Postoperative accelerated radiotherapy (POPART) versus conventional postoperative radiotherapy (CPORT) in squamous cell head and neck cancer: A multicenter prospective randomized study of the Dutch Head and Neck Cooperative Study Group.

Langendijk, J.A.; Kaanders, Johannes H.A.M.; Doornaert, P.; Burlage, Fred R.; Ende, P. L. van den; Oei, S.B.; Keus, Ronald B.; Nuyts, Sandra; Leemans, C. René; Terhaard, Chris H.J.; Head, Dutch

doi:10.1200/jco.2010.28.15_suppl.5508

Cited by 5 publications

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“…The control group of a four-arm trial 4 was triplicated (ie, data for patients in the control group were copied twice to have three control arms to compare with each experimental arm), a 2 × 2 trial (EORTC 22962 45 ) included three relevant comparisons for the meta-analysis, and three three-arm trials 36,37,55 included two relevant comparisons. The 33 trials included in the analysis of fractionation schedules (comparison 1) were divided into four predefined subgroups, depending on the type of radiotherapy: hyperfractionation (eight comparisons, including the unpublished EORTC 22962 trial), 4,33,44,45,49,50,56 moderately accelerated radiotherapy (19 comparisons), 2,4,30,32,34–39,41,42,46,54,55,57–59 very accelerated radiotherapy (seven comparisons, including the unpublished CHARTWEL trial), 3,47,51–53,60 and moderately hypofractionated (dose per fraction between 2–2·5 Gy [two comparisons]; 31,40 appendix pp 17–18). After discussion with the steering committee, the moderately hypofractionated trials were included in the moderately accelerated radiotherapy group.…”

Section: Resultsmentioning

confidence: 99%

Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis

Lacas

Bourhis

Overgaard

et al. 2017

The Lancet Oncology

263

177

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Summary Background The Meta-Analysis of Radiotherapy in squamous cell Carcinomas of Head and neck (MARCH) showed that altered fractionation radiotherapy is associated with improved overall and progression-free survival compared with conventional radiotherapy, with hyperfractionated radiotherapy showing the greatest benefit. This update aims to confirm and explain the superiority of hyperfractionated radiotherapy over other altered fractionation radiotherapy regimens and to assess the benefit of altered fractionation within the context of concomitant chemotherapy with the inclusion of new trials. Methods For this updated meta-analysis, we searched bibliography databases, trials registries, and meeting proceedings for published or unpublished randomised trials done between Jan 1, 2009, and July 15, 2015, comparing primary or postoperative conventional fractionation radiotherapy versus altered fractionation radiotherapy (comparison 1) or conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone (comparison 2). Eligible trials had to start randomisation on or after Jan 1, 1970, and completed accrual before Dec 31, 2010; had to have been randomised in a way that precluded prior knowledge of treatment assignment; and had to include patients with non-metastatic squamous cell carcinoma of the oral cavity, oropharynx, hypopharynx, or larynx undergoing first-line curative treatment. Trials including a non-conventional radiotherapy control group, investigating hypofractionated radiotherapy, or including mostly nasopharyngeal carcinomas were excluded. Trials were grouped in three types of altered fractionation: hyperfractionated, moderately accelerated, and very accelerated. Individual patient data were collected and combined with a fixed-effects model based on the intention-to-treat principle. The primary endpoint was overall survival. Findings Comparison 1 (conventional fractionation radiotherapy vs altered fractionation radiotherapy) included 33 trials and 11 423 patients. Altered fractionation radiotherapy was associated with a significant benefit on overall survival (hazard ratio [HR] 0·94, 95% CI 0·90–0·98; p=0·0033), with an absolute difference at 5 years of 3·1% (95% CI 1·3–4·9) and at 10 years of 1·2% (−0·8 to 3·2). We found a significant interaction (p=0·051) between type of fractionation and treatment effect, the overall survival benefit being restricted to the hyperfractionated group (HR 0·83, 0·74–0·92), with absolute differences at 5 years of 8·1% (3·4 to 12·8) and at 10 years of 3·9% (−0·6 to 8·4). Comparison 2 (conventional fractionation radiotherapy plus concomitant chemotherapy versus altered fractionation radiotherapy alone) included five trials and 986 patients. Overall survival was significantly worse with altered fractionation radiotherapy compared with concomitant chemoradiotherapy (HR 1·22, 1·05–1·42; p=0·0098), with absolute differences at 5 years of −5·8% (−11·9 to 0·3) and at 10 years of −5·1% (−13·0 to 2·8). Interpretation This up...

