Hyperfractionated or accelerated radiotherapy in head and neck cancer : a fractional benefit? Commentary : a meta-analysis. Commentary
Identifieur interne : 009E88 ( Main/Exploration ); précédent : 009E87; suivant : 009E89Hyperfractionated or accelerated radiotherapy in head and neck cancer : a fractional benefit? Commentary : a meta-analysis. Commentary
Auteurs : Lori Wirth ; Aaron M. Allen ; Mitchell Machtay ; Jean Bourhis [France] ; Jens Overgaard [Danemark] ; Hélène Audry [France] ; Kian K. Ang [États-Unis] ; Michele Sounders [Royaume-Uni] ; Jacques Bernier [Suisse] ; Jean-Claude Horiot [France] ; Aurélie Le Maitre [France] ; Thomas F. Pajak [États-Unis] ; Michael G. Poulsen [Australie] ; Brian O'Sullivan [Canada] ; Werner Dobrowsky [Royaume-Uni] ; Andrzej Hliniak [Pologne] ; Krzysztof Skladowske [Pologne] ; John H. Hay [Canada] ; Luiz H. J. Pinto [Brésil] ; Carlo Fallai [Italie] ; Karen K. Fu [États-Unis] ; Richard Sylvester [Belgique] ; Jean-Pierre Pignon [France]Source :
- Lancet : (British edition) [ 0140-6736 ] ; 2006.
Descripteurs français
- Pascal (Inist)
- Wicri :
- topic : Médecine.
English descriptors
Abstract
Background Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival. Methods Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction. Findings 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3.4% at 5 years (hazard ratio 0.92, 95% CI 0.86-0.97; p=0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at 5 years, p=0.02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at 5 years; p<0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0.78 [0.65-0.94] for under 50 year olds, 0.95 [0.83-1.09] for 51-60 year olds, 0.92 [0.81-1.06] for 61-70 year olds, and 1.08 [0.89-1.30] for over 70 year olds; test for trends p=0.007). Interpretation Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit.
Affiliations:
- Australie, Belgique, Brésil, Canada, Danemark, France, Italie, Pologne, Royaume-Uni, Suisse, États-Unis
- Bourgogne, Bourgogne-Franche-Comté, Canton de Genève, Lombardie, Région de Bruxelles-Capitale, État de Rio de Janeiro
- Bruxelles, Dijon, Genève, Milan, Rio de Janeiro
- Université de Genève
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Allen</name></author><author><name sortKey="Machtay, Mitchell" sort="Machtay, Mitchell" uniqKey="Machtay M" first="Mitchell" last="Machtay">Mitchell Machtay</name></author><author><name sortKey="Bourhis, Jean" sort="Bourhis, Jean" uniqKey="Bourhis J" first="Jean" last="Bourhis">Jean Bourhis</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Radiation Oncology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Overgaard, Jens" sort="Overgaard, Jens" uniqKey="Overgaard J" first="Jens" last="Overgaard">Jens Overgaard</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Experimental Clinical Oncology</s1><s2>Aarhus</s2><s3>DNK</s3><sZ>5 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Department of Experimental Clinical Oncology</wicri:noRegion></affiliation></author><author><name sortKey="Audry, Helene" sort="Audry, Helene" uniqKey="Audry H" first="Hélène" last="Audry">Hélène Audry</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Biostatistics and Epidemiology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>6 aut.</sZ><sZ>11 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Ang, Kian K" sort="Ang, Kian K" uniqKey="Ang K" first="Kian K." last="Ang">Kian K. 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Pajak</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>RTOG Statistical Headquarters</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>RTOG Statistical Headquarters</wicri:noRegion></affiliation></author><author><name sortKey="Poulsen, Michael G" sort="Poulsen, Michael G" uniqKey="Poulsen M" first="Michael G." last="Poulsen">Michael G. Poulsen</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Southern Zone Radiation Oncology-Mater Centre</s1><s2>Brisbane, Queensland</s2><s3>AUS</s3><sZ>13 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Southern Zone Radiation Oncology-Mater Centre</wicri:noRegion></affiliation></author><author><name