Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity – The ARTSCAN 2 study

Abstract

Background and purpose: An earlier prospective randomised multicentre study (ARTSCAN) in head and neck cancer patients that compared conventionally fractionated radiotherapy (CF) with accelerated radiotherapy (AF) was inconclusive. In the subgroup of oral cavity squamous cell cancer (OCSCC) a large absolute, but not statistically significant, difference in local control was seen in favour of AF. This difference was more pronounced in resectable tumours. The finding raised the hypothesis that AF could be beneficial for OCSCC patients. In addition, the longstanding controversy on pre-or postoperative radiotherapy was addressed. Materials and methods: Patients with OCSCC, judged to withstand and likely benefit from combined therapy, were recruited. Subjects were randomised to either preoperative AF with 43 fractions given as a concomitant boost with two fractions/day to the tumour bearing volume to a total dose of 68 Gy in 4.5 weeks followed by surgery, or primary surgery with postoperative CF, total dose 60 or 66 Gy in 6-7 weeks. For patients whose tumours had high-risk features, 66 Gy and concomitant cisplatin was prescribed. Results: 250 patients were randomised. Median follow-up was 5 years for locoregional control (LRC) and 9 years for overall survival (OS). There were no statistically significant differences between the two treatment arms regarding LRC and OS. LRC at five years was 73% (95% CI, 65-82) in preoperative AF and 78% (95% CI, 70-85) in postoperative CF.Toxicity was more pronounced in preoperative AF. Conclusion: This study does not support that AF prior to surgery improves outcome in oral cavity cancer compared with postoperative CF.

Cost-effectiveness analysis of (accelerated) pre-operative versus (conventional) post-operative radiotherapy for patients with oral cavity cancer in Sweden

“…Two-hundred-fifty patients were randomised in the ARTSCAN 2 RCT, which involved combined therapy with surgery and RT for advanced, resectable OCC performed at six centres in Sweden from 2008 through 2016 [ 5 ]. The patients were offered to participate after the diagnostic work-up was finalised.…”

“…Treatment for resectable OCC often includes combinations of surgery and radiotherapy (RT), but there is no conclusive information on the preferred treatment order [ 3 , 4 ]. This issue was partly addressed in the multicentre ARTSCAN 2 randomised controlled trial (RCT) [ 5 ].…”

“…The primary outcome was locoregional control (LRC) and secondary objectives included overall survival (OS). LRC was similar for the two treatment regimens [ 5 ]. A trend towards better OS for post-operative RT ( cf .…”

“…pre-operative RT) was observed but failed to reach statistical significance. Median and minimum follow-up times for OS were nine and five years, respectively [ 5 ].…”

Long‐term outcomes of patients with oral cavity cancer receiving postoperative radiotherapy after salvage neck dissection for cervical lymph node recurrence

“…6,[8][9][10] Many studies have focused on treatment results in patients receiving PORT after the initial surgery for oral cavity cancer. [11][12][13] However, the clinical outcomes of PORT, such as prognosis, recurrence patterns, and adverse events, after salvage neck dissection for cervical LN recurrence in patients with oral cavity cancer have not been fully clarified. In particular, the long-term outcomes of patients who undergo PORT have yet to be established.…”