I question the essential validity of the study, due to the fact that a different patient population (older, poorer performance status) was used for the weekly dose, and younger, better performing patients were used for the 21 day regimen. A more valid study would have been to use similar patient populations in each treatment modality, then compare.

My CCC uses the weekly regimen as its primary therapeutic methodology, and has had good results.

I am also curious about the low (50% and 40%) Complete Response Rates. That is significantly below what is acheived at most CCC's these days, based upon my reading. Would be interesting to see what the TMN and location characteristics for the test population.

Also tough to draw too many broad conclusions, since test population was small.

I concur, but this is all that I came across. A study with a more comparable population (eating, drinking, smoking, health care etc) would be better. What is needed is an "identical" set of patients for the 3 vs 7 treatments.

.... It would seem reasonable that the younger group can tolerate a harsher treatment better than the older group. If the outcome and adverse effects are similar then this favors the weekly regimen (in my mind).

Perhaps we are splitting hairs here. The important thing may just be that one HAS concurrent chemo with IMRT. I will see my MO (young guy) this Saturday and will query him regarding and his take on this.

This one deals with recurrent HNC
http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=2621229
They strongly advocate radiation +/- chemo to reduce rHNC.

M

Markus said above....They strongly advocate radiation +/- chemo to reduce rHNC.

That's an understatement... as they recommend postoperative radiation and chemo if the expected recurrence rate is only 10%, pretty much regardless of initial tumor size or other Staging factors so unless I'm missing something, that's pretty much saying almost everyone with HN cancer should get concurrent rad/chemo.

ah, but David this is what they said:

Conclusions: Gabriela Studer,1 Klaus W Graetz,2 and Christoph Glanzmann, Radiat Oncol. 2008; 3: 43.

re rHNC
"A low salvage rate of only ~50% at 2 years was found. Calculated numbers of patients needed to treat with postoperative radiation after initial surgery, in order to avoid recurrence and tumor-specific death, suggest a rather generous use of adjuvant irradiation, usually with simultaneous chemotherapy."

.... while the results are pretty convincing, it will take more (and independent) confirmation (also in the US).

M

quite often you find a cautious tone (i.e. suggest) in a scientific article. Unfortunately, the cranks do not stay away from absolutes.

Thanks Marcus and David, didn't even think about the chemo schedule, but for some reason I want to say it would be weekly. I would love to hear what your MO says Marcus.

John just completed radiation, after surgery to remove the primary tumor (right tonsillar region though he had a tonsillectomy as a kid) and the three cancerous lymph nodes (plus a number of others that were matted together but turned out to be noncancerous). The ENT and RO decided on surgery followed by radiation vs radiation and chemo, so now we'll see; he finished up the treatments on the 14th...
best of wishes for your situation