Accelerated postoperative radiotherapy with weekly concomitant boost in patients with locally advanced head and neck cancer

Abderrahim Zouhair, David Azria, Philippe Pasche, Roger Stupp, Julia Chevalier, Michael Betz, René O. Mirimanoff, Mahmut Ozsahin*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

13 Scopus citations


Background and purpose: To assess the feasibility and efficacy of accelerated 66-Gy postoperative radiotherapy (PORT) using a single-fraction regimen from Mondays to Thursdays and a concomitant boost on Friday afternoon sessions in patients with locally advanced head and neck cancer (LAHNC). Patients and methods: Between December 1997 and June 2002, 89 consecutive patients with pT1-pT4 and/or pN0-pN3 LAHNC were included. PORT was indicated in patients with positive surgical margins, T4 tumors, or extracapsular nodal infiltration. RT consisted of 66Gy (2Gy/fr) in 5 weeks and 3 days. Median follow-up was 21 months (range 2-59). Results: Acute morbidity was acceptable: grade 3 mucositis in 20 (22%) patients, grade 3 dysphagia in 22 (25%) patients, and grade 3 skin erythema in 18 (20%) patients. Median weight loss was 2 kg (range 0-14.5). No grade 4 toxicity was observed. Late effects included grade 3 xerostomia in 6 (7%) patients, and grade 3 edema in 2 (2%) patients. Median time to locoregional relapse was 10 months (range 2-21). Two-year overall, cause-specific, and disease-free survival rates were 70% (95% confidence interval (CI) 59-81), 75% (95% CI 64-86), and 63% (95% CI 52-74), respectively. The 2-year actuarial locoregional control rate was 80% (95% CI 70-90). Distant metastasis probability at 4 years was 38% (95% CI 20-56). Multivariate analysis revealed that pT-classification (pT1-2 vs. pT3-4) and extranodal extension (0, 1 vs. 2 or more) were the two factors independently influencing the outcome. Conclusions: We conclude that reducing the overall treatment time using an accelerated PORT schedule including a once-weekly concomitant boost (six fractions per week) is easily feasible with excellent local control. Acute and late RT-related morbidity is acceptable. Given the disease progression pattern (distant metastases), adjuvant chemotherapy should be considered.

Original languageEnglish (US)
Pages (from-to)183-188
Number of pages6
JournalRadiotherapy and Oncology
Issue number2
StatePublished - Feb 2004


  • Accelerated radiotherapy
  • Head and neck cancer
  • Locally advanced
  • Postoperative

ASJC Scopus subject areas

  • Hematology
  • Oncology
  • Radiology Nuclear Medicine and imaging


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