Intensifying Head and Neck Cancer Treatment

Head and neck cancer patient survival extended with altered fractionation radiotherapy

/ Author:  / Reviewed by: Robert Carlson, M.D Beth Bolt, RPh

(RxWiki News) Giving chemotherapy at the same time as radiation therapy is called chemoradiation. It’s the standard of care for people who have head and neck cancers that have spread to nearby tissue. An analysis of previous studies has uncovered another option for these patients.

Radiation that’s given at higher doses more frequently can help head and neck cancer patients live longer than they do with standard radiation therapy, a new analysis revealed.

This method offers additional treatment options to patients who aren’t good candidates for chemoradiation.

"Ask questions about the type of radiation therapy you’ll be receiving."

Pierre Blanchard, MD, a radiation oncologist from the Institut Gustave Roussy, Villejuif, France, led a team of researchers who looked at previous studies relating to the effectiveness of different radiotherapy techniques.

Researchers analyzed 31 trials involving 11,085 patients with locally advanced (spread to nearby tissues or lymph nodes) head and neck cancer.

The goal of the study was to compare the effectiveness of altered fractionation radiotherapy (AFRT) with standard fractionation radiotherapy (SFRT).

Altered fractionation radiation therapy delivers higher doses of radiation and is given in various schedules, whereas standard radiotherapy delivers a lower dose of radiation over a longer period of time.

Hyperfractionation (higher doses given more frequently) where radiation was given twice a day for 10 days, totalling 80 units of radiation, compared to standard radiation given over seven weeks totalling 70 units.

Another AFRT regimen delivered the same or lower amounts of radiation over a shorter period of time than standard radiation.

After seven years of follow-up, researchers discovered that the hyperfractionated radiotherapy improved survival, with 41 percent of the patients alive five years after the treatment compared with 33 percent of those in the standard radiotherapy group.

Serious side effects following treatment were more severe in the AFRT group than in the SFRT group, but late effects that appear years later were about the same in both groups.

David Horvick, MD, radiation oncologist with 21st Century Oncology of New Jersey, told dailyRx News, “This report, which combines data from multiple prior studies, indicates that intensification of radiation treatment schedules leads to improved control of cancer and improved survival compared to conventional radiation schedules. Chemotherapy given with radiation has, also, been shown to improve head and neck cancer control and survival and is the standard of care in the United States," Dr. Horvick said.

“For patients who are not candidates for chemotherapy, hyperfractionationed radiation is an excellent option,” said Dr. Horvick, who was not involved in this study.

Results of this study were presented at the 2013 European Cancer Congress (ECC2013). Before publication in a peer-reviewed journal, all research is considered preliminary.

The research was funded by funded by the French Ministry of Health (Programme Hospitalier de Recherche Clinique) and the French Anticancer League (Ligue contre le Cancer).

No conflicts of interest were reported.

Review Date: 
September 27, 2013
Last Updated:
December 31, 2013