A prospective, multicenter DAHANCA study of hyperfractionated, accelerated radiotherapy for head and neck squamous cell carcinoma

Mette Saksø*, Elo Andersen, Jens Bentzen, Maria Andersen, Jørgen Johansen, Hanne Primdahl, Jens Overgaard, Jesper Grau Eriksen

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Background: The study aimed to evaluate Hyperfractionated, Accelerated Radiotherapy (HART) with nimorazole for patients with head and neck squamous cell carcinoma (HNSCC) using loco-regional failure (LRF), overall survival (OS), early and late morbidity as endpoints. Material and methods: From February 2007 to January 2018, 295 patients with unresected HNSCC, T1-T4, N0-N3, M0, were treated with HART prescribed as 76 Gy in 56 fractions (fx), 10 fx weekly. IMRT was used in >90% of patients. No chemotherapy was given. Patients were prospectively registered in the DAHANCA database. Results: The median age was 64 years, 75% of patients were males. Primary sites were larynx (25%), pharynx (64%) and oral cavity (11%). In total, 59% were stage III-IV (UICC 2002). Of the 150 oropharyngeal cancer (OPC) patients, 42% were p16+. The proportion of patients receiving HART as planned was 97%. The median follow-up time was 66 months. Three-year actuarial LRF was 19% and OS was 66%. LRF was significantly higher for stage III-IV patients compared to stage I-II (25% vs. 11%, HR 2.12 [1.21-3.74]). The site-specific LRF rates were: for larynx 22% [12-32], hypopharynx 30% [16-45], non-p16+ oropharynx 15% [8-23], p16+ oropharynx 7% [1-13] and oral cavity 35% [18-53]. During therapy, 51% reported severe dysphagia and 60% required feeding tubes. The peak incidence of late, severe dysphagia and xerostomia was 21% and 9%, respectively. A comparison to historical data from previous DAHANCA trials showed that tumor control and morbidity are comparable to treatment with acceleration and/or chemo-radiation. Conclusions: HART represents an attractive approach for patients with HNSCC where treatment intensification is indicated.

Original languageEnglish
JournalActa Oncologica
Volume58
Issue number10
Pages (from-to)1495-1501
ISSN0284-186X
DOIs
Publication statusPublished - Oct 2019

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Multicenter Studies
Deglutition Disorders
Larynx
Nimorazole
Oropharyngeal Neoplasms
Xerostomia
Enteral Nutrition
Databases
Incidence
Neoplasms

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Saksø, Mette ; Andersen, Elo ; Bentzen, Jens ; Andersen, Maria ; Johansen, Jørgen ; Primdahl, Hanne ; Overgaard, Jens ; Eriksen, Jesper Grau. / A prospective, multicenter DAHANCA study of hyperfractionated, accelerated radiotherapy for head and neck squamous cell carcinoma. In: Acta Oncologica. 2019 ; Vol. 58, No. 10. pp. 1495-1501.
@article{30c60f4beb0a444ba979cf9f6508a024,
title = "A prospective, multicenter DAHANCA study of hyperfractionated, accelerated radiotherapy for head and neck squamous cell carcinoma",
abstract = "Background: The study aimed to evaluate Hyperfractionated, Accelerated Radiotherapy (HART) with nimorazole for patients with head and neck squamous cell carcinoma (HNSCC) using loco-regional failure (LRF), overall survival (OS), early and late morbidity as endpoints. Material and methods: From February 2007 to January 2018, 295 patients with unresected HNSCC, T1-T4, N0-N3, M0, were treated with HART prescribed as 76 Gy in 56 fractions (fx), 10 fx weekly. IMRT was used in >90{\%} of patients. No chemotherapy was given. Patients were prospectively registered in the DAHANCA database. Results: The median age was 64 years, 75{\%} of patients were males. Primary sites were larynx (25{\%}), pharynx (64{\%}) and oral cavity (11{\%}). In total, 59{\%} were stage III-IV (UICC 2002). Of the 150 oropharyngeal cancer (OPC) patients, 42{\%} were p16+. The proportion of patients receiving HART as planned was 97{\%}. The median follow-up time was 66 months. Three-year actuarial LRF was 19{\%} and OS was 66{\%}. LRF was significantly higher for stage III-IV patients compared to stage I-II (25{\%} vs. 11{\%}, HR 2.12 [1.21-3.74]). The site-specific LRF rates were: for larynx 22{\%} [12-32], hypopharynx 30{\%} [16-45], non-p16+ oropharynx 15{\%} [8-23], p16+ oropharynx 7{\%} [1-13] and oral cavity 35{\%} [18-53]. During therapy, 51{\%} reported severe dysphagia and 60{\%} required feeding tubes. The peak incidence of late, severe dysphagia and xerostomia was 21{\%} and 9{\%}, respectively. A comparison to historical data from previous DAHANCA trials showed that tumor control and morbidity are comparable to treatment with acceleration and/or chemo-radiation. Conclusions: HART represents an attractive approach for patients with HNSCC where treatment intensification is indicated.",
author = "Mette Saks{\o} and Elo Andersen and Jens Bentzen and Maria Andersen and J{\o}rgen Johansen and Hanne Primdahl and Jens Overgaard and Eriksen, {Jesper Grau}",
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A prospective, multicenter DAHANCA study of hyperfractionated, accelerated radiotherapy for head and neck squamous cell carcinoma. / Saksø, Mette; Andersen, Elo; Bentzen, Jens; Andersen, Maria; Johansen, Jørgen; Primdahl, Hanne; Overgaard, Jens; Eriksen, Jesper Grau.

