There is debate among oncologists about the optimum treatment time for patients given radiotherapy for head and neck cancer. Jens Overgaard from Aarhus University Hospital, Denmark, and colleagues investigated whether the shortening of treatment time by use of six instead of five radiotherapy fractions per week improved patients' tumour response.
In a randomised controlled trial between 1992 and 1997, around 1400 patients with head and neck cancer were allocated to receive either five or six fractions of radiotherapy per week (spread over 46 and 39 days, respectively); the total radiation dose was the same for both groups.
Five-year tumour control was 10% better in patients given six fractions per week (70% tumour control) compared with those given radiotherapy five times a week (60%). Accelerated radiotherapy helped voice preservation in patients with laryngeal cancer; it also was associated with a small increase in disease-specific survival compared with patients given five fractions per week, although acute morbidity was more common among those given accelerated radiotherapy.
Jens Overgaard comments: "Although all patients in the accelerated treatment arm did better, some did better than others, and we are currently trying to identify those groups where the benefit is largest. It appears to be linked to two factors - a high degree of expression of epidermal growth factor receptor (EGFR) and a good differentiation of the tumour."
* The results will be presented next week at ECCO 12 - the European Cancer Conference2, taking place in Copenhagen, Denmark.
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The Lancet