Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis

Bourhis, Jean, Overgaard, Jens, Audry, Helene, Ang, Kian K., Saunders, Michelle, Bernier, Jacques, Horiot, Jean-Claude, Le Maitre, Aurelie, Pajak, Thomas F., Poulsen, Michael G., O'Sullivan, Brian, Dobrowsky, Werner, Hliniak, Andrzej, Skladowski, Krzysztof, Hay, John H., Pinto, Luiz H. J., Fallai, Carlo, Fu, Karen K., Sylvester, Richard and Pignon, Jean-Pierre (2006) Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis. Lancet, 368 9538: 843-854. doi:10.1016/S0140-6736(06)69121-6


Author Bourhis, Jean
Overgaard, Jens
Audry, Helene
Ang, Kian K.
Saunders, Michelle
Bernier, Jacques
Horiot, Jean-Claude
Le Maitre, Aurelie
Pajak, Thomas F.
Poulsen, Michael G.
O'Sullivan, Brian
Dobrowsky, Werner
Hliniak, Andrzej
Skladowski, Krzysztof
Hay, John H.
Pinto, Luiz H. J.
Fallai, Carlo
Fu, Karen K.
Sylvester, Richard
Pignon, Jean-Pierre
Title Hyperfractionated or accelerated radiotherapy in head and neck cancer: A meta-analysis
Journal name Lancet   Check publisher's open access policy
ISSN 0140-6736
1474-547X
Publication date 2006-09-02
Year available 2006
Sub-type Article (original research)
DOI 10.1016/S0140-6736(06)69121-6
Open Access Status Not yet assessed
Volume 368
Issue 9538
Start page 843
End page 854
Total pages 12
Place of publication London, United Kingdom
Publisher The Lancet Publishing Group
Language eng
Abstract Background Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival.
Formatted abstract
Background: Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival.
Methods: Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction.
Findings: 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III–IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3·4% at 5 years (hazard ratio 0·92, 95% CI 0·86–0·97; p=0·003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1·7% with total dose reduction at 5 years, p=0·02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6·4% at 5 years; p<0·0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0·78 [0·65–0·94] for under 50 year olds, 0·95 [0·83–1·09] for 51–60 year olds, 0·92 [0·81–1·06] for 61–70 year olds, and 1·08 [0·89–1·30] for over 70 year olds; test for trends p=0·007).
Interpretation: Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit.
Keyword Medicine, General & Internal
General & Internal Medicine
MEDICINE, GENERAL & INTERNAL
Q-Index Code C1
Q-Index Status Provisional Code
Grant ID 2U10CA11488-36
Institutional Status Non-UQ
Additional Notes 2-8 September 2006

Document type: Journal Article
Sub-type: Article (original research)
Collection: School of Medicine Publications
 
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Created: Wed, 24 Nov 2010, 00:45:23 EST