sortKey="O Sullivan, Brian" sort="O Sullivan, Brian" uniqKey="O Sullivan B" first="Brian" last="O'Sullivan">Brian O'Sullivan</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Radiation Oncology Department, Princess Margaret Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion></affiliation></author><author><name sortKey="Dobrowsky, Werner" sort="Dobrowsky, Werner" uniqKey="Dobrowsky W" first="Werner" last="Dobrowsky">Werner Dobrowsky</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Newcastle General Hospital</s1><s2>Newcastle</s2><s3>GBR</s3><sZ>15 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Newcastle General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Hliniak, Andrzej" sort="Hliniak, Andrzej" uniqKey="Hliniak A" first="Andrzej" last="Hliniak">Andrzej Hliniak</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Center of Oncology Institute</s1><s2>Warsaw</s2><s3>POL</s3><sZ>16 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Center of Oncology Institute</wicri:noRegion></affiliation></author><author><name sortKey="Skladowske, Krzysztof" sort="Skladowske, Krzysztof" uniqKey="Skladowske K" first="Krzysztof" last="Skladowske">Krzysztof Skladowske</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Maria Curie Memorial Institute</s1><s2>Gliwice</s2><s3>POL</s3><sZ>17 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Maria Curie Memorial Institute</wicri:noRegion></affiliation></author><author><name sortKey="Hay, John H" sort="Hay, John H" uniqKey="Hay J" first="John H." last="Hay">John H. Hay</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>British Colombia Cancer Agency</s1><s2>Vancouver, BC</s2><s3>CAN</s3><sZ>18 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>British Colombia Cancer Agency</wicri:noRegion></affiliation></author><author><name sortKey="Pinto, Luiz H J" sort="Pinto, Luiz H J" uniqKey="Pinto L" first="Luiz H. J." last="Pinto">Luiz H. J. Pinto</name><affiliation wicri:level="3"><inist:fA14 i1="15"><s1>Instituto Nadonal de Cancer</s1><s2>Rio de Janeiro</s2><s3>BRA</s3><sZ>19 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Fallai, Carlo" sort="Fallai, Carlo" uniqKey="Fallai C" first="Carlo" last="Fallai">Carlo Fallai</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>Dipartimento di Radiotherapia, Istituto NazionaleTumori</s1><s2>Milan</s2><s3>ITA</s3><sZ>20 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Fu, Karen K" sort="Fu, Karen K" uniqKey="Fu K" first="Karen K." last="Fu">Karen K. Fu</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>University of California</s1><s2>San Francisco, CA</s2><s3>USA</s3><sZ>21 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of California</wicri:noRegion></affiliation></author><author><name sortKey="Sylvester, Richard" sort="Sylvester, Richard" uniqKey="Sylvester R" first="Richard" last="Sylvester">Richard Sylvester</name><affiliation wicri:level="3"><inist:fA14 i1="18"><s1>EORTC Statistical Headquarters</s1><s2>Brussels</s2><s3>BEL</s3><sZ>22 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Pignon, Jean Pierre" sort="Pignon, Jean Pierre" uniqKey="Pignon J" first="Jean-Pierre" last="Pignon">Jean-Pierre Pignon</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Biostatistics and Epidemiology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>6 aut.</sZ><sZ>11 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author></titleStmt><publicationStmt><idno type="wicri:source">INIST</idno><idno type="inist">06-0407262</idno><date when="2006">2006</date><idno type="stanalyst">PASCAL 06-0407262 INIST</idno><idno type="RBID">Pascal:06-0407262</idno><idno type="wicri:Area/PascalFrancis/Corpus">004215</idno><idno type="wicri:Area/PascalFrancis/Curation">001E80</idno><idno type="wicri:Area/PascalFrancis/Checkpoint">003F76</idno><idno type="wicri:explorRef" wicri:stream="PascalFrancis" wicri:step="Checkpoint">003F76</idno><idno type="wicri:doubleKey">0140-6736:2006:Wirth L:hyperfractionated:or:accelerated</idno><idno type="wicri:Area/Main/Merge">00A998</idno><idno type="wicri:Area/Main/Curation">009E88</idno><idno