Two-Year Results From A Swedish Study On Conventional Versus Accelerated Radiotherapy In Head And Neck Squamous Cell Carcinoma (ARTSCAN)

Main Category: Radiology / Nuclear Medicine
Also Included In: Cancer / Oncology;  Neurology / Neuroscience
Article Date: 22 Sep 2008 - 3:00 PDT

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It is known that in radiotherapy prolonging the overall treatment time beyond seven weeks leads to less effective treatment of e.g. cancers of the head and neck. Consequently, the aim of several studies has been to evaluate the effect of shortened treatment time by "accelerated fractionation" (AF). The results have not been easy to interpret. In Sweden both conventional fractionation (CF) and AFwere used at different centres. To achieve a national consensus this randomised controlled clinical study was performed to study the effects of AFversus CF.

Previously, untreated patients with squamous cell cancer of the oral cavity, oropharynx, larynx and hypopharynx were included. Patients were randomised to either CF for 49 days or to AFin 35 days. The same total dose (68 Gy) was given in both treatment arms.

Central monitoring of the treatment process was performed. Furthermore, data on volumes and doses to both tumours and critical organs were collected for each patient.

The study was closed in June 2006 after the inclusion of 750 patients. For the whole group of patients there were no significant differences between the treatments regarding overall survival (OS), tumour control or long term side effects. The AF group had significantly worse acute reactions. The OS at two years was 68% for AF and 67% for CF. There was a non-significant trend towards improved tumour control for oral cancers treated with AF.

So far, the AF regimen has not proved to be more efficacious than CF. The trend of improved results in AF for oral cancers needs to be further investigated. As the follow up continues and more analyses are made new results will appear and be of help in designing future studies and therapies. The collected data on tumour effects and side-effects together with the database of dose distributions in different organs will help to increase knowledge on how to optimise radiotherapy for future patients.

Zackrisson Björn et al. Umeå University Hospital, Umeå, Sweden

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