Very accelerated versus conventional radiotherapy in HNSCC: Results of the GORTEC 94-02 randomized trial
Presenter: J. Bourhis, et al.
Affiliation: Institut Gustave Roussy, Villejuif, France
Squamous cell carcinomas of the head & neck are considered to be fairly rapid growing tumors. Advanced tumors are frequently unresectable and treated with radiotherapy. Theoretically, better tumor control might be obtained if radiation treatment was accelerated.
- 268 patients with inoperable head and neck squamous cell carcinoma were randomized to receive 70 Gy over 7 weeks or 62-64 Gy in 3 weeks (2 Gy BID).
- The most frequent site was oropharynx (75 %) and most of the patients had T4 (70%) and N2-3 disease.
- Acute toxicity was significantly higher in the accelerated arm with 83% of patients having grade 3-4 mucositis, compared to 28% in the conventional arm (p < 0.001).
- A feeding tube was needed in 90% of the patients in the accelerated and 41% in the conventional arm.
- With a median follow-up of 28 months no difference was seen between groups, regarding late toxicity.
- The actuarial loco-regional control at 2 years was 58% and 34% in the accelerated and conventional arm, respectively (p < 0.01).
- There was no significanct difference between groups for overall survival.
- The very accelerated regimen used in this study led to a marked increase in acute toxicity along with a significant improvement in local control.
- No benefit in terms of overall survival was seen with accelerated fractionation.
- While increased acute toxicity is to be expected with the more intense regimen, longer follow-up of these patients will be needed to fully assess late toxicity.
- Issues of alternated fractionation may become less relevant in the future, given that combined chemoradiation regimens have been found superior to radiation- only treatments, in terms of overall survival in this group of patients.