Long-Term Results of Conventional Radiotherapy versus Accelerated Hyperfractionated Radiotherapy versus Concomitant Radiotherapy and Chemotherapy in Locoregionally Advanced Carcinoma of the Oropharynx

Abstract

The results obtained with the combination of CT and RT compared with RT alone did not reach statistical significance, but combined treatment almost doubled the five-year overall survival, relapse-free survival and locoregional control rate. Patients with advanced squamous cell carcinomas of the oropharynx who are medically suitable for the combined approach should be treated with a combination of radiotherapy and chemotherapy. The occurrence of second tumors is relatively common in these patients and may contribute substantially to the causes of death.

Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

“…Of these, 172 abstracts were excluded (review articles, non-randomised comparisons or randomised comparisons with conventionally fractionated radiotherapy), leaving a total of nine abstracts, wherein fulltext articles were retrieved wherever available for consideration for inclusion in the meta-analysis. One study (ORO 93-01) [20] published in full earlier was subsequently updated, resulting in another full-text publication [21] with mature results; appropriate data from both were included in the meta-analysis. Groupe d'Oncologie Radiotherapie Tete et Cou (GORTEC 99-02) [22] was the largest study included in the meta-analysis.…”

“…First, only two [22,25] of the five trials had sufficient patient numbers and were adequately powered for showing statistical significance. Second, two trials included oropharyngeal cancers only [21,25], whereas the other three allowed inclusion of all head and neck primary sites [22e24] except nasopharynx and paranasal sinus. Three trials used Forest plots of concurrent chemoradiotherapy (CCRT) versus altered fractionation radiotherapy (AFRT) for late xerostomia.…”

“…The point estimate for grade 2 or worse xerostomia (b) also favours AFRT, but is statistically non-significant as its 95% confidence interval straddles the line of unity. combination chemotherapy comprising carboplatin and 5-flourouracil [21,22,24] concurrently during radiotherapy, whereas the other two trials used single agent cisplatin (weekly [23] and 3 weekly [25], respectively) as concurrent chemotherapy. The AFRT schedules that were used in the studies were also heterogeneous.…”

“…The first of these (ORO 93-01) [20,21] was a three-arm trial that randomised 192 patients with advanced oropharyngeal cancer to either conventionally fractionated radiotherapy alone; a split-course accelerated-hyperfractionated schedule; or CCRT using conventional fractionation. At a median follow-up of 8.3 years, the 5 year locoregional control (21% versus 48%, P ¼ 0.5), disease-free survival (26% versus 43%, P ¼ 0.7), as well overall survival (21% versus 40%, P ¼ 0.3), although numerically superior for CCRT, were not statistically significantly different from split-course AFRT.…”

Treatment Deintensification for Human Papillomavirus-Associated Oropharyngeal Cancer

“…Several trials demonstrated the efficacy of concurrent chemoradiotherapy for OPSCC compared with radiation alone. These trials include the 94-01 GORTEC trial, 3 an Italian phase III trial showing improved but non-significant survival with chemoradiotherapy, 4 as well as a meta-analysis demonstrating better survival with concurrent chemoradiation versus radiation alone for HNSCC. 5 During this shift to more intense concurrent chemoradiation, advances in surgery allowed transoral resection of primary HNSCC, with better functional outcomes compared with open surgery.…”