Accelerated radiotherapy effective in alcohol-, tobacco-related head and neck cancer
Key takeaways:
- Hypofractionated radiotherapy proved noninferior to conventional radiotherapy in head and neck cancer subtype.
- The accelerated regimen could lower cancer care burden in the most commonly affected countries.
Researchers observed similar outcomes between hypofractionated and conventional radiation therapy among patients with alcohol- and tobacco-associated, locally advanced head and neck cancer, according to phase 3 study results.
The findings — presented at American Society for Radiation Oncology Annual Meeting — additionally showed the hypofractionated treatment regimen did not increase treatment-related adverse events.
“Patients in low- and middle-income countries generally have limited access to radiation therapy, which is an issue,” Søren Bentzen, PhD, DMSc, FASTRO, professor of radiation oncology and director in the division of biostatistics and bioinformatics in the department of epidemiology and public health at University of Maryland School of Medicine, said during a press briefing. “If we could reduce the number of radiation dose fractions needed to treat these patients, then more patients could be treated.”
Rationale and methods
The majority of the world’s cancer burden occurs in low- and middle-income countries, according to Bentzen.
“It is estimated that there are about 10 million deaths worldwide due to cancer, and 7 million of these occur in low- and middle-income countries,” he said. “Head and neck cancer is a relatively infrequent cancer when looking at it worldwide, but it affects low- and middle-income countries disproportionately, in part because of the etiological link to tobacco and alcohol use in parts of the world.”
Researchers used mathematical models to examine outcomes of randomized controlled trials, which predicted that a 55 Gy, 20-fraction, 4-week radiation therapy schedule could provide inferior outcomes in tumor control rates and adverse events compared with a standard 66 Gy, 33-fraction, 5.5-week schedule.
The phase 3 HYPNO trial included 792 patients (87% men; 87% with history of tobacco smoking/chewing) receiving treatment for locally advanced head and neck squamous cell carcinoma (50.5% oropharynx cancer; 73% diagnosed with stage III or stage IV cancer; 49% with cancer that spread to lymph nodes) across 12 health centers in 10 low- and middle-income countries — Argentina, Brazil, Cuba, India, Indonesia, Pakistan, the Philippines, South Africa, Thailand and Uruguay. Most patients (76%) also received chemotherapy.
Co-primary endpoints included locoregional tumor control and grade 3 or higher late adverse events.
Findings
At a median follow-up of 3 years, results showed patients who received hypofractionated radiation treatment experienced similar levels of locoregional tumor control compared with those assigned conventional treatment (50.7% vs. 51.2%).
Researchers observed similar results for late-term grade 3 or higher adverse events (18.8% vs. 20.2%).
“We can conclude that the hypofractioned schedule is noninferior, with a P value of 0.04 for local control, and a P value of 0.004 for grade three or higher adverse events,” Bentzen said.
Results also showed similar OS rates at 54.1% with hypofractionated vs. 55.5% with conventional radiation therapy. Researchers observed the same for PFS (44% vs. 45.3%).
“Accelerating radiation treatment is tricky because delivering too high a dose or too many doses too quickly can cause side effects that lower a person’s quality of life,” Bentzen said in a press release. “But not delivering enough radiation may allow the cancer to return. There is actually a ‘sweet spot’ where you get exactly the right balance between the total dose, the total treatment time and the dose you deliver in each fraction. The net result is that you hit the tumor hard enough to get good control, but you don’t affect the normal tissue more than you would with the standard treatment.”
Future research
Looking ahead, Benzen and colleagues plan to complete additional subgroup analyses to confirm the hypofractionated radiation regimen is also effective in patients with other head and neck cancer subtypes.
References:
- Accelerated radiation treatment could reduce head and neck cancer patient burden in low- and middle-income countries (press release). Available at: https://www.astro.org/News-and-Publications/News-and-Media-Center/News-Releases/2023/Accelerated-radiation-treatment-could-reduce-head. Published Oct. 2, 2023. Accessed Oct. 3, 2023.
- Bentzen S, et al. Abstract: LBA 02. Presented at: American Society for Radiation Oncology Annual Meeting; Sept. Oct. 1-Oct. 4, 2023; San Diego.
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Bentzen S, et al. Abstract: LBA 02. Presented at: American Society for Radiation Oncology Annual Meeting; Sept. Oct. 1-Oct. 4, 2023; San Diego.