type="wicri:Area/Main/Exploration">009E88</idno></publicationStmt><sourceDesc><biblStruct><analytic><title xml:lang="en" level="a">Hyperfractionated or accelerated radiotherapy in head and neck cancer : a fractional benefit? Commentary : a meta-analysis. Commentary</title><author><name sortKey="Wirth, Lori" sort="Wirth, Lori" uniqKey="Wirth L" first="Lori" last="Wirth">Lori Wirth</name></author><author><name sortKey="Allen, Aaron M" sort="Allen, Aaron M" uniqKey="Allen A" first="Aaron M." last="Allen">Aaron M. Allen</name></author><author><name sortKey="Machtay, Mitchell" sort="Machtay, Mitchell" uniqKey="Machtay M" first="Mitchell" last="Machtay">Mitchell Machtay</name></author><author><name sortKey="Bourhis, Jean" sort="Bourhis, Jean" uniqKey="Bourhis J" first="Jean" last="Bourhis">Jean Bourhis</name><affiliation wicri:level="1"><inist:fA14 i1="01"><s1>Radiation Oncology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>4 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Overgaard, Jens" sort="Overgaard, Jens" uniqKey="Overgaard J" first="Jens" last="Overgaard">Jens Overgaard</name><affiliation wicri:level="1"><inist:fA14 i1="02"><s1>Department of Experimental Clinical Oncology</s1><s2>Aarhus</s2><s3>DNK</s3><sZ>5 aut.</sZ></inist:fA14><country>Danemark</country><wicri:noRegion>Department of Experimental Clinical Oncology</wicri:noRegion></affiliation></author><author><name sortKey="Audry, Helene" sort="Audry, Helene" uniqKey="Audry H" first="Hélène" last="Audry">Hélène Audry</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Biostatistics and Epidemiology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>6 aut.</sZ><sZ>11 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Ang, Kian K" sort="Ang, Kian K" uniqKey="Ang K" first="Kian K." last="Ang">Kian K. Ang</name><affiliation wicri:level="1"><inist:fA14 i1="04"><s1>Radiation Oncology Department, MD Anderson Cancer Center</s1><s2>Houston, TX</s2><s3>USA</s3><sZ>7 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>Houston, TX</wicri:noRegion></affiliation></author><author><name sortKey="Sounders, Michele" sort="Sounders, Michele" uniqKey="Sounders M" first="Michele" last="Sounders">Michele Sounders</name><affiliation wicri:level="1"><inist:fA14 i1="05"><s1>Radiation Oncology, Mount Vernon Hospital</s1><s2>Northwood</s2><s3>GBR</s3><sZ>8 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Northwood</wicri:noRegion></affiliation></author><author><name sortKey="Bernier, Jacques" sort="Bernier, Jacques" uniqKey="Bernier J" first="Jacques" last="Bernier">Jacques Bernier</name><affiliation wicri:level="4"><inist:fA14 i1="06"><s1>Faculty of Medicine, University of Geneva</s1><s3>CHE</s3><sZ>9 aut.</sZ></inist:fA14><country>Suisse</country><placeName><settlement type="city">Genève</settlement><region nuts="3" type="region">Canton de Genève</region></placeName><orgName type="university">Université de Genève</orgName></affiliation></author><author><name sortKey="Horiot, Jean Claude" sort="Horiot, Jean Claude" uniqKey="Horiot J" first="Jean-Claude" last="Horiot">Jean-Claude Horiot</name><affiliation wicri:level="3"><inist:fA14 i1="07"><s1>Centre F Leclerc</s1><s2>Dijon</s2><s3>FRA</s3><sZ>10 aut.</sZ></inist:fA14><country>France</country><placeName><region type="region">Bourgogne-Franche-Comté</region><region type="old region">Bourgogne</region><settlement type="city">Dijon</settlement></placeName></affiliation></author><author><name sortKey="Le Maitre, Aurelie" sort="Le Maitre, Aurelie" uniqKey="Le Maitre A" first="Aurélie" last="Le Maitre">Aurélie Le Maitre</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Biostatistics and Epidemiology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>6 aut.