Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis.
Background: Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival.Metho...
| Publicado en: | Lancet Vol. 368; no. 9538; pp. 843 - 855 |
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| Autores principales: | , , , , , , , , , , , , , , , , , , , |
| Formato: | research tables/charts Journal Article |
| Publicado: |
Lancet
9/2/2006
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=106211522&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 106211522 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 01406736 LAN jtl: Lancet issn: 01406736 maglogo: N pubinfo: dt: 9/2/2006 vid: 368 iid: 9538 pid: 1297 pub: Lancet place: Philadelphia, Pennsylvania artinfo: ui: 106211522 106211522 NLM16950362 2009294702 10.1016/s0140-6736(06)69121-6 NLM16950362 106211522 ppf: 843 ppct: 12 formats: fmt: @attributes: type: P tig: atl: Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. aug: au: Bourhis J Overgaard J Audry H Ang KK Saunders M Bernier J Horiot J Le Maître A Pajak TF Poulsen MG O'Sullivan B Dobrowsky W Hliniak A Skladowski K Hay JH Pinto LHJ Fallai C Fu KK Sylvester R Pignon J sug: subj: Head and Neck Neoplasms Radiotherapy Aged Aged, 80 and Over Chi Square Test Embase Female Funding Source Log-Rank Test Male Medline Meta Analysis Middle Age Mortality Neoplasm Metastasis Radiotherapy Methods Survival Treatment Failure Treatment Outcomes Human Aged: 65+ years Aged, 80 & over Middle Aged: 45-64 years Female Male ab: Background: Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival.Methods: Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction.Findings: 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3.4% at 5 years (hazard ratio 0.92, 95% CI 0.86-0.97; p=0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at 5 years, p=0.02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at 5 years; p<0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0.78 [0.65-0.94] for under 50 year olds, 0.95 [0.83-1.09] for 51-60 year olds, 0.92 [0.81-1.06] for 61-70 year olds, and 1.08 [0.89-1.30] for over 70 year olds; test for trends p=0.007).Interpretation: Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit. pubtype: Academic Journal doctype: research tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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