In: Acta Oncologica, Vol. 58, No. 10, 10.2019, p. 1495-1501.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - A prospective, multicenter DAHANCA study of hyperfractionated, accelerated radiotherapy for head and neck squamous cell carcinoma

AU - Saksø, Mette

AU - Andersen, Elo

AU - Bentzen, Jens

AU - Andersen, Maria

AU - Johansen, Jørgen

AU - Primdahl, Hanne

AU - Overgaard, Jens

AU - Eriksen, Jesper Grau

PY - 2019/10

Y1 - 2019/10

N2 - Background: The study aimed to evaluate Hyperfractionated, Accelerated Radiotherapy (HART) with nimorazole for patients with head and neck squamous cell carcinoma (HNSCC) using loco-regional failure (LRF), overall survival (OS), early and late morbidity as endpoints. Material and methods: From February 2007 to January 2018, 295 patients with unresected HNSCC, T1-T4, N0-N3, M0, were treated with HART prescribed as 76 Gy in 56 fractions (fx), 10 fx weekly. IMRT was used in >90% of patients. No chemotherapy was given. Patients were prospectively registered in the DAHANCA database. Results: The median age was 64 years, 75% of patients were males. Primary sites were larynx (25%), pharynx (64%) and oral cavity (11%). In total, 59% were stage III-IV (UICC 2002). Of the 150 oropharyngeal cancer (OPC) patients, 42% were p16+. The proportion of patients receiving HART as planned was 97%. The median follow-up time was 66 months. Three-year actuarial LRF was 19% and OS was 66%. LRF was significantly higher for stage III-IV patients compared to stage I-II (25% vs. 11%, HR 2.12 [1.21-3.74]). The site-specific LRF rates were: for larynx 22% [12-32], hypopharynx 30% [16-45], non-p16+ oropharynx 15% [8-23], p16+ oropharynx 7% [1-13] and oral cavity 35% [18-53]. During therapy, 51% reported severe dysphagia and 60% required feeding tubes. The peak incidence of late, severe dysphagia and xerostomia was 21% and 9%, respectively. A comparison to historical data from previous DAHANCA trials showed that tumor control and morbidity are comparable to treatment with acceleration and/or chemo-radiation. Conclusions: HART represents an attractive approach for patients with HNSCC where treatment intensification is indicated.

AB - Background: The study aimed to evaluate Hyperfractionated, Accelerated Radiotherapy (HART) with nimorazole for patients with head and neck squamous cell carcinoma (HNSCC) using loco-regional failure (LRF), overall survival (OS), early and late morbidity as endpoints. Material and methods: From February 2007 to January 2018, 295 patients with unresected HNSCC, T1-T4, N0-N3, M0, were treated with HART prescribed as 76 Gy in 56 fractions (fx), 10 fx weekly. IMRT was used in >90% of patients. No chemotherapy was given. Patients were prospectively registered in the DAHANCA database. Results: The median age was 64 years, 75% of patients were males. Primary sites were larynx (25%), pharynx (64%) and oral cavity (11%). In total, 59% were stage III-IV (UICC 2002). Of the 150 oropharyngeal cancer (OPC) patients, 42% were p16+. The proportion of patients receiving HART as planned was 97%. The median follow-up time was 66 months. Three-year actuarial LRF was 19% and OS was 66%. LRF was significantly higher for stage III-IV patients compared to stage I-II (25% vs. 11%, HR 2.12 [1.21-3.74]). The site-specific LRF rates were: for larynx 22% [12-32], hypopharynx 30% [16-45], non-p16+ oropharynx 15% [8-23], p16+ oropharynx 7% [1-13] and oral cavity 35% [18-53]. During therapy, 51% reported severe dysphagia and 60% required feeding tubes. The peak incidence of late, severe dysphagia and xerostomia was 21% and 9%, respectively. A comparison to historical data from previous DAHANCA trials showed that tumor control and morbidity are comparable to treatment with acceleration and/or chemo-radiation. Conclusions: HART represents an attractive approach for patients with HNSCC where treatment intensification is indicated.

U2 - 10.1080/0284186X.2019.1658897

DO - 10.1080/0284186X.2019.1658897

M3 - Journal article

VL - 58

SP - 1495

EP - 1501

JO - Acta Oncologica

JF - Acta Oncologica

SN - 0284-186X

IS - 10

ER -