Hyperfractionated Radiotherapy With Chemotherapy Prolongs Overall Survival in HNSCC

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This meta-analysis pooled data from 34 randomized trials that included 11969 patients with squamous cell carcinoma of the head and neck.
This meta-analysis pooled data from 34 randomized trials that included 11969 patients with squamous cell carcinoma of the head and neck.

Altered fractionation, specifically hyperfractionated radiotherapy, administered concomitantly with chemotherapy improved overall survival (OS) among patients with HNSCC, according to study published in The Lancet Oncology.1

This updated meta-analysis of the MARCH trial pooled data from 34 randomized trials that included 11969 patients with HNSCC. The study authors investigated the effects of conventional fractionation radiotherapy vs altered fractionation radiotherapy with or without chemotherapy, or conventional fractionation radiotherapy plus chemotherapy vs altered fractionation radiotherapy alone.

Three types of altered fractionation radiotherapy — hyperfractionated, moderately accelerated, and very accelerated — were studied in the trials.

When comparing conventional fractionation radiotherapy vs altered fractionation radiotherapy, altered fractionation demonstrated significant benefit in OS (hazard ratio [HR], 0.94; 95% CI, 0.90-0.98; P = .0033). An absolute difference was observed at 5 years with 3.1% (95% CI, 1.3%-4.9%) and at 10 years with 1.2% (95% CI, -0.8-3.2).

The OS benefit was significantly associated (P  = .051) only with hyperfractionated radiotherapy (HR, 0.83; 95% CI, 0.74-0.92), with an absolute difference observed at 5 years with 8.1% (95% CI, 3.4%-12.8%) and at 10 years with 3.9% (95% CI, -0.6%-8.4%).

When comparing conventional fractionation radiotherapy plus chemotherapy vs altered fractionation therapy alone, OS was significantly inferior in altered fractionation vs conventional chemoradiotherapy (HR, 1.22; 95% CI, 1.0-1.42; P = .0098), with absolute differences at 5 years of -5.8% (95%CI, -11.9%-0.3%) and 10 years of -5.1% (95% CI, -13.0-2.8).

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Despite these results, the authors concluded that “further research is still needed to compare efficacy of hyperfractionated radiotherapy and concomitant chemoradiotherapy, and to look for predictive markers of treatment efficacy.”

Reference

  1. Lacas B, Bourhis J, Overgaard J, et al. Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol. 2017 Jul 27. doi: 10.1016/S1470-2045(17)30458-8 [Epub ahead of print]

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