Hyperfractionated or accelerated radiotherapy for head and neck cancer.

Bertrand Baujat, Jean Bourhis, Pierre Blanchard, Jens Overgaard, Kian K. Ang, Michelle Saunders, Aurélie Le Maître, Jacques Bernier, Jean Claude Horiot, Emilie Maillard, Thomas F. Pajak, Michael G. Poulsen, Abderrahmane Bourredjem, Brian O'Sullivan, Werner Dobrowsky, Hliniak Andrzej, Krzystof Skladowski, John H. Hay, Luiz Hj Pinto, Karen K. FuCarlo Fallai, Richard Sylvester, Jean Pierre Pignon, Collaborative Group MARCH Collaborative Group

Research output: Contribution to journalArticle

71 Citations (Scopus)

Abstract

Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4% at five years (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at five years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at five 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 (under 50 year old) (HR 0.78, 95% CI 0.65 to 0.94), 0.95 (95% CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95% CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95% CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.

Original languageEnglish
JournalThe Cochrane database of systematic reviews
Volume12
Publication statusPublished - 2010

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Head and Neck Neoplasms
Radiotherapy
Survival
Meta-Analysis
Outcome Assessment (Health Care)
Oropharynx
Larynx
Pharynx
Nose
PubMed
Ear
Mortality
Therapeutics

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Baujat, B., Bourhis, J., Blanchard, P., Overgaard, J., Ang, K. K., Saunders, M., ... MARCH Collaborative Group, C. G. (2010). Hyperfractionated or accelerated radiotherapy for head and neck cancer. The Cochrane database of systematic reviews, 12.

Hyperfractionated or accelerated radiotherapy for head and neck cancer. / Baujat, Bertrand; Bourhis, Jean; Blanchard, Pierre; Overgaard, Jens; Ang, Kian K.; Saunders, Michelle; Le Maître, Aurélie; Bernier, Jacques; Horiot, Jean Claude; Maillard, Emilie; Pajak, Thomas F.; Poulsen, Michael G.; Bourredjem, Abderrahmane; O'Sullivan, Brian; Dobrowsky, Werner; Andrzej, Hliniak; Skladowski, Krzystof; Hay, John H.; Pinto, Luiz Hj; Fu, Karen K.; Fallai, Carlo; Sylvester, Richard; Pignon, Jean Pierre; MARCH Collaborative Group, Collaborative Group.

In: The Cochrane database of systematic reviews, Vol. 12, 2010.

Research output: Contribution to journalArticle

Baujat, B, Bourhis, J, Blanchard, P, Overgaard, J, Ang, KK, Saunders, M, Le Maître, A, Bernier, J, Horiot, JC, Maillard, E, Pajak, TF, Poulsen, MG, Bourredjem, A, O'Sullivan, B, Dobrowsky, W, Andrzej, H, Skladowski, K, Hay, JH, Pinto, LH, Fu, KK, Fallai, C, Sylvester, R, Pignon, JP & MARCH Collaborative Group, CG 2010, 'Hyperfractionated or accelerated radiotherapy for head and neck cancer.', The Cochrane database of systematic reviews, vol. 12.
Baujat B, Bourhis J, Blanchard P, Overgaard J, Ang KK, Saunders M et al. Hyperfractionated or accelerated radiotherapy for head and neck cancer. The Cochrane database of systematic reviews. 2010;12.
Baujat, Bertrand ; Bourhis, Jean ; Blanchard, Pierre ; Overgaard, Jens ; Ang, Kian K. ; Saunders, Michelle ; Le Maître, Aurélie ; Bernier, Jacques ; Horiot, Jean Claude ; Maillard, Emilie ; Pajak, Thomas F. ; Poulsen, Michael G. ; Bourredjem, Abderrahmane ; O'Sullivan, Brian ; Dobrowsky, Werner ; Andrzej, Hliniak ; Skladowski, Krzystof ; Hay, John H. ; Pinto, Luiz Hj ; Fu, Karen K. ; Fallai, Carlo ; Sylvester, Richard ; Pignon, Jean Pierre ; MARCH Collaborative Group, Collaborative Group. / Hyperfractionated or accelerated radiotherapy for head and neck cancer. In: The Cochrane database of systematic reviews. 2010 ; Vol. 12.
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abstract = "Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74{\%}) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4{\%} at five years (hazard ratio (HR) 0.92, 95{\%} CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8{\%} at five years) than with accelerated radiotherapy (2{\%} with accelerated fractionation without total dose reduction and 1.7{\%} with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4{\%} at five 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 (under 50 year old) (HR 0.78, 95{\%} CI 0.65 to 0.94), 0.95 (95{\%} CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95{\%} CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95{\%} CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.",
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TY - JOUR

T1 - Hyperfractionated or accelerated radiotherapy for head and neck cancer.

AU - Baujat, Bertrand

AU - Bourhis, Jean

AU - Blanchard, Pierre

AU - Overgaard, Jens

AU - Ang, Kian K.

AU - Saunders, Michelle

AU - Le Maître, Aurélie

AU - Bernier, Jacques

AU - Horiot, Jean Claude

AU - Maillard, Emilie

AU - Pajak, Thomas F.

AU - Poulsen, Michael G.

AU - Bourredjem, Abderrahmane

AU - O'Sullivan, Brian

AU - Dobrowsky, Werner

AU - Andrzej, Hliniak

AU - Skladowski, Krzystof

AU - Hay, John H.

AU - Pinto, Luiz Hj

AU - Fu, Karen K.

AU - Fallai, Carlo

AU - Sylvester, Richard

AU - Pignon, Jean Pierre

AU - MARCH Collaborative Group, Collaborative Group

PY - 2010

Y1 - 2010

N2 - Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4% at five years (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at five years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at five 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 (under 50 year old) (HR 0.78, 95% CI 0.65 to 0.94), 0.95 (95% CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95% CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95% CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.

AB - Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4% at five years (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at five years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at five 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 (under 50 year old) (HR 0.78, 95% CI 0.65 to 0.94), 0.95 (95% CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95% CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95% CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.

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