Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis
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 orde...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2018-10-01
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| Series: | Radiation Oncology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13014-018-1133-8 |
| _version_ | 1828975453152477184 |
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| author | 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 |
| author_facet | 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 |
| author_sort | Christiane Matuschek |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T14:20:11Z |
| format | Article |
| id | doaj.art-e7b6fa1772d54029886156b33524bed7 |
| institution | Directory Open Access Journal |
| issn | 1748-717X |
| language | English |
| last_indexed | 2024-12-14T14:20:11Z |
| publishDate | 2018-10-01 |
| publisher | BMC |
| record_format | Article |
| series | Radiation Oncology |
| spelling | doaj.art-e7b6fa1772d54029886156b33524bed72022-12-21T22:58:05ZengBMCRadiation Oncology1748-717X2018-10-0113111210.1186/s13014-018-1133-8Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysisChristiane Matuschek0Jan Haussmann1Edwin Bölke2Stephan Gripp3Patrick J. Schuler4Bálint Tamaskovics5Peter Arne Gerber6Freddy-Joel Djiepmo-Njanang7Kai Kammers8Christian Plettenberg9Bahar Anooshahr10Klaus Orth11Wilfried Budach12Department of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Oto-Rhino-Laryngology, Head and Neck Surgery, Ulm University Medical CenterDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Dermatology, Medical Faculty Heinrich Heine University DusseldorfDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDivision of Biostatistics and Bioinformatics, Department of Oncology, The Sidney Kimmel Comprehensive Cancer Center at Johns Hopkins, The Johns Hopkins University School of MedicineDepartment of Oto-Rhino-Laryngology, Head and Neck Surgery, Heinrich Heine University DusseldorfVincere Cancer CenterDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityDepartment of Radiotherapy and Radiooncology, Medical Faculty, Heinrich Heine UniversityAbstract 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.http://link.springer.com/article/10.1186/s13014-018-1133-8Radiation therapyHead and neck cancerHigh riskAdjuvant therapyConventional fractionationAccelerated fractionation |
| spellingShingle | 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 Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis Radiation Oncology Radiation therapy Head and neck cancer High risk Adjuvant therapy Conventional fractionation Accelerated fractionation |
| title | Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis |
| title_full | Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis |
| title_fullStr | Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis |
| title_full_unstemmed | Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis |
| title_short | Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis |
| title_sort | accelerated vs conventionally fractionated adjuvant radiotherapy in high risk head and neck cancer a meta analysis |
| topic | Radiation therapy Head and neck cancer High risk Adjuvant therapy Conventional fractionation Accelerated fractionation |
| url | http://link.springer.com/article/10.1186/s13014-018-1133-8 |
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