Alternating Chemo-Radiotherapy Versus Partly Accelerated Radiotherapy in Advanced Squamous Cell Carcinoma of the Head and Neck: Results of a Phase III Randomized Trial

Joel W. Goldwein, MD
OncoLink Founder
Last Modified: May 20, 2000

Presenter: M. Benasso
Affiliation: Inst Nazionale per la Ricera sul Cancro and affiliated centers, Genoa, Italy

It has previously been shown that alternating chemo-radiotherapy (ALT) has improved outcome compared with conventional RT in advanced-stage Squamous cell carcinoma of the head and neck. This study compared the alternating chemo-RT regimen with a partly accelerated radiotherapy (PA-RT) regimen without chemotherapy in a similar patient population.

Materials and Methods:

  • 136 patients with unfavorable Stage II or Stage III, IV Squamous Cell Carcinoma were randomized to either of 2 regimens, n=70 for ALT and n=60 for PA-RT; 69 were eligible for ALT, 64 for PA-RT
  • ALT=3 splits of 20Gy each of RT with CDDP + 5- FU
  • PA-RT=60Gy/30fx/6wks and 15gy/10fx during last 2 weeks of treatment


  • The study was closed early due to poor accrual.
  • The CR rate was 51% in the ALT and 39% in PA- RT arms (p=NS).
  • The failure rates were 27% vs. 24% in ALT vs. PA-RT arms (p=NS)
  • The 3-year PFS was 34% and 255, and the 3- year OS was 37% and 29% in the ALT and PA-RT arms
  • Significantly more dermatitis and grade 2 late toxicities were seen in the PA-RT patients compared with ALT-treated patients

Authors' Conclusions

  • No significant difference in response or survival was seen between the 2 regimens.
  • PA-RT was associated with significantly more dermatitis and grade 2 late toxicicity.
  • Low accrual may have contributed to this outcome.

Clinical/Scientific Implications:

  • A more toxic regimen was, in this case, not associated with a better survival
  • The ALT regimen will continue to be the standard therapy against which new regimens will be compared at this institution.


Smoothies for All Occasions
by OncoLink Editorial Team
May 24, 2016