Comparison of concomitant boost radiotherapy against concurrent chemoradiation in locally advanced oropharyngeal cancers: a phase III randomised trial.

Abstract

PURPOSE:

To test the toxicity and efficacy of concomitant boost radiotherapy alone against concurrent chemoradiation (conventional fractionation) in locally advanced oropharyngeal cancer in our patient population.

METHODS AND MATERIALS:

In this open-label, randomised trial, 216 patients with histologically proven Stage III-IVA oropharyngeal cancer were randomly assigned between June 2006 and December 2010 to receive either chemoradiation (CRT) to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (100 mg/m(2) on days 1, 22 and 43) or accelerated radiotherapy with concomitant boost (CBRT) to a dose of 67.5 Gy in 40 fractions over 5 weeks. The compliance, toxicity and quality of life were investigated. Disease-free survival (DFS) and overall survival (OS) curves were estimated with the Kaplan-Meier method and compared using log rank test.

RESULTS:

The compliance to radiotherapy was superior in concomitant boost with lesser treatment interruptions (p=0.004). Expected acute toxicities were significantly higher in CRT, except for grade 3/4 mucositis which was seen more in CBRT arm (39% and 55% in CRT and CBRT, respectively; p=0.02). Late toxicities like Grade 3 xerostomia were significantly high in CRT arm than CBRT arm (33% versus 18%; p<0.0001). The quality of life was significantly poor in CRT arm at all follow up visits (p<0.0001). The rates of 2 year disease-free survival were similar with 56% in the chemoradiotherapy group and 61% in CBRT group (p=0.2; HR-0.81, 95%CI-0.53-1.2). Subgroup analysis revealed that patients with nodal size >2 cm had significantly better DFS with CRT (p=0.05; HR-1.59, 95%CI-0.93-2.7).

CONCLUSION:

In selected patients of locally advanced oropharyngeal cancer, concomitant boost offers a better compliance, toxicity profile and quality of life with similar disease control, than chemoradiation.

• Authors: Anupam Rishi, Sushmita Ghoshal, Roshan Verma, Arun S Oinam, Vijai M Patil, Rakesh Mohinder, Suresh C Sharma
• Journal: Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology (Radiother Oncol) Vol. 107 Issue 3 Pg. 317-24 (Jun 2013) ISSN: 1879-0887 [Electronic] Ireland
• PMID: 23746674 (Publication Type: Clinical Trial, Phase III, Comparative Study, Journal Article, Randomized Controlled Trial)
• Copyright: Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.

Topics

• Adult
• Aged
• Chemoradiotherapy (adverse effects)
• Disease-Free Survival
• Female
• Humans
• Male
• Middle Aged
• Neoplasm Staging
• Oropharyngeal Neoplasms (mortality, psychology, therapy)
• Patient Compliance
• Quality of Life