Lancet: Should accelerated radiotherapy be standard for head, neck cancer?

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An accelerated schedule of radiotherapy for squamous-cell carcinoma of the head and neck (HNSCC) is more effective than conventional fractionation, and since it does not require additional resources it might be a suitable new global standard baseline treatment for radiotherapy of HNSCC, according to a study published online April 9 in the Lancet Oncology.

The findings of the study called the International Atomic Energy Agency (IAEA) trial showed that accelerated radiotherapy (increasing the number of treatments from five to six a week) prevented local disease recurrence and improved disease-free survival, with no increase in late radiation-induced side-effects, in HNSCC patients in resource-limited settings.

Jens Overgaard, MD, chief of the experimental clinical oncology department at Aarhus University Hospital in Denmark and international colleagues from Asia, Europe, the Middle East, Africa and South America recruited 908 patients with HNSCC of the larynx, pharynx and oral cavity who were eligible for curative radiotherapy from Jan. 6, 1999 to March 31, 2004.

Patients were randomly assigned to an accelerated schedule of six fractions of radiotherapy per week of 2 Gy (458 patients) or to a conventional radiotherapy schedule of five fractions per week of 2 Gy (450 patients), up to a total dose 66-70 Gy in 33-35 fractions, according to Overgaard and colleagues.

The median treatment time was 40 days in the accelerated group and 47 days in the conventional group. Five year locoregional control was 12 percent better in patients given the accelerated regimen (42 percent) compared with those given the conventional regimen (30 percent), according to Overgaard and colleagues.

Additionally, the investigators found that disease-free survival was significantly greater for patients in the accelerated regimen group than in the conventional treatment group (50 vs. 40 percent).

Acute morbidity in the form of confluent mucositis was noted in 45 patients by the investigators in the accelerated group and 22 patients in the conventional group. Also, severe skin reactions were noted in 87 patients in the accelerated group and 50 patients in the conventional group. However, there were no significant differences in late radiation side-effects, wrote Overgaard and colleagues.

The accelerated schedule is therefore more effective than conventional fractionation, and since it does not require additional resources it might be a suitable new international standard of treatment, concluded Overgaard and colleagues.