Follow-up data of our pilot study on concomitant hyperfractionated radiotherapy and cisplatinum (CDDP) in patients with advanced cancer of the head and neck.

Since 1988, 52 patients with stage III/IV squamous cell cancer of the head and neck have been treated by concomitant irradiation with 2 x 1.2 Gy/d on five days per week up to a total dose between 72 and 76.8 Gy without split and 5 x 20 mg/m2 cisplatinum (CDDP) as short infusion finished approximately 30 min before the second session on five days of the first and the fifth week of radiotherapy. Radiotherapy has been suspended after 30 and 50 Gy in three patients for insufficient response. In all other patients, radiotherapy has been completed. Due to a slow haematologic recovery, 34% of the patients received only one cycle of CDDP Grade 3 mucositis, occurring during radiotherapy in all patients, healed in a couple of weeks after radiotherapy. Three patients have a persisting ulcer between eight and 36 months after radiotherapy with biopsies negative for tumour and also no other signs of tumour. The ulcers are situated in the region of the former primary tumour with an extensive destruction of tissue already before radiotherapy (cumulative risk of this complication after three years 8%). There were no other major complication. Cumulative local control after three years was 67% (75% including salvage surgery in two patients) with a plateau after twelve months. Total survival after three years was 62%. For the whole follow-up period, local control in the region of the primary tumour after radiotherapy was: 19/29 (T4), 10/15 (T3), 7/10 (T1 + 2, including salvage surgery: 8/10). Local control in the region of the nodal metastasis after radiotherapy was: 5/14 (N3, including salvage surgery: 6/14). 18/21 (N2) and 6/8 (N1).