Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis

Jean Bourhis, Jens Overgaard, Hélène Audry, Kian K. Ang, Michele Saunders, Jacques Bernier, Jean Claude Horiot, Aurélie Le Maître, Thomas F. Pajak, Michael G. Poulsen, Brian O'Sullivan, Werner Dobrowsky, Andrzej Hliniak, Krzysztof Skladowski, John H. Hay, Luiz HJ Pinto, Carlo Fallai, Karen K. Fu, Richard Sylvester, Jean Pierre Pignon

Research output: Contribution to journalArticlepeer-review


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

Original languageEnglish
Pages (from-to)843-854
Number of pages12
Issue number9538
Publication statusPublished - Sep 2 2006

ASJC Scopus subject areas

  • Medicine(all)


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