• 9/19/2003
  • New York
  • Reuters Health

An accelerated course of radiotherapy that involves six fractions per week instead of five improves survival and offers other benefits for patients with head and neck cancer, new research indicates.

The findings, which are published in the September 20th issue of The Lancet, are based on a randomized trial of 1476 patients with squamous-cell cancer of the head and neck.

Regardless of whether patients were randomized to six or five fractions per week, most received a total of 66 to 68 Gy in 33 to 34 fractions, lead author Dr. Jens Overgaard, from Aarhus University in Denmark, and colleagues note. The exception was patients with well differentiated T1 glottic tumors, who received a total dose of 62 Gy.

Median treatment times for the six- and five-fraction regimens were 39 and 46 days, respectively, the authors note.

Disease-specific survival at 5 years in the six-fraction group was 73%, while the rate in the five-fraction group was significantly lower–66% (p = 0.01). Overall survival was comparable for both groups, a finding that may reflect the general poor health that typifies head and neck cancer patients.

The locoregional control rate with the six-fraction regimen was 70%, significantly higher than the 60% rate seen with the five-fraction regimen (p = 0.0005). Similarly, the corresponding primary tumor control rates were 76% and 64% (p = 0.0001). In contrast, neck-node control did not differ significantly between the groups.

Another benefit of the six-fraction regimen was improved voice preservation among patients with laryngeal cancer, the researchers state. The preservation rate in the six-fraction group was 80%, about 12% higher than the rate in the five-fraction group (p = 0.007).

Although acute morbidity was more common with the six-fraction regimen, these effects were transient, the authors point out. Severe late morbidity did not differ between the groups.

The results indicate that “moderately accelerated radiotherapy in head and neck cancer with a 1-week reduction in overall treatment time, but with no change to total dose and number of fractions, is better than a conventional treatment schedule,” Dr. Overgaard’s team notes.

“We recommend that modified fractionation schedules should constitute a new baseline for further exploration of radiotherapy in head and neck cancer,” they add.