TY - JOUR
T1 - Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer
T2 - A meta-analysis
AU - Matuschek, Christiane
AU - Haussmann, Jan
AU - Bölke, Edwin
AU - Gripp, Stephan
AU - Schuler, Patrick J.
AU - Tamaskovics, Bálint
AU - Gerber, Peter Arne
AU - Djiepmo-Njanang, Freddy Joel
AU - Kammers, Kai
AU - Plettenberg, Christian
AU - Anooshahr, Bahar
AU - Orth, Klaus
AU - Budach, Wilfried
N1 - Publisher Copyright:
© 2018 The Author(s).
PY - 2018/10/4
Y1 - 2018/10/4
N2 - 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.
AB - 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.
KW - Accelerated fractionation
KW - Adjuvant therapy
KW - Conventional fractionation
KW - Head and neck cancer
KW - High risk
KW - Radiation therapy
UR - http://www.scopus.com/inward/record.url?scp=85054430822&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85054430822&partnerID=8YFLogxK
U2 - 10.1186/s13014-018-1133-8
DO - 10.1186/s13014-018-1133-8
M3 - Article
C2 - 30286777
AN - SCOPUS:85054430822
SN - 1748-717X
VL - 13
JO - Radiation Oncology
JF - Radiation Oncology
IS - 1
M1 - 195
ER -