</sZ><sZ>11 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author><author><name sortKey="Pajak, Thomas F" sort="Pajak, Thomas F" uniqKey="Pajak T" first="Thomas F." last="Pajak">Thomas F. Pajak</name><affiliation wicri:level="1"><inist:fA14 i1="08"><s1>RTOG Statistical Headquarters</s1><s2>Philadelphia, PA</s2><s3>USA</s3><sZ>12 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>RTOG Statistical Headquarters</wicri:noRegion></affiliation></author><author><name sortKey="Poulsen, Michael G" sort="Poulsen, Michael G" uniqKey="Poulsen M" first="Michael G." last="Poulsen">Michael G. Poulsen</name><affiliation wicri:level="1"><inist:fA14 i1="09"><s1>Southern Zone Radiation Oncology-Mater Centre</s1><s2>Brisbane, Queensland</s2><s3>AUS</s3><sZ>13 aut.</sZ></inist:fA14><country>Australie</country><wicri:noRegion>Southern Zone Radiation Oncology-Mater Centre</wicri:noRegion></affiliation></author><author><name sortKey="O Sullivan, Brian" sort="O Sullivan, Brian" uniqKey="O Sullivan B" first="Brian" last="O'Sullivan">Brian O'Sullivan</name><affiliation wicri:level="1"><inist:fA14 i1="10"><s1>Radiation Oncology Department, Princess Margaret Hospital</s1><s2>Toronto</s2><s3>CAN</s3><sZ>14 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>Toronto</wicri:noRegion></affiliation></author><author><name sortKey="Dobrowsky, Werner" sort="Dobrowsky, Werner" uniqKey="Dobrowsky W" first="Werner" last="Dobrowsky">Werner Dobrowsky</name><affiliation wicri:level="1"><inist:fA14 i1="11"><s1>Newcastle General Hospital</s1><s2>Newcastle</s2><s3>GBR</s3><sZ>15 aut.</sZ></inist:fA14><country>Royaume-Uni</country><wicri:noRegion>Newcastle General Hospital</wicri:noRegion></affiliation></author><author><name sortKey="Hliniak, Andrzej" sort="Hliniak, Andrzej" uniqKey="Hliniak A" first="Andrzej" last="Hliniak">Andrzej Hliniak</name><affiliation wicri:level="1"><inist:fA14 i1="12"><s1>Center of Oncology Institute</s1><s2>Warsaw</s2><s3>POL</s3><sZ>16 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Center of Oncology Institute</wicri:noRegion></affiliation></author><author><name sortKey="Skladowske, Krzysztof" sort="Skladowske, Krzysztof" uniqKey="Skladowske K" first="Krzysztof" last="Skladowske">Krzysztof Skladowske</name><affiliation wicri:level="1"><inist:fA14 i1="13"><s1>Maria Curie Memorial Institute</s1><s2>Gliwice</s2><s3>POL</s3><sZ>17 aut.</sZ></inist:fA14><country>Pologne</country><wicri:noRegion>Maria Curie Memorial Institute</wicri:noRegion></affiliation></author><author><name sortKey="Hay, John H" sort="Hay, John H" uniqKey="Hay J" first="John H." last="Hay">John H. Hay</name><affiliation wicri:level="1"><inist:fA14 i1="14"><s1>British Colombia Cancer Agency</s1><s2>Vancouver, BC</s2><s3>CAN</s3><sZ>18 aut.</sZ></inist:fA14><country>Canada</country><wicri:noRegion>British Colombia Cancer Agency</wicri:noRegion></affiliation></author><author><name sortKey="Pinto, Luiz H J" sort="Pinto, Luiz H J" uniqKey="Pinto L" first="Luiz H. J." last="Pinto">Luiz H. J. Pinto</name><affiliation wicri:level="3"><inist:fA14 i1="15"><s1>Instituto Nadonal de Cancer</s1><s2>Rio de Janeiro</s2><s3>BRA</s3><sZ>19 aut.</sZ></inist:fA14><country>Brésil</country><placeName><settlement type="city">Rio de Janeiro</settlement><region type="state">État de Rio de Janeiro</region></placeName></affiliation></author><author><name sortKey="Fallai, Carlo" sort="Fallai, Carlo" uniqKey="Fallai C" first="Carlo" last="Fallai">Carlo Fallai</name><affiliation wicri:level="3"><inist:fA14 i1="16"><s1>Dipartimento di Radiotherapia, Istituto NazionaleTumori</s1><s2>Milan</s2><s3>ITA</s3><sZ>20 aut.</sZ></inist:fA14><country>Italie</country><placeName><settlement type="city">Milan</settlement><region nuts="2">Lombardie</region></placeName></affiliation></author><author><name sortKey="Fu, Karen K" sort="Fu, Karen K" uniqKey="Fu K" first="Karen K." last="Fu">Karen K. Fu</name><affiliation wicri:level="1"><inist:fA14 i1="17"><s1>University of California</s1><s2>San Francisco, CA</s2><s3>USA</s3><sZ>21 aut.</sZ></inist:fA14><country>États-Unis</country><wicri:noRegion>University of California</wicri:noRegion></affiliation></author><author><name sortKey="Sylvester, Richard" sort="Sylvester, Richard" uniqKey="Sylvester R" first="Richard" last="Sylvester">Richard Sylvester</name><affiliation wicri:level="3"><inist:fA14 i1="18"><s1>EORTC Statistical Headquarters</s1><s2>Brussels</s2><s3>BEL</s3><sZ>22 aut.