A prospective trial of accelerated radiotherapy in the postoperative treatment of high-risk squamous cell carcinoma of the head and neck
International Journal of Radiation Oncology*Biology*PhysicsPublished 1 April 1993
Andy Trotti, Douglas Klotch, James Endicott, Marion B. Ridley, Harvey Greenberg
Citations43
SJR quartileQ1
SJR score2.06
SNIP1.72
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TL;DR
It is concluded that postoperative accelerated radiotherapy is feasible and has acceptable toxicity in this population of high risk squamous cell carcinoma patients and support the concept of rapid tumor repopulation after resection.
Abstract
While acute side effects appear to be increased compared to conventional radiotherapy, we conclude that postoperative accelerated radiotherapy is feasible and has acceptable toxicity in this population. These results support the concept of rapid tumor repopulation after resection. A randomized multi-institutional trial is currently underway to compare conventional and accelerated fractionation in the postoperative setting.
Keywords
Medicine
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International Journal of Radiation Oncology*Biology*PhysicsDose fractionation and regeneration in radiotherapy for cancer of the oral cavity and oropharynx. Part 2. Normal tissue responses: acute and late effects
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International Journal of Radiation Oncology*Biology*PhysicsRadiotherapy with thrice-a-day fractionation in a short overall time: Clinical experiences
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International Journal of Radiation Oncology*Biology*PhysicsPostoperative irradiation for squamous cell carcinomas of the head and neck: analysis of time-dose factors related to control above the clavicles
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International Journal of Radiation Oncology*Biology*PhysicsResults of twice-a-day irradiation of squamous cell carcinomas of the head and neck
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International Journal of Radiation Oncology*Biology*PhysicsImportance of the time interval between surgery postoperative radiation therapy in the combined management of head & neck cancer
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International Journal of Radiation Oncology*Biology*PhysicsContinuous hyperfractionated accelerated radiotherapy in locally advanced carcinoma of the head and neck region
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International Journal of Radiation Oncology*Biology*PhysicsCombined surgery and postoperative radiation therapy for advanced laryngeal and hypopharyngeal carcinomas
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