Mature Results of a Randomized Trial of Accelerated Hyperfractionated Versus Conventional Radiotherapy in Head-and-Neck Cancer

Saunders, Michele I.; Rojas, Ana M.; Parmar, Mahesh; Dische, Stanley

doi:10.1016/j.ijrobp.2009.04.082

Cited by 38 publications

(16 citation statements)

References 27 publications

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“…Similar results are described by Cvek et al; 17 after hyperfractionated accelerated RT with integrated boosts, no 3 or 4 grade toxicity was observed (RTOG/EORTC). Saunders et al 19 described a small, but significant reduction in epidermal and mucosal late adverse effects in the arm treated with accelerated hyperfractionation in comparison with Conv. treatment.…”

Section: Discussionmentioning

confidence: 99%

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Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

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Objective: Evaluation of the efficacy and toxicity of splitcourse accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. Methods: We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used.Results: QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. Conclusion: Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. Advances in knowledge: Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.There are, and have been, many attempts to create a clear and effective treatment modality for advanced inoperable head and neck (H&N) cancers. The most common are different combinations of chemoradiotherapy, or different schedules of altered and usually intensive radiation treatment. It is clear that intense dose delivery combined with a high total dose (TD) and short treatment time gives a higher probability of tumour destruction; unfortunately, it is also connected with a higher, usually unacceptable, risk of normal tissue damage. One of the causes of radiation toxicity in such cases is the inability of sufficient repair of healthy tissue damage.The reason for this is the intensity of dose delivery and the lack of time for repopulation of normal cells and proper repair. On the other hand, the accelerated repopulation of squamous cancer cells starts 4 weeks after radiotherapy (RT); therefore, radiation treatment should be completed in that time. Considering the aforementioned facts, we tried to construct a very intense and short RT schedule allowing for normal tissue (mainly mucosa) repair. We went back to the old concept of split-course RT and combined it with accelerated, continuous, intense hyperfractionation.Finally, we proposed twice-a-day irradiation, usi...

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Section: Discussionmentioning

confidence: 99%

“…[7][8][9][10][11][12][13][14][15] Less frequent were attempts of RT as an alone utility. [16][17][18][19][20] Some individual publications describe a combination of RT and surgery. 21,22 There is very limited data concerning QOL after such therapies.…”

Section: Discussionmentioning

confidence: 99%

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

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“…Both the presence of dysphagia and mucositis have been identified in the literature as persisting in the early phase post-treatment with AFRT (4)(5)(6)(7)(8). Acute toxicity, such as mucositis and pain, has been associated with deteriorating functional outcomes known to impact on swallowing and mastication (9), resulting in a large proportion of patients requiring modified diets and nutritional supplementation (10,11).…”

Section: Introductionmentioning

confidence: 99%

“…Based on radiobiological principles, late-radiation effects are dependent on the total dose and the dose per fraction, with larger fraction sizes increasing the risk of severe late effects (4,12). Hence, as a consequence of the reduced dose per fraction used in accelerated radiotherapy regimens, late toxicity rates for necrosis, xerostomia, laryngeal edema, skin, and subcutaneous toxicity have been found to be significantly less for accelerated regimens compared with conventional counterparts post-treatment (7,8). It is possible then that dysphagia and associated toxicities may also be less severe in the long term.…”

Section: Introductionmentioning

confidence: 99%

Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

et al. 2012

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“…Another approach to improving outcomes for patients with locally advanced NSCLC is to alter radiotherapy fractionation, either by increasing the number of fractions delivered each day, delivering the radiation over a shorter period of time (acceleration), or a combination of the two [4,16].…”

Section: Introductionmentioning

confidence: 99%

The Challenges Faced in Developing Novel Drug Radiation Combinations in Non-small Cell Lung Cancer

et al. 2016

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Mature Results of a Randomized Trial of Accelerated Hyperfractionated Versus Conventional Radiotherapy in Head-and-Neck Cancer

Cited by 38 publications

References 27 publications

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Long-term Functional Outcomes and Patient Perspective Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

The Challenges Faced in Developing Novel Drug Radiation Combinations in Non-small Cell Lung Cancer

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