苷标记指数（TLI）作为肿瘤增殖指标。AHF后的早期黏膜反应比CF后稍严重，且峰值出现更早。AHF组的3年精算并发症发生率（64%）显著低于CF组（87%）。这可能与每次分割剂量较小和总剂量较低有关。3年无病生存率总计为46±7%。性别、解剖部位、淋巴结状态、体能状态和TLI已被证明是重要的预后因素，但只有后两者被证明是独立的协变量。总体而言，分割方式似乎不影响生存率。然而，AHF似乎在快速生长的肿瘤中提供更高的生存概率，对于TLI>10.4%（Tpot<4.5天）的肿瘤达到显著水平。然而，CF和AHF在生长缓慢的肿瘤中生存率相似。CF和AHF方案的相对有效性可根据线性二次模型预测。在肿瘤反应方面，假设从一开始就发生微观残留的加速再增殖，则必须纳入时间因素。（摘要截断于250字）
