Do We Need More Intense Radiotherapy In Locally Advanced Head And Neck Cancers? Results From A Large Randomized Trial From The GORTEC

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

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The objective of the trial was to test new therapeutic approaches in patients with locally advanced head and neck carcinomas. These cancers are generally treated with conventional radiotherapy (RT), con¬comitant with chemotherapy (CT), which is a well accepted standard therapeutic approach.

The main question was whether giving more intense RT using a marked acceleration of RT was able to increase the tumour control?

For this Purpose 3 regimens were compared in a large randomised trial including 840 patients with locally advanced head and neck carcinoma. The first was a very intense, accelerated RT without CT (very intense RT), the second was a combination of accelerated RT + CT (intense-RT + CT) and the last regimen was a combination of conventional RT + CT (Classical RT +CT).

The distribution of the main characteristics of the patients and tumours was well balanced between the 3 treatments arms. The tolerance of the 3 different regimens was relatively close, although a trend was observed in favour of classical RT + CT. With a median follow-up of 4.6 years, no significant difference was seen between the 2 RT-CT arms in survival, tumour control and survival without disease progression. On the other hand the very intense RT was inferior to classical RT + CT in terms of survival without cancer progression.

This study was the first to test whether a more intense RT can improve the outcome of patients with head and neck carcinoma, when the patients are treated with concomitant RT-CT. The first conclusion is that more intense RT does not provide significant benefit, as compared to classical RT, when concomitant RT-CT is used and the second conclusion is that a combination of RT-CT is preferable to very intense RT alone in this type of cancer. The results of this study should have an impact on the daily clinical practice and should contribute to better define the guidelines for treating head and neck cancer patients, throughout Europe and beyond.

Bourhis Jean on behalf of the GORTEC, Groupe d'Oncologie Radiothérapie Tête et Cou, France & Belgium

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