Radiation-free weekend rescued! Continuous accelerated irradiation of 7-days per week is equal to accelerated fractionation with concomitant boost of 7 fractions in 5-days per week: report on phase 3 clinical trial in head-and-neck cancer patients.

Abstract

PURPOSE:

To report long-term results of randomized trial comparing 2 accelerated fractionations of definitive radiation therapy assessing the need to irradiate during weekend in patients with head and neck squamous cell carcinoma.

METHODS AND MATERIALS:

A total of 345 patients with SCC of the oral cavity, larynx, and oro- or hypo-pharynx, stage T2-4N0-1M0, were randomized to receive continuous accelerated irradiation (CAIR: once per day, 7 days per week) or concomitant accelerated boost (CB: once per day, 3 days per week, and twice per day, 2 days per week). Total dose ranged from 66.6-72 Gy, dose per fraction was 1.8 Gy, number of fractions ranged from 37-40 fractions, and overall treatment time ranged from 37-40 days.

RESULTS:

No differences for all trial end-points were noted. At 5 and 10 years, the actuarial rates of local-regional control were 63% and 60% for CAIR vs 65% and 60% for CB, and the corresponding overall survival were 40% and 25% vs 44% and 25%, respectively. Confluent mucositis was the main acute toxicity, with an incidence of 89% in CAIR and 86% in CB patients. The 5-year rate of grade 3-4 late radiation morbidity was 6% for both regimens.

CONCLUSIONS:

Results of this trial indicate that the effects of accelerated fractionation can be achieve by delivering twice-per-day irradiation on weekday(s). This trial has also confirmed that an accelerated, 6-weeks schedule is a reasonable option for patients with intermediate-stage head-and-neck squamous cell carcinoma because of the associated high cure rate and minimal severe late toxicity.

• Authors: Krzysztof Skladowski, Marcin Hutnik, Andrzej Wygoda, Maria Golen, Boleslaw Pilecki, Wieslawa Przeorek, Tomasz Rutkowski, Beata Lukaszczyk-Widel, Alicja Heyda, Rafal Suwinski, Rafal Tarnawski, Boguslaw Maciejewski
• Journal: International journal of radiation oncology, biology, physics (Int J Radiat Oncol Biol Phys) Vol. 85 Issue 3 Pg. 741-6 (Mar 01 2013) ISSN: 1879-355X [Electronic] United States
• PMID: 22836063 (Publication Type: Clinical Trial, Phase III, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2013 Elsevier Inc. All rights reserved.

Topics

• Adult
• Aged
• Carcinoma, Squamous Cell (mortality, pathology, radiotherapy)
• Dose Fractionation, Radiation
• Female
• Follow-Up Studies
• Head and Neck Neoplasms (mortality, pathology, radiotherapy)
• Humans
• Incidence
• Male
• Middle Aged
• Neoplasms, Second Primary (pathology)
• Radiation Injuries (epidemiology, pathology)
• Stomatitis (epidemiology, etiology, pathology)
• Time Factors
• Tumor Burden