Hyperfractionated or accelerated radiotherapy for head and neck cancer

Area of Science:

• Oncology
• Radiotherapy
• Head and Neck Cancer

Background:

• The efficacy of altered fractionation radiotherapy in head and neck squamous cell carcinoma (HNSCC) remains unclear despite numerous trials.
• Conventional radiotherapy is the standard, but investigations into modified fractionation schedules aim to improve outcomes.

Purpose of the Study:

• To conduct an individual patient data (IPD) meta-analysis to determine if altered fractionation radiotherapy improves survival in HNSCC patients.
• To compare the survival benefits of different altered fractionation techniques.

Main Methods:

• A systematic search of multiple databases identified randomized trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy for non-metastatic HNSCC.
• Fifteen trials involving 6515 patients, with recruitment between 1969 and 1998, were included.
• Overall survival was the primary outcome, with secondary outcomes including locoregional control, distant control, and cause-specific mortality.

Main Results:

• Altered fractionation radiotherapy demonstrated a significant survival benefit, with an absolute 3.4% improvement at five years (HR 0.92).
• Hyperfractionated radiotherapy yielded a greater survival benefit (8% at five years) compared to accelerated radiotherapy (1.7-2% at five years).
• A significant benefit in locoregional control (6.4% at five years) was observed, particularly in reducing local failures, with a more pronounced effect in younger patients (<50 years).

Conclusions:

• Altered fractionation radiotherapy significantly enhances survival in patients with head and neck squamous cell carcinoma.
• Hyperfractionation appears to be the most beneficial altered fractionation strategy.
• An updated meta-analysis (MARCH 2) is underway to further refine these findings.