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Section: Resultsmentioning

confidence: 99%

Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis

Lacas

Bourhis

Overgaard

et al. 2017

The Lancet Oncology

263

177

View full text Add to dashboard Cite

show abstract

“…The NCDB does not provide data on local‐regional control, which would have been another useful outcome in this study. The use of accelerated RT was not examined in this study, although previous trials show no local‐regional control or survival benefit with the use of accelerated RT in the adjuvant setting …”

Section: Discussionmentioning

confidence: 99%

Examining adjuvant radiation dose in head and neck squamous cell carcinoma

et al. 2019

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Background: Compare adjuvant radiation dose trends and outcomes in head and neck squamous cell carcinoma (HNSCC). Methods: Nonmetastatic HNSCCs treated between 2004 and 2014 with primary site surgery, lymph node dissection, and adjuvant radiation were identified in the National Cancer Database. Standard dose radiation (SD-RT) was defined as an equivalent dose in 2 Gy (EQD2) ≥56.64 and ≤60 Gy and high-dose radiation (HD-RT) as an EQD2 >60 and <70 Gy. Results: HD-RT was given to 46% of the 15 836 HNSCC patients managed with adjuvant radiation. When adjusted for poor prognostic factors, HD-RT was associated with increased mortality (HR1.09; 95%CI 1.02-1.16). In nonoropharynx or human papillomavirus-negative oropharynx primary that had positive margins, ≥5 positive lymph nodes, and/or extranodal extension, HD-RT was still not associated with improved survival (HR 1.01, 95% CI 0.91-1.12). Conclusions: There was no survival benefit from postoperative dose escalation above EQD2 60 Gy even in a high-risk cohort.

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“…Published hazard ratios and hazard ratios extracted from available survival curves were the basis of the meta-analysis. Additionally, we extracted and categorized the published acute and late side effects from the published papers [ 6 – 11 , 18 , 19 ]. The idea for this meta-analysis was originally generated in 2016.…”

Section: Methodsmentioning

confidence: 99%

“…These observations allow an investigation of accelerated schedules in the postoperative setting and to the best of our knowledge no meta-analysis has focused on this aspect yet. The results of six randomized trials addressing this question in adjuvant RT were retrieved and analyzed [ 6 – 11 , 18 ].…”

Section: Introductionmentioning

confidence: 99%

Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis

et al. 2018

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BackgroundAdjuvant radiotherapy in advanced head and neck squamous cell cancer (HNSCC) reduces the risk of local-regional failure and most likely increases the survival rate. Patients at high risk for tumor recurrence may benefit from more aggressive altered fractionation schedules in order to reduce the overall time from surgery to completion of radiotherapy. Here, we reviewed the results of six randomized trials addressing the above hypothesis.MethodsIn the six trials of interest, a total of 988 patients with locally advanced HNSCC were randomly assigned to receive either accelerated or conventionally fractionated adjuvant radiotherapy. Hazard ratios (HR) were extracted from available publications for local-regional control, distant metastasis as well as overall-, cancer specific- and disease-free survival. Meta-analysis of the effect sizes was performed using fixed and random effect models. Acute and late side effects were categorized and summarized for comparison.ResultsAccelerated radiotherapy did not improve the loco-regional control (n = 988, HR = 0.740, CI = 0.48–1.13, p = 0.162), progression-free survival (HR = 0.89, CI = 0.76–1.04, p = 0.132) or overall survival (HR = 0.88, CI = 0.75–1.04, p = 0.148) significantly. Acute confluent mucositis occurred with significant higher frequency with accelerated radiotherapy. Late side effects did not differ significantly in either group.ConclusionAccelerated radiotherapy does not result in a significant improvement of loco-regional control or overall survival in high-risk patients. Acute but not late radiation toxicity were more frequent with the accelerated RT technique. In clinical practice accelerated postoperative radiation therapy might be a suitable option only for a subset of patients.

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Postoperative accelerated radiotherapy (POPART) versus conventional postoperative radiotherapy (CPORT) in squamous cell head and neck cancer: A multicenter prospective randomized study of the Dutch Head and Neck Cooperative Study Group.

Cited by 5 publications

References 0 publications

Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis

Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis

Examining adjuvant radiation dose in head and neck squamous cell carcinoma

Accelerated vs. conventionally fractionated adjuvant radiotherapy in high-risk head and neck cancer: a meta-analysis

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