June 27, 2017
5 min read
Save

Hypofractionated radiotherapy may improve glottic cancer survival

You've successfully added to your alerts. You will receive an email when new content is published.

Click Here to Manage Email Alerts

We were unable to process your request. Please try again later. If you continue to have this issue please contact customerservice@slackinc.com.

Hypofractionated radiotherapy improved survival in patients with early-stage glottic cancer compared with conventionally fractionated radiotherapy, according to a study published in Journal of the National Cancer Institute.

Perspective from

“The study was prompted by controversy about whether using a hypofractionated radiation approach was superior to standard radiation approaches for early-stage glottic cancer,” Zain A. Husain, MD, assistant professor of therapeutic radiology and director of head and neck radiotherapy at Smilow Cancer Hospital, told HemOnc Today. “The National Comprehensive Cancer Network guidelines currently say both standard-fraction and hypofractionated options are accepted; however, previous randomized data did suggest a control benefit to hypofractionated radiation.”

Zain A. Husain

Previous studies showed an OS benefit with hypofractionation in patients with advanced-stage oropharyngeal and laryngeal cancers.

Conventionally fractionated radiotherapy includes receipt of 2 Gy per fraction to a total dose of 66 Gy to 70 Gy, whereas hypofractionated radiotherapy involves 2.25 Gy per fraction to a total dose of 63 Gy to 65.25 Gy.

Researchers divided patients diagnosed with stage I or stage II glottic cancer and treated with radiotherapy between 2004 and 2013 into those who had conventionally fractionated radiotherapy (n = 6,182; median age, 66 years; 86.4% men; 76.9% non-Hispanic white) and those who had hypofractionated radiotherapy (n = 4,030; median age, 65 years; 86.3% men; 77.1% non-Hispanic white).

A greater proportion of patients who received hypofractionated radiotherapy had stage T1 disease than those who received conventionally fractionated radiotherapy (82.2% vs. 76.6%; P < .001).

Aims of the study included to define OS and the use of hypofractionated radiotherapy over time.

Researchers conducted median follow-up at 5 years.

Hypofractionated radiotherapy improved 5-year OS compared with conventional radiotherapy on unadjusted (77.1% vs. 73.5%; P < .001) and multivariable analyses (HR = 0.89; 95% CI, 0.81-0.98).

Improvement in 5-year OS persisted with hypofractionated radiotherapy when researchers analyzed patients with clinical stage TI disease (78.2% vs. 76%; P = .05) and T2 disease (70.8% vs. 64.5%; P = .02). On multivariable analysis, the association in stage I disease lost significance (HR = 0.93; 95% CI, 0.84-1.03), whereas the association remained significant in stage II disease (HR = 0.79; 95% CI, 0.65-0.96).

The use of hypofractionated radiotherapy increased during the study period, from 22.1% in 2004 to 58% in 2013.

“Radiation using doses of 2.25 Gy per day was associated with an OS benefit for patients with early-stage glottic cancer,” Husain said. “Fortunately, the patterns-of-care portion of the study showed that hypofractionated radiation was being increasingly utilized nationally. In 2004 the rate was low at about only 25%, but by 2013 — the last year we assessed — the rate was about 50%, which demonstrates a rapid uptake of the technique.”

PAGE BREAK

Factors associated with receipt of hypofractionated radiotherapy included clinical T1 disease, recent year of diagnosis, and treatment at academic and high-volume centers (P < .001 for all).

Although the optimal radiotherapy regimen for early-stage glottic cancer remains controversial, researchers noted the data from their study, combined with those from previous clinical trials, provide support for hypofractionated radiotherapy.

“Based on the results of the study, we would strongly suggest that hypofractionated radiation therapy be the preferred approach for patients with early-stage glottic cancer,” Husain said. – by Chuck Gormley

For more information:

Zain A. Husain, MD, can be reached at Department of Therapeutic Radiology, Smilow Cancer Hospital, 35 Park St., Suite LL 515, New Haven, CT 06511; email: zain.husain@yale.edu.

Disclosure: Husain reports research funding from Merck. Please see the full study for a list of all other researchers’ relevant financial disclosures.