Fast neutron therapy at the end of 1988--a survey of the clinical data.

The clinical results reported from the different neutron therapy centres, in USA, Europe and Asia, are reviewed. Fast neutrons were proven to be superior to photons for locally extended inoperable salivary gland tumours. The reported overall local control rates are 67% and 24% respectively. Paranasal sinuses and some tumours of the head and neck area, especially extended tumours with large fixed lymph nodes, are also indications for neutrons. By contrast, the results obtained for brain tumours were, in general, disappointing. Neutrons were shown to bring a benefit in the treatment of well differentiated slowly growing soft tissue sarcomas. The reported overall local control rates are 53% and 38% after neutron and photon irradiation respectively. Better results were also reported for bone- and chondrosarcomas. The reported local control rates are 54% for osteosarcomas and 49% for chondrosarcomas after neutron irradiation; the corresponding values are 21% and 33% respectively after photon irradiation. For locally extended prostatic adenocarcinoma, the superiority of mixed schedule (neutrons + photons) was demonstrated by a RTOG randomized trial (local control rates 77% for mixed schedule compared to 31% for photons). Neutrons were also shown to be useful for palliative treatment of melanomas. Further studies are needed in order to evaluate the benefit of fast neutrons for other localisations such as cervix, bladder, rectum. It can be concluded that fast neutrons are superior to photons for at least 10% of the radiotherapy patients. It is likely that the new high- energy hospital-based cyclotrons will further extend the indications of neutron therapy. However, patient selection remains one of the main problems and there is a need for development of individual predictive tests.