Very accelerated versus conventional radiotherapy in HNSCC: Results of the GORTEC 94-02 randomized trial

William Levin, MD
OncoLink Assistant Editor
Last Modified: October 23, 2000

Presenter: J. Bourhis, et al.
Affiliation: Institut Gustave Roussy, Villejuif, France


Squamous cell carcinomas of the head & neck are considered to be fairly rapid growing tumors. Advanced tumors are frequently unresectable and treated with radiotherapy. Theoretically, better tumor control might be obtained if radiation treatment was accelerated.


  • 268 patients with inoperable head and neck squamous cell carcinoma were randomized to receive 70 Gy over 7 weeks or 62-64 Gy in 3 weeks (2 Gy BID).

  • The most frequent site was oropharynx (75 %) and most of the patients had T4 (70%) and N2-3 disease.


  • Acute toxicity was significantly higher in the accelerated arm with 83% of patients having grade 3-4 mucositis, compared to 28% in the conventional arm (p<0.001).

  • A feeding tube was needed in 90% of the patients in the accelerated and 41% in the conventional arm.

  • With a median follow-up of 28 months no difference was seen between groups, regarding late toxicity.

  • The actuarial loco-regional control at 2 years was 58% and 34% in the accelerated and conventional arm, respectively (p<0.01).

  • There was no significanct difference between groups for overall survival.

Author's Conclusions:

  • The very accelerated regimen used in this study led to a marked increase in acute toxicity along with a significant improvement in local control.

  • No benefit in terms of overall survival was seen with accelerated fractionation.

Clinical/Scientific Implications:

  • While increased acute toxicity is to be expected with the more intense regimen, longer follow-up of these patients will be needed to fully assess late toxicity.

  • Issues of alternated fractionation may become less relevant in the future, given that combined chemoradiation regimens have been found superior to radiation- only treatments, in terms of overall survival in this group of patients.