Fast neutron therapy for locally advanced head and neck tumors

Between October 1972 and April 1979, 187 patients with locally advanced head and neck tumors were treated with 50 MeV_d→Be neutrons or with conventional treatment in the M. D. Anderson Hospital-Texas A & M University variable energy cyclotron (MDAH-TAMVEC) program. Of these, 114 patients were treated in pilot studies and 73 in a randomized clinical trial. In the pilot studies, 49 patients were treated with neutrons alone, 25 with mixed-beam irradiation (two neutron and three photon fractions per week), and 40 with conventional treatment (surgery, photons, or combined surgery and photons). There was no appreciable difference among patients in these studies with regard to local tenor control or servival. However, the patients in the conventional-treatment pilot study had less advanced disease than those in either of the other studies. The complication rates in the neutrons-only and conventional-treatment studies were significantly greater than the complication rate observed in the mixed-beam pilot study. In the randomized clinical trial, 41 patients were treated with mixed-beam irradiation and 32 with photon irradiation. The preliminary results of this trial show a slight superiority with mixed-beam irradiation. In the mixed-beam group, 61% had local tumor control, 7% developed major complications, and 4996 were alive at the time of analysis; whereas in the photon group, 47% had local tumor control, 3% developed major complications, and 25% were alive at the time of analysis.