Accelerated treatment.

Abstract

In the first third of this century, the prevailing concept was that malignant cells had a brief period of sensitivity and radiation treatments were ideally given in overall times of 2 weeks or less. Following the Second World War, routine treatment times were extended to 5 to 8 weeks to avoid severe acute normal tissue reactions and achieve higher tumor doses. In reaction to these prolonged overall times, a series of large-fraction, shortened-overall-time clinical experiments were attempted, with disastrous normal tissue effects and poor tumor control. More recently, attempts to accelerate treatment have been accomplished by utilizing multiple fractions per day or semicontinuous irradiation. Unfortunately, the majority of these attempts have been forced by the occurrence of unacceptable normal tissue reactions to significantly reduce total dose or introduce lengthy splits in treatment. These results suggest that in our current state of knowledge accelerated schedules be reserved for use in the treatment of rapidly proliferating neoplasms or for palliation.