Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701)

Kodaira, Takeshi; Kagami, Yoshikazu; Shibata, Taro; Shikama, Naoto; Nishimura, Yasumasa; Ishikura, Satoshi; Nakamura, Kenichi; Saito, Yoshihiro; Matsumoto, Yasuo; Teshima, Teruki; Ito, Yoshiaki; Akimoto, Tetsuo; Nakata, Kensei; Toshiyasu, Takashi; Nakagawa, Kazuhiko; Nagata, Yasushi; Nishimura, Tetsuo; Umemura, Takashi; Kataoka, Makoto; Yorozu, Atsunori; Hiraoka, Masahiro

doi:10.1093/annonc/mdy036

Cited by 33 publications

(31 citation statements)

References 16 publications

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“…To the best of our knowledge, this is the first study that has directly compared the treatment results of CF, hypofractionation, and late-course accelerated hyperfractionation as definitive RT for EGSCC. The LC and OS rates in our study were comparable to those of recent prospective randomized studies involving hypofractionation (11,13). Prolongation of RT for head and neck cancer may worsen LC because of so-called 'accelerated tumor clonogen repopulation during RT', which leads to treatment resistance (19).…”

Section: Discussionsupporting

confidence: 79%

“…The accelerated repopulation of surviving clonogenic tumor cells during the RT period, known to be a key factor determining the LC rate in head and neck cancer, has also been observed in patients with early glottic carcinomas. The LC rate of accelerated RT using an accelerated fractionation strategy (AFS) that reduces the overall treatment time (OTT) by either increasing the number of fractions per day (hyperfractionation) or increasing the dose per fraction (hypofractionation) has been reported to be superior to that of conventional fractionation (CF) with a 1.8-2.0 Gy daily schedule (10)(11)(12)(13).…”

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confidence: 99%

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Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Suzuki

Yamazaki

Aibe

et al. 2020

In Vivo

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Background/Aim: Radiotherapy is widely accepted as the treatment of choice for early glottic squamous cell carcinoma (EGSCC), although it varies greatly with respect to dose, dose per fraction, and treatment techniques. The study aim was to evaluate the use of accelerated fractionation strategy (AFS) for EGSCC in standard clinical practice. Patients and Methods: Patients treated with definitive radiotherapy for EGSCC between 2008 and 2019 were retrospectively identified and received either conventional fractionation, hypofractionation, or hyperfractionation. Results: One hundred six patients were analyzed, and 19, 71, and 16 patients underwent conventional fractionation, hypofractionation, and hyperfractionation, respectively. The median follow-up was 56 months. The 5-year local control and overall survival rates were 79% and 83%; 78% and 79%; and 87% and 77%, respectively, and no significant difference was observed between the fractionation schedules. Conclusion: Our findings confirmed the utility of AFS in standard clinical practice and support its use for patients with EGSCC.

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Section: Discussionsupporting

confidence: 79%

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confidence: 99%

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Suzuki

Yamazaki

Aibe

et al. 2020

In Vivo

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“…Current recommendation in the national guidelines is to treat EGSCC with fraction sizes of 2 Gy up to 66 (stage I) - 70 Gy (stage II) preferably in an accelerated schedule or with hypofractionation, with fraction sizes such as 2.25 Gy up to 63 Gy (stage I) – 65.25 Gy (stage II) and 2.75 Gy to a dose of 55 Gy (20–23). On the other hand, there are also published works with findings contradicting with the above-mentioned information (24, 25). Furthermore, there seem to be other factors such as sex, which were suggested to influence tumor control (26, 27) and survival (28, 29).…”

Section: Introductionmentioning

confidence: 87%

Influencing Factors on Radiotherapy Outcome in Stage I-II Glottic Larynx Cancer—A Multicenter Study

et al. 2019

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Background and Purpose: Larynx cancer represents one of the most frequently diagnosed head and neck malignancies, which is most often confined to the glottic area. The aim of this study was to report the oncological outcome and identify prognostic factors in early-stage glottic squamous cell carcinoma treated with radiotherapy.Material and Methods: Patients (n = 761) diagnosed and treated in 10 centers between 1990 and 2015 were retrospectively analyzed. Probabilities of loco-regional control (LRC) and overall survival (OS) were calculated and possible prognostic factors were analyzed using Cox proportional hazards models.Results: The median follow-up was 63 months (range: 2–243). Three hundred and sixty-four, 148 and 249 patients had cT1a, cT1b, and cT2 stage I-II disease, respectively. Five and 10-years LRC/OS rates in the whole cohort were 83/82% and 80/68%, respectively. Three patients developed distant recurrences. In univariate analysis, male sex (HR: 3.49; 95% CI: 1.47–11.37; p < 0.01), T2 vs. T1a (HR: 1.62; 95% CI: 1.08–2.43; p = 0.02) and anterior commissure involvement (ACI) (HR: 1.66; 95% CI: 1.38–2.45; p < 0.01) were associated with impaired LRC. In multivariate analysis, male sex (HR: 3.42; 95% CI: 1.44–11.17; p < 0.01) and ACI (HR: 1.51; 95% CI: 1.01–2.28; p = 0.047) remained poor prognostic factors. No relation of treatment technique and biologically equivalent dose (BED) to oncological outcome was identified except for higher BED10(L = 25; T = 1) yielding better LRC in T1a tumors (p = 0.04) in univariate analyses.Conclusion: Our results highlight the negative impact of ACI on tumor control. A less-expected finding was the impact of sex on tumor control. Further research is needed to validate its prognostic value and investigate any related biologic or behavioral factors, which may be modified to improve oncologic outcome.

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“…Recently, along with the increased number of cancer survivors, larynx cancer was frequently diagnosed as the second primary malignant neoplasms (SPMs). Unfortunately, those patients with a prior cancer history were ruled out by most of the clinical trials concentrating on larynx cancer [ 8 – 12 ]. Given the sizable number of these patients, the exclusion criterion may limit the accuracy and generalizability of clinical trials, thus leaving some essential clinical questions unanswered [ 13 , 14 ].…”

Section: Introductionmentioning

confidence: 99%

Impact of prior cancer history on the survival of patients with larynx cancer

et al. 2020

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Background Patients with a prior history of cancer are commonly excluded from clinical trial. Increasing number of studies implied that a prior cancer did not adversely affect the clinical outcome among various types of cancer patients. However, the impact of prior cancer on survival of larynx cancer patients remains largely unknown. The aim of this study was to evaluate the prevalence of prior cancer and assess its impact on survival of patients diagnosed with larynx cancer. Methods Patients with larynx cancer as the first or second primary malignancy diagnosed from 2004 to 2015 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. Propensity score matching (PSM) was conducted to balance baseline characteristics. Kaplan-Meier method, multivariate Cox proportional hazard model, and multivariate competing risk model were performed for survival analysis. Results A total of 24,812 eligible patients with larynx cancer were included in the study, wherein a total of 2436 patients (9.8%) had a prior history of cancer. Prostate (36%), lung and bronchus (10%), urinary bladder (7%), and breast (6%) were the most common types of prior cancer. A prior cancer history served as a risk factor for overall survival (AHR =1.30; 95% CI [1.21–1.41]; P < 0.001) but a protective factor for cancer-specific mortality (AHR = 0.83; 95% CI [0.72–0.94]; P = 0.004) in comparison with those without prior cancer. The subgroup analysis showed that a prior history of cancer adversely affected overall survival of patients with larynx cancer in most subgroups stratified by timing and types of prior cancer, as well as by different clinicopathologic features. Conclusion Our study indicated an adverse survival impact of a prior history of cancer on patients with larynx cancer. Except for a few particular prior cancer, clinical trials should be considered prudently for laryngeal cancer patients with prior cancers.

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Results of a multi-institutional, randomized, non-inferiority, phase III trial of accelerated fractionation versus standard fractionation in radiation therapy for T1-2N0M0 glottic cancer: Japan Clinical Oncology Group Study (JCOG0701)

Abstract: UMIN Clinical Trial Registry, number UMIN000000819.

Cited by 33 publications

References 16 publications

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Comparison of Three Fractionation Schedules in Radiotherapy for Early Glottic Squamous Cell Carcinoma

Influencing Factors on Radiotherapy Outcome in Stage I-II Glottic Larynx Cancer—A Multicenter Study

Impact of prior cancer history on the survival of patients with larynx cancer

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