Hyperfractionated radiotherapy in head and neck cancer – pro

Hyperfrationated radiotherapy has been extensively studied, both in the treatment of head and neck cancer and in other cancer types. Hyperfractionated radiotherapy (multiple fractions per day) yields higher rates of acute toxicity compared with conventional radiotherapy (one fraction per day, five days per week). Data on the incidence and severity of late complications associated with hyperfractionation are incomplete. It is premature to conclude that hyperfractionation with dose escalation does not increase late tissue complications.
Although the improvements in loco-regional control and survival are promising, longer follow-up and more complete information on late complications will be needed to meaningfully compare these results to those achieved with concomitant chemoradiation in locally advanced squamous cell carcinoma of the head and neck.
A recent guideline concluded that conclusions regarding loco-regional control are limited by the quality of the published data. To date, only three of seven randomized controlled trials have provided convincing evidence of improved loco-regional control with hyperfractionation compared with conventional radiotherapy. In one of these three studies, improved loco-regional control was accompanied by an increase in overall survival. Two other randomized controlled trials have documented improved overall survival with hyperfractionation, but both studies have been criticized for failing to report complete data. Another emtaanalysis, hosever, concluded that altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma and that comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit. The issue requires more study and the propsoed treatment should be considered experimental.

Head and Neck Cancer Disease Site Group. Mackenzie RG, Hodson DI, Browman GP, Zuraw L. Hyperfractionated radiotherapy for locally advanced squamous cell carcinoma of the head and neck [full report]. Toronto (ON): Cancer Care Ontario (CCO); 2003 Jan [online update]. 13 p. (Practice guideline report; no. 5-6b). [22 references]

Lancet. 2006 Sep 2;368(9538):843-54. Links

Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, Horiot JC, Le Maître A, Pajak TF, Poulsen MG, O’Sullivan B, Dobrowsky W, Hliniak A, Skladowski K, Hay JH, Pinto LH, Fallai C, Fu KK, Sylvester R, Pignon JP;Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis.Bourhis J,  Meta-Analysis of Radiotherapy in Carcinomas of Head and neck (MARCH) Collaborative Group.Comment in:
Lancet. 2006 Nov 25;368(9550):1867-8; author reply 1868.
Lancet. 2006 Nov 25;368(9550):1867; author reply 1868.
Lancet. 2006 Sep 2;368(9538):819-21.
Republished in:
Clin Otolaryngol. 2007 Apr;32(2):119.

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