Very accelerated versus conventional radiotherapy in HNSCC: Results of the GORTEC 94-02 randomized trial

William Levin, MD
OncoLink Assistant Editor
Last Modified: October 23, 2000

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Presenter: J. Bourhis, et al.
Affiliation: Institut Gustave Roussy, Villejuif, France


Summary:

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.


Methods:

  • 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.


Results:

  • 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.


Author's Conclusions:

  • 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.


Clinical/Scientific Implications:

  • 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.