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Hyperfractionated radiation improves head and neck cancer survival
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Patients with advanced head and neck cancer who underwent twice-a-day radiation treatments combined with chemotherapy experienced a 20% greater survival rate than those treated with standard of care, according to research presented at the European Cancer Congress.
“This research provides good evidence for the benefits of treating advanced-stage head and neck cancer patients with a combination of twice-daily radiation therapy and chemotherapy, compared to one or even none of these separately,” Philip Poortmans, MD, PhD, president-elect of the European CanCer Organization (ECCO) and head of the radiation oncology department at Radbound University Medical Center, said in a press release. “Before we can apply these very interesting results into daily clinical practice, we need to wait for the outcome of the next stage of this research — namely the evaluation of the short- and long-term side effects. This is of utmost importance for the quality of life of the patients and their relatives.”
However, study did not examine side effects experienced by patients during or following treatment, and more research is needed to determine the safety of twice-daily radiation, known as hyperfractionated radiotherapy, according to study researcher Claire Petit, resident in radiation oncology at Gustave Roussy Cancer Center in Paris.
Head and neck cancer accounts for about 3% of all cancers in the United States, with about 60,000 new diagnoses (73% men) and 13,000 deaths each year. The 5-year survival rate is 82% for localized tumors and 57% for locally advanced tumors.
“There are a number of new treatments that have shown promise in head and neck cancer trials,” Petit said. “This large study has enabled us to compare several of these treatments to see which is best overall in terms of reducing mortality.”
Petit and colleagues used network meta-analysis to examine data from 117 different trials that included 28,804 patients from around the world. Researchers compared 16 different treatments for squamous cell carcinoma, which is the most common type of head and neck cancer and typically originates in the oropharynx, oral cavity, hypopharynx or larynx.
In total, 19,131 deaths and 20,586 progression events occurred in the study population.
Researchers found hyperfractionated radiotherapy with concomitant chemotherapy to be the most effective treatment compared with platinum-based concomitant chemoradiation in terms of OS (HR = 0.8; 95% CI, 0.65-0.99) and PFS (HR = 0.77; 95% CI, 0.62-0.96).
Hyperfractionated radiotherapy plus concomitant chemotherapy also improved OS compared with locoregional treatment alone (HR = 0.62; 95% CI, 0.51-0.76).
Other treatments outperformed platinum-based concomitant chemoradiation, but their HR for death did not reach statistical significance. These included induction therapy followed by locoregional treatment (HR = 0.9; 95% CIO, 0.73-1.12), accelerated radiotherapy with concomitant chemotherapy (HR = 0.97; 95% CI, 0.86-1.1), and induction chemotherapy followed by concomitant chemoradiotherapy (HR = 0.98; 95% COI, 0.8-1.21).
Network meta-analysis, which combines direct and indirect treatment comparisons, is a new method that “needs to be interpreted with prudence,” Petit said.
“However,” Petit added, “this is an important finding for this group of patients who have a higher risk for their cancer recurring following [standard] treatment.”
Prospective trials would help confirm the efficacy and safety of twice-a-day radiation therapy, Poortmans said.
“If that is not feasible, or if we cannot wait for their outcome for some subgroups of patients who have the worst survival currently, then we should at least register carefully all the outcome parameters in prospective multicenter databases so that they are available later on for analysis,” he said. – by Chuck Gormley
Reference:
Petit C, et al. Abstract 823. Presented at: European Cancer Congress; Jan. 27-30, 2017; Amsterdam.
Disclosures: The study was funded by the French League National Control Center and the French Ministry of Health. Petit reports a scholarship grant from the French Foundation ARC.