Chemotherapy, Twice-Daily Radiotherapy Combination Improves Head and Neck Cancer Survival

Hyperfractionated radiotherapy combined with chemotherapy improves survival in patients with head and neck cancer, a recent study indicates.

This form of radiotherapy is a twice-daily treatment that allows patients to be administered a higher and more efficacious dose. The investigators hope that it can be achieved without increasing adverse events (AEs).

Included in the study were patients with tumors in their mouths, throats, or voice boxes that had begun to metastasize to neighboring tissue. The investigators used a relatively novel technique called a network meta-analysis to compile data from 117 trials, which included 28,804 patients worldwide.

This technique allowed researchers to compare 16 different treatments to determine which option best reduced the spread of cancer and deaths from the disease.

The results of the study showed the twice-daily treatment used in combination with chemotherapy reduced deaths by 20% compared with once-daily radiotherapy with chemotherapy. Furthermore, it reduced the risk of cancer progression by 23%, according to the investigators.

“There are a number of new treatments that have shown promise in head and neck cancer trials,” said lead investigator Dr Claire Petit. “This large study has enabled us to compare several of these treatments to see which is best overall in terms of reducing mortality.”

Although the results of the study show promise, the investigators warn that AEs experienced during treatment, or in the longer term, have not yet been studied.

“Some of the studies we looked at did not include data on [AEs]; others did not follow patients long enough to pick up long-term [AEs],” Dr Petit said. “This will be the focus of more research over the next year.

“Moreover, the method we used, network meta-analysis, which combines direct and indirect treatment comparisons, is a new method that needs to be interpreted with prudence. However, this is an important finding for this group of patients who have a higher risk of their cancer recurring following treatment.”

Each year, approximately 600,000 individuals are diagnosed with head and neck cancer around the globe. This particular disease can be difficult to treat due to the large proportion of vital structures within the infected areas.

“This research provides good evidence for the benefits of treating advanced stage head and neck cancer patients with a combination of twice-daily radiation therapy and chemotherapy, compared [with] 1 or even none of these separately,” said Philip Poortmans, president-elect of the European Cancer Congress. “Before we can apply these very interesting results into daily clinical practice, we need to wait for the outcome of the next stage of this research—–namely the evaluation of the short and long-term [AEs]. This is the utmost importance for the quality of life of the patients and their relatives.

“Moreover, it would be preferable to perform prospective trials to confirm these results. If that is not feasible, or if we cannot wait for their outcome for some subgroups of patients who have the worst survival currently, then we should at least register carefully all the outcome parameters in prospective, multi-center databases so that they are available later on for analysis.”

The study’s findings were presented at the European Cancer Congress 2017.