TY - JOUR
T1 - Hyperfractionated or accelerated radiotherapy in head and neck cancer
T2 - a meta-analysis
AU - Bourhis, Jean
AU - Overgaard, Jens
AU - Audry, Hélène
AU - Ang, Kian K.
AU - Saunders, Michele
AU - Bernier, Jacques
AU - Horiot, Jean Claude
AU - Le Maître, Aurélie
AU - Pajak, Thomas F.
AU - Poulsen, Michael G.
AU - O'Sullivan, Brian
AU - Dobrowsky, Werner
AU - Hliniak, Andrzej
AU - Skladowski, Krzysztof
AU - Hay, John H.
AU - Pinto, Luiz HJ
AU - Fallai, Carlo
AU - Fu, Karen K.
AU - Sylvester, Richard
AU - Pignon, Jean Pierre
PY - 2006/9/2
Y1 - 2006/9/2
N2 - 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
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
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U2 - 10.1016/S0140-6736(06)69121-6
DO - 10.1016/S0140-6736(06)69121-6
M3 - Article
C2 - 16950362
AN - SCOPUS:33747881607
VL - 368
SP - 843
EP - 854
JO - The Lancet
JF - The Lancet
SN - 0140-6736
IS - 9538
ER -