</sZ></inist:fA14><country>Belgique</country><placeName><settlement type="city">Bruxelles</settlement><region nuts="2">Région de Bruxelles-Capitale</region></placeName></affiliation></author><author><name sortKey="Pignon, Jean Pierre" sort="Pignon, Jean Pierre" uniqKey="Pignon J" first="Jean-Pierre" last="Pignon">Jean-Pierre Pignon</name><affiliation wicri:level="1"><inist:fA14 i1="03"><s1>Biostatistics and Epidemiology Department, Institut Gustave Roussy</s1><s2>Villejuif</s2><s3>FRA</s3><sZ>6 aut.</sZ><sZ>11 aut.</sZ><sZ>23 aut.</sZ></inist:fA14><country>France</country><wicri:noRegion>Villejuif</wicri:noRegion><wicri:noRegion>Institut Gustave Roussy</wicri:noRegion><wicri:noRegion>Villejuif</wicri:noRegion></affiliation></author></analytic><series><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno><imprint><date when="2006">2006</date></imprint></series></biblStruct></sourceDesc><seriesStmt><title level="j" type="main">Lancet : (British edition)</title><title level="j" type="abbreviated">Lancet : (Br. ed.)</title><idno type="ISSN">0140-6736</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="KwdEn" xml:lang="en"><term>Critical study</term><term>Head and neck cancer</term><term>Medicine</term><term>Metaanalysis</term><term>Radiotherapy</term><term>Treatment</term></keywords><keywords scheme="Pascal" xml:lang="fr"><term>Radiothérapie</term><term>Traitement</term><term>Etude critique</term><term>Métaanalyse</term><term>Médecine</term><term>Cancer tête cou</term></keywords><keywords scheme="Wicri" type="topic" xml:lang="fr"><term>Médecine</term></keywords></textClass></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">Background Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival. Methods Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction. Findings 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3.4% at 5 years (hazard ratio 0.92, 95% CI 0.86-0.97; p=0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at 5 years, p=0.02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at 5 years; p<0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0.78 [0.65-0.94] for under 50 year olds, 0.95 [0.83-1.09] for 51-60 year olds, 0.92 [0.81-1.06] for 61-70 year olds, and 1.08 [0.89-1.30] for over 70 year olds; test for trends p=0.007). Interpretation Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit.</div></front></TEI><affiliations><list><country><li>Australie</li><li>Belgique</li><li>Brésil</li><li>Canada</li><li>Danemark</li><li>France</li><li>Italie</li><li>Pologne</li><li>Royaume-Uni</li><li>Suisse</li><li>États-Unis</li></country><region><li>Bourgogne</li><li>Bourgogne-Franche-Comté</li><li>Canton de Genève</li><li>Lombardie</li><li>Région de Bruxelles-Capitale</li><li>État de Rio de Janeiro</li></region><settlement><li>Bruxelles</li><li>Dijon</li><li>Genève</li><li>Milan</li><li>Rio de Janeiro</li></settlement><orgName><li>Université de Genève</li></orgName></list><tree><noCountry><name sortKey="Allen, Aaron M" sort="Allen, Aaron M" uniqKey="Allen A" first="Aaron M." last="Allen">Aaron M. Allen</name><name sortKey="Machtay, Mitchell" sort="Machtay, Mitchell" uniqKey="Machtay M" first="Mitchell" last="Machtay">Mitchell Machtay</name><name sortKey="Wirth, Lori" sort="Wirth, Lori" uniqKey="Wirth L" first="Lori" last="Wirth">Lori Wirth</name></noCountry><country name="France"><noRegion><name sortKey="Bourhis, Jean" sort="Bourhis, Jean" uniqKey="Bourhis J" first="Jean" last="Bourhis">Jean Bourhis</name></noRegion><name sortKey="Audry, Helene" sort="Audry, Helene" uniqKey="Audry H" first="Hélène" last="Audry">Hélène Audry</name><name sortKey="Horiot, Jean Claude" sort="Horiot, Jean Claude" uniqKey="Horiot J" first="Jean-Claude" last="Horiot">Jean-Claude Horiot</name><name sortKey="Le Maitre, Aurelie" sort="Le Maitre, Aurelie" uniqKey="Le Maitre A" first="Aurélie" last="Le Maitre">Aurélie Le Maitre</name><name sortKey="Pignon, Jean Pierre" sort="Pignon, Jean Pierre" uniqKey="Pignon J" first="Jean-Pierre" last="Pignon">Jean-Pierre Pignon</name></country><country name="Danemark"><noRegion><name sortKey="Overgaard, Jens" sort="Overgaard, Jens" uniqKey="Overