Short course high fractional dose irradiation in advanced and recurrent head and neck cancer

Thirty patients with advanced head and neck cancer were treated with 400 rad daily to a total of 4400 to 5200 rad. Twenty-three patients had previously untreated stage III and IV cancer and 7 patients had recurrent head and neck cancer. As a pilot study, 9 of 30 patients also had received metronidazole (6 Mg/M²) every other day during radiotherapy. The previously untreated patients (stage III (2), stage IV (21) ) had a local control rate of 61 % (14/23) with a 45% two year actuarial survival. Three of 9 patients who were treated with high fractional dose irradiation plus metronidazole developed confluent mucositis of more than three weeks duration. Only 3 of the remaining 21 patients experienced similar mucositis. In all cases mucositis subsided without sequelae. One patient who received radiation and metronidazole and another who received radiation only developed laryngeal edema which required tracheotomy. Seven of 9 metronidazole treated patients remain disease free at this time. The 7 patients with recurrent disease achieved some degree of palliation but none survived.