TOPLINE:

A recent real-world cohort study suggested that accelerating radiotherapy delivery using 6 fractions per week instead of 5 fractions per week was associated with an improvement in locoregional control (LRC) among patients with locally advanced head and neck squamous cell carcinoma (HNSCC), most of whom also received concurrent chemotherapy. The 5-year LRC was 84% vs 78% in the 6-fraction-per-week group vs the 5-fraction-per-week group; however, the study did not identify an overall survival difference between groups.

METHODOLOGY:

• Moderately accelerated radiation therapy using 6 fractions per week instead of 5 fractions per week shortens overall treatment time by 1 week for patients with HNSCC and may improve patient outcomes, but more research is needed. In a real-world analysis, researchers aimed to clarify whether a 6-fraction strategy led to improved outcomes in patients with locally advanced HNSCC, most of whom received concurrent chemotherapy.
• Researchers conducted a nationwide cohort study using data from the prospective Swedish Head and Neck Cancer Register, which included 940 patients (aged 70 years or younger) with locally advanced HNSCC treated across six Swedish healthcare regions.
• Patients received definitive radiotherapy at 68 Gy in 34 fractions, with 405 patients receiving 6 fractions per week (79% with concurrent weekly cisplatin) and 535 receiving 5 fractions per week (66% with concurrent weekly cisplatin).
• The median follow-up was 4.5 years for overall survival (the primary endpoint) and 3.2 years for tumor control (the secondary endpoint).

TAKEAWAY:

• At 5 years, significantly more patients receiving 6 fractions per week achieved LRC (84% vs 78%; hazard ratio [HR], 0.69), corresponding to a roughly 6% absolute benefit. The benefit appeared larger in p16-negative disease, where absolute LRC gains approached roughly 10%.
• There was no significant difference in 5-year overall survival between the two groups (67% vs 66%; HR, 0.93; 95% CI, 0.73-1.19; P = .60).
• The benefit of the 6-fraction approach appeared to be greater among patients with p16-negative disease. Among patients with oral, hypopharyngeal, laryngeal, and p16-negative oropharyngeal squamous cell carcinoma tumors, 5-year LRC was 73% vs 62% with 6 fractions vs 5 fractions per week, with a 10.2% absolute improvement (P = .06).

IN PRACTICE:

“Moderately accelerated radiotherapy given with 6 fractions per week given with concurrent weekly chemotherapy provided improved locoregional control in patients with locally advanced HNSCC in this retrospective nationwide register-based study using prospectively reported data,” the authors of the study concluded. However, “no difference in overall survival was found.”

SOURCE:

The study, led by Gabriel Adrian, MD, PhD, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Lund, Sweden, was published online in Radiotherapy and Oncology.

LIMITATIONS:

The study was retrospective and nonrandomized, with treatment allocation based on regional guidelines rather than individual patient characteristics, which may introduce systematic differences at the regional level including potential variations in socioeconomic factors. Concurrent chemotherapy was used more frequently in patients receiving 6 fractions per week (79%) than in those receiving 5 fractions per week (66%), which may partly account for the observed improvement in local control. The prescribed dose of 68 Gy differs from the more commonly used international standard of 70 Gy, which may limit generalizability.

DISCLOSURES:

Adrian disclosed receiving funding from the Swedish Society for Medical Research (grant 23-0341), the Maggie Stephen’s Foundation, and the Mrs Berta Kamprad Foundation. The authors reported having no relevant conflicts of interest.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.