Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer

Karen K. Fu, Jay S. Cooper, Victor A. Marcial, George E. Laramore, Thomas F. Pajak, John Jacobs, Muhyi Al-Sarraf, Arlene A. Forastiere, James D. Cox

Research output: Contribution to journalArticle

Abstract

During the past 25 years, the Radiation Therapy Oncology Group (RTOG) has played a major role in head and neck cancer clinical research. The major research themes for recent and currently active trials have been: (a) combined modality therapy, (b) altered fractionation radiotherapy, (e) hypoxic cell sensitizers, (d) organ preservation, (e) chemoprevention, and (f) clinical/laboratory correlations. For advanced operable disease, the RTOG showed improved local-regional control with postoperative radiotherapy as compared to preoperative radiotherapy for carcinoma of the supraglottic larynx and hypopharynx. This established the use of surgery followed by postoperative radiotherapy as the standard treatment in subsequent RTOG and Intergroup trials for operable disease. For advanced inoperable disease, the RTOG demonstrated the feasibility of testing altered fractionation radiotherapy in a multiinstitutional clinical trials setting. A Phase III trial comparing hyperfractionation and accelerated fractionation to conventional fractionation is now in progress. Phase I/II combined modality studies established the efficacy of concurrent high-dose cisplatin and radiotherapy in the treatment of advanced disease and provided the basis for further testing in Phase III trials for nasopharyngeal carcinoma, larynx preservation, and high-risk advanced operable disease. Analysis of the extensive RTOG Head and Neck Cancer database established the incidence of second malignancies and their adverse impact on patients whose initial tumors were cured by radiotherapy, and provided the basis for chemoprevention trials. Recursive partitioning analysis identified 6 distinct prognostically homogeneous patient groups based on pretreatment tumor or patient characteristics and/or treatment variables. Retrospective analysis identified tumor p105 antigen density as an independent prognostic indicator in patients irradiated for head and neck cancer. Future trials will continue to focus on the reduction of morbidity and mortality, and improvement of the quality of life of head and neck cancer patients through innovative radiotherapy delivery, multimodality approaches, use of chemical and biological modifiers, and other novel therapies, identification of clinical and biological prognostic indicators, and prevention or diminution of acute morbidity and late complications of the disease and its treatment.

Original languageEnglish (US)
Pages (from-to)425-438
Number of pages14
JournalInternational Journal of Radiation Oncology, Biology, Physics
Volume35
Issue number3
DOIs
StatePublished - Jun 1 1996

Fingerprint

Radiation Oncology
Head and Neck Neoplasms
radiation therapy
Radiotherapy
cancer
Clinical Trials
fractionation
larynx
tumors
Chemoprevention
Larynx
therapy
Organ Preservation
Morbidity
Therapeutics
Hypopharynx
Combined Modality Therapy
Second Primary Neoplasms
mortality
Neoplasm Antigens

Keywords

  • Clinical trials
  • Combined modality
  • Head and neck cancer
  • Radiotherapy
  • RTOG

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation

Cite this

Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer. / Fu, Karen K.; Cooper, Jay S.; Marcial, Victor A.; Laramore, George E.; Pajak, Thomas F.; Jacobs, John; Al-Sarraf, Muhyi; Forastiere, Arlene A.; Cox, James D.

In: International Journal of Radiation Oncology, Biology, Physics, Vol. 35, No. 3, 01.06.1996, p. 425-438.

Research output: Contribution to journalArticle

Fu, Karen K. ; Cooper, Jay S. ; Marcial, Victor A. ; Laramore, George E. ; Pajak, Thomas F. ; Jacobs, John ; Al-Sarraf, Muhyi ; Forastiere, Arlene A. ; Cox, James D. / Evolution of the Radiation Therapy Oncology Group clinical trials for head and neck cancer. In: International Journal of Radiation Oncology, Biology, Physics. 1996 ; Vol. 35, No. 3. pp. 425-438.
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