Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: A meta-analysis

Christiane Matuschek, Jan Haussmann, Edwin Bölke, Stephan Gripp, Patrick J. Schuler, Bálint Tamaskovics, Peter Arne Gerber, Freddy Joel Djiepmo-Njanang, Kai Kammers, Christian Plettenberg, Bahar Anooshahr, Klaus Orth, Wilfried Budach

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Abstract

Background: Adjuvant radiotherapy in advanced head and neck squamous cell cancer (HNSCC) reduces the risk of local-regional failure and most likely increases the survival rate. Patients at high risk for tumor recurrence may benefit from more aggressive altered fractionation schedules in order to reduce the overall time from surgery to completion of radiotherapy. Here, we reviewed the results of six randomized trials addressing the above hypothesis. Methods: In the six trials of interest, a total of 988 patients with locally advanced HNSCC were randomly assigned to receive either accelerated or conventionally fractionated adjuvant radiotherapy. Hazard ratios (HR) were extracted from available publications for local-regional control, distant metastasis as well as overall-, cancer specific- and disease-free survival. Meta-analysis of the effect sizes was performed using fixed and random effect models. Acute and late side effects were categorized and summarized for comparison. Results: Accelerated radiotherapy did not improve the loco-regional control (n = 988, HR = 0.740, CI = 0.48-1.13, p = 0.162), progression-free survival (HR = 0.89, CI = 0.76-1.04, p = 0.132) or overall survival (HR = 0.88, CI = 0.75-1.04, p = 0.148) significantly. Acute confluent mucositis occurred with significant higher frequency with accelerated radiotherapy. Late side effects did not differ significantly in either group. Conclusion: Accelerated radiotherapy does not result in a significant improvement of loco-regional control or overall survival in high-risk patients. Acute but not late radiation toxicity were more frequent with the accelerated RT technique. In clinical practice accelerated postoperative radiation therapy might be a suitable option only for a subset of patients.

Original languageEnglish (US)
Article number195
JournalRadiation Oncology
Volume13
Issue number1
DOIs
Publication statusPublished - Oct 4 2018

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Keywords

  • Accelerated fractionation
  • Adjuvant therapy
  • Conventional fractionation
  • Head and neck cancer
  • High risk
  • Radiation therapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Matuschek, C., Haussmann, J., Bölke, E., Gripp, S., Schuler, P. J., Tamaskovics, B., ... Budach, W. (2018). Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: A meta-analysis. Radiation Oncology, 13(1), [195]. https://doi.org/10.1186/s13014-018-1133-8