ECC: Hyperfractionated Radiotherapy Improved Survival for Head and Neck Cancers

The use of altered fractionation radiotherapy increased overall survival in patients with locally advanced head and neck cancers when compared with standard radiation, according to the results of a meta-analysis presented on Saturday at the 2013 European Cancer Congress in Amsterdam.

“The improvement in survival is marked for patients in the hyperfractionated regimen, with an absolute benefit of 8.1% at 5 years,” said Pierre Blanchard, MD, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, who presented the results.

Blanchard and colleagues undertook a meta-analysis that examined randomized trials comparing standard radiation therapy with altered fractionation radiation therapy with or without concomitant chemotherapy in patients with local head and neck squamous cell carcinomas.

Fractionation was defined as either standard, 5 fractions per week for 7 weeks, or altered. Altered therapy could have been either hyperfractionated; (10 fractions per week for 7 weeks resulting in a higher dose); accelerated, which is the same dose given over 6 weeks; or very accelerated, which is a low dose given in about 3 weeks.

The researchers collected data from 31 trials representing more than 11,500 patients. After 7 years of follow-up, the data show that the higher dose intensity of altered fractionation radiotherapy improved outcomes in these patients.

Altered fractionation radiotherapy improved overall survival (3.1% gained at 5 years, corresponding to a reduction of the risk of death of 6%) and progression-free survival (reduction of the risk of progression or death of 10% at 5 years), Blanchard told Cancer Network.

“While the acute side-effects of altered fractionation radiotherapy are increased compared to those experienced by patients on standard fractionation radiotherapy, the late side-effects are comparable and, overall, side effects are more than compensated for by the significant increase in survival in the altered fractionation radiotherapy group,” Blanchard said.

Finally, a secondary analysis has shown that altered fractionation radiotherapy was inferior for overall survival to standard fractionation radiotherapy when the latter is associated with concomitant chemotherapy. Therefore, Blanchard said that in order to use altered fractionation radiotherapy in advanced cases of stage III or IV cancer, those patients cannot be candidates for concomitant chemotherapy.

The meta-analysis was carried out by an international collaboration known as MARCH, including many countries in Europe, the USA, Canada, and Brazil, Egypt and developing countries through the International Atomic Energy Authority. The researchers said that the survival benefits are mostly related to improvements in locoregional control, the area located close to the primary tumor being by far the most common first site of relapse in this disease.

“These data are a major advance for understanding the role in AFRT in head and neck squamous cell carcinoma,” Blanchard said in a press release. “By carrying out a large-scale analysis such as this one, we believe that we have provided enough evidence to indicate that doctors should recommend AFRT as a validated treatment option for head and neck cancer patients.”