RADIOTHERAPY SIDE EFFECTS IN HEAD AND NECK CARCINOMA PATIENTS

Four hundred and eight head and neck carcinoma patients were planned to have radiotherapy from July1991 to December 1995. Three hundred seventy three of these patients have completed the planned radiotherapy. Amongst the available systems to assess the side effects of radiotherapy RTOG/EORTC criteria was chosen to record morbidity in our patients. Disease distribution of these patients include: 186 (46 %) larynx carcinomas; 98 (24 %) oral cavity and oropharynx carcinomas; 46 (11 %) nasopharynx carcinomas; 28 (7 %) hypopharynx carcinomas; 16 (4 %) salivary glands carcinomas and 34 (8 %) others. There were 338 (83 %) men and 70 (17 %) women with median age of 58 (13-84). Radiotherapy was given conventionally in 360 patients, altered fractionation (twice daily or concommitant boost) in 13 patients, and reirradiation after a radical course of radiotherapy in 8 patients. Thirty two of patients treated with concommitant chemoradiotherapy. Grade III early side effects were seen in 15 (4 %) of patients. Late complications could be evaluated only in 245 patients. Grade III-IV late complications were seen in 7 (3 %) patients at a follow 'up period of 2 to 60 months (median 19). The incidence of side effects according to different radiotherapy approach were analysed with Fisher's exact test. Early side effects were common in patients who had concommitant chemoradiotherapy (p=0.000005) and who were treated with altered fractionated regimens (p=0.01) compared to conventional radiotherapy. Grade III and IV late complications were common in patients who had salvage radiotherapy and salvage surgery than who had only primary therapy and no evidence of locally and regionally recurrent disease (p=0.000002). Over 70 Gy, late complications were significantly higher too (p=0.0004). These observations compatible with clinical findings. Therefore RTOG/EORTC system is the best available system to record radiotherapy side effects. However it has a couple of disadvantages. Side effects in the same patient could be recorded with different grading and it is difficult to remember all in details.