An international study of patients with squamous cell carcinoma of the larynx, pharynx, or oral cavity reported that an accelerated schedule of radiation therapy improved cancer control and was feasible even in low-resource settings. These results were recently published in the journal The Lancet Oncology.
Worldwide, head and neck cancer is diagnosed in approximately 640,000 people annually and is responsible for approximately 350,000 deaths each year. Most patients diagnosed with head and neck squamous cell carcinoma (HNSCC) have disease that is “locoregional”, which means that the cancer has not spread beyond the lymph nodes in the neck. Standard treatment of locoregional disease involves surgery and radiation. Results from several clinical trials indicate that shortening the overall treatment time with radiation therapy may improve patient outcomes. One strategy that decreases the duration of therapy and the potential for tumor repopulation between treatments is called accelerated fractionation. A large randomized controlled trial comparing radiation with conventional five fractions per week versus an accelerated schedule of six fractions per week resulted in a 15% treatment benefit for the patients receiving the accelerated schedule. Acute and late complications are increased with the use of an accelerated schedule of radiation to the head and neck.
In this study, HNSCC patients with locoregional disease were enrolled from Asia, Europe, the Middle East, Africa, and South America. Patients were randomized to receive either a conventional schedule of five fractions per week (448 patients) or an accelerated schedule of six fractions per week (452 patients). The two groups of patients received the same total dose of radiation.
- Five-year disease-free survival was 50% for the accelerated group versus 40% for the conventional group.
- Overall survival was 35% for the accelerated group versus 28% for the conventional group.
- Severe skin reactions, mucositis, and tube feeding were significantly more common in the accelerated group.
- Late complications resulting from treatment were not significantly different between the two groups.
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These researchers concluded that the accelerated schedule was more effective than the conventional schedule of radiation therapy. Because accelerated fractionation does not require additional resources, this may be a treatment option for patients with HNSCC in developing countries. Any patient considering treatment with an accelerated schedule of radiation should be aware of the risks and benefits of treatment in order to make an informed decision.
 Overgaard J, Mohanti BK, Begum N, et al. Five versus six fractions of radiotherapy per week for squamous-cell carcinoma of the head and neck (IAEA-ACC study): a randomised, multicentre trial. Lancet Oncology [early online publication]. April 8, 2010.