Fast neutron therapy for squamous cell carcinoma in the head and neck region: results of a randomized trial |
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| Authors: | W Duncan J A Orr S J Arnott W J Jack G R Kerr J R Williams |
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| Affiliation: | 1. Division of Cancer Care and Epidemiology, Queen''s Cancer Research Institute, Kingston, Ontario, Canada;2. Department of Oncology, Queen''s University, Kingston, Ontario, Canada;1. Department of Radiation Oncology, Fujian Medical University Cancer Hospital, Fuzhou, China;2. Department of Radiology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China;3. Department of Radiation Oncology, Fujian Cancer Hospital & Fujian Medical University Cancer Hospital, Fuzhou, China;4. Key Laboratory of Systems Biomedicine (Ministry of Education), Shanghai Center for Systems Biomedicine, Shanghai Jiao Tong University, Shanghai, China;5. Department of Radiation Oncology, Princess Margaret Cancer Centre/University of Toronto, Toronto, Canada;6. Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fujian Medical University Cancer Hospital, Fuzhou, China;1. Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, Netherlands;2. OncoRay – National Center for Radiation Research in Oncology, Faculty of Medicine and University Hospital Carl Gustav Carus, Technische Universität Dresden, Helmholtz-Zentrum Dresden-Rossendorf, Germany;3. INFN Rome, Italy;4. University of Cambridge, UK;5. MGH, USA;6. HollandPTC, Delft, Netherlands;7. Hokkaido University, Japan;8. University Medical Center Hamburg-Eppendorf, Germany;9. ETH, Zuerich, Switzerland;10. Paul Scherrer Institut (PSI), Villigen, Switzerland;11. The Institute of Cancer Research and the Royal Marsden NHS Foundation Trust, London, UK;12. Strahlenklinik, Universitätsklinikum Erlangen, Germany;13. Lyon 1 University and CNRS/IN2P3, UMR 5822, 69622 Villeurbanne, France;14. Centre for Medical Image Computing, Dept. Medical Physics and Bioengineering, University College London, London, UK;1. Medical Physics Department, AUSL 4 Teramo – Hospital G. Mazzini, Piazza Italia 1, 64100 Teramo (TE), Italy;2. Post-graduate School in Medical Physics, University of L’Aquila, Piazzale Salvatore Tommasi 1, 67100 L’Aquila (AQ), Italy |
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| Abstract: | A randomized trial of fast neuron therapy compared with 4MV photons for patients with head and neck cancer is reported. One hundred and sixty-eight patients were recruited between 1977 and 1984. The minimum follow-up is 2 years. Three patients were withdrawn before treatment began. Eighty-five were allocated to neutron therapy and 80 to receive photon therapy. All patients had squamous cell cancers in one of four primary sites: oral cavity, oropharynx, larynx, and hypopharynx. Local tumor control was similar in both groups: 44.7% after neutrons and 45.0% after photons. Salvage surgery was performed on 18 patients in each treatment group for residual or recurrent cancer. Acute radiation reactions of the mucous membranes were significantly more severe after photons. The number of patients with serious late reactions was greater after neutron therapy but the difference was not statistically significant. There were six deaths related to late morbidity after neutron therapy but none after photon therapy. Survival was better after photon therapy but the difference compared with the neutron group failed to reach statistical significance. When intercurrent deaths are excluded, the difference is less marked. Photon therapy was clearly better in terms of disease-free survival giving a 2-year local disease-free rate of 41.3% (s.e. 5.5%) compared with 29.4% (s.e. 4.9%) after neutrons. |
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