Shortening radiotherapy treatment time is a feasible and more effective alternative to standard radiotherapy for head and neck cancers in resourced-limited countries in the developing world, where 75% of these cancers occur. Accelerated radiotherapy (increasing the number of treatments from five to six a week) prevents local disease recurrence and improves disease-free survival, with no increase in late radiation-induced side-effects, in patients in resource-limited settings. Since it does not require additional resources, this accelerated schedule of radiotherapy should be considered as a new international standard of treatment, concludes an article published in The Lancet Oncology.

Squamous-cell carcinoma of the head and neck (HNSCC) is the fourth most common cancer worldwide. Previous studies have shown that reducing treatment time, but not the dose, of radiotherapy in these patients can result in better tumour control without the need for additional resources. But these accelerated regimens have also been shown to increase the risk of late radiation side-effects, and trials have not been done to prove their feasibility and effectiveness in resource-limited countries.

To provide more evidence, Jens Overgaard (Aarhus University Hospital in Denmark) and international colleagues designed the International Atomic Energy Agency (IAEA) ACC trial to investigate the suitability of accelerated fractionated radiotherapy for patients with HNSCC in resource-limited countries.

908 patients from Asia, Europe, the Middle East, Africa, and South America were randomly assigned to an accelerated schedule of six fractions of radiotherapy per week of 2 Gy (n=458) or to a conventional radiotherapy schedule of five fractions per week of 2 Gy (n=450), up to a total dose 66–70 Gy in 33–35 fractions.

5-year locoregional control was 12% better in patients given the accelerated regimen (42%) compared with those given the conventional regimen (30%). Additionally, disease-free survival was significantly greater for patients in the accelerated regimen group than in the conventional treatment group (50% vs 40%).

Acute morbidity was significantly more common in the accelerated group—confluent mucositis was reported in 45 patients in the accelerated group and 22 in the conventional group. Additionally, more patients in the accelerated group (87) experienced severe skin reactions than in the conventional group (50). But no significant difference was found in late radiation side-effects between the two groups.

The authors say: "The six fractions per week schedule, resulting in a 1-week reduction in treatment time relative to conventional treatment, seems to give a good balance between improved tumour control and the avoidance of excess late morbidity".

They conclude: "The accelerated schedule is therefore more effective than conventional fractionation, and since it does not require additional resources, it might be a suitable new international standard of treatment."


Source: Lancet Oncology