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Mature results from a Swedish comparison study of conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN trial
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
Umeå universitet, Medicinska fakulteten, Institutionen för strålningsvetenskaper, Onkologi.
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2015 (Engelska)Ingår i: Radiotherapy and Oncology, ISSN 0167-8140, E-ISSN 1879-0887, Vol. 117, nr 1, s. 99-105Artikel i tidskrift (Refereegranskat) Published
Abstract [en]

Background and purpose: This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. Material and methods: Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, NO glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1 Gy + 2 Gy per day, 5 days/week for 4.5 weeks, total dose 68 Gy) and conventional fractionation (CF) (2 Gy per day, 5 days/week for 7 weeks, total dose 68 Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. Results: There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p = 0.75). LRC at 5 years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p = 0.99). The estimated cancer specific survival (CSS) at 5 years was 62.2% (AF) and 63.3% (CF) (p = 0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16 tumours. Conclusion: This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.

Ort, förlag, år, upplaga, sidor
2015. Vol. 117, nr 1, s. 99-105
Nyckelord [en]
Radiotherapy, Accelerated fractionation, HPV, p16, HNSCC
Nationell ämneskategori
Cancer och onkologi Radiologi och bildbehandling
Identifikatorer
URN: urn:nbn:se:umu:diva-112280DOI: 10.1016/j.radonc.2015.09.024ISI: 000364247700016PubMedID: 26427805Scopus ID: 2-s2.0-84945546848OAI: oai:DiVA.org:umu-112280DiVA, id: diva2:877648
Tillgänglig från: 2015-12-07 Skapad: 2015-12-04 Senast uppdaterad: 2023-03-24Bibliografiskt granskad
Ingår i avhandling
1. Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
Öppna denna publikation i ny flik eller fönster >>Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
2017 (Engelska)Doktorsavhandling, sammanläggning (Övrigt vetenskapligt)
Alternativ titel[sv]
Radioterapi för huvud-, halscancer : risk och nytta av tid, dos och volym
Abstract [en]

Background In the treatment of head and neck cancers (HNCs), radiotherapy (RT) has the advantage of organ preservation compared to surgery. However, treatment toxicities associated with RT can affect important functions for everyday life, both in the acute and late stage. RT to macroscopic tumour in HNC is commonly combined with elective RT to cervical lymph nodes at risk of microscopic involvement. The resulting risk reduction of the elective treatment based on dose-volume parameters is sparsely evaluated. So is the relationship between the elective treatment and treatment toxicity. The present thesis addresses these aspects.

A strategy aimed at improving the outcome of RT is accelerated fractionation (AF). AF strives to shorten total treatment time to minimise proliferation of the tumour tissue during the RT period. We have investigated the impact of AF on both disease control and toxicity.

Methods In the ARTSCAN study, 750 patients with localised HNC were randomised between AF (68 Gy in 4.5 weeks) and conventional fractionation (CF) (68 Gy in 7 weeks). The elective treatment volume was prescribed 46 Gy with CF in both treatment arms. The thesis is based on four individual papers, investigating the issues above in the whole study population or in sub-populations.

Results No difference in disease control or late toxicity between CF and AF was observed at five years. However, there was an increased acute toxicity with AF. Weight loss was associated with treatment volume, independent of tumour stage. The elective treatment volume was found to be an independent risk factor for late aspiration, as well as mean dose to the pharyngeal constrictor muscles, neck dissection, and age at randomisation. There was a significant risk reduction for node relapses in volumes treated to an elective dose. Only a relapse in volumes treated to >60 Gy affected the survival.

Conclusion The present thesis questions the benefit of AF in definitive RT as well as extensive elective treatment of the cervical nodes.

Ort, förlag, år, upplaga, sidor
Umeå: Umeå Universitet, 2017. s. 29
Serie
Umeå University medical dissertations, ISSN 0346-6612 ; 1880
Nyckelord
radiotherapy, head and neck cancer, adjuvant treatment, accelerated fractionation
Nationell ämneskategori
Cancer och onkologi
Forskningsämne
biomedicinsk strålningsvetenskap
Identifikatorer
urn:nbn:se:umu:diva-131021 (URN)978-91-7601-646-6 (ISBN)
Disputation
2017-02-24, Sal 933, Norrlands Universitetssjukhus, Umeå, 09:00 (Svenska)
Opponent
Handledare
Tillgänglig från: 2017-02-03 Skapad: 2017-02-02 Senast uppdaterad: 2018-06-09Bibliografiskt granskad

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Zackrisson, BjörnSöderström, KarinFranzén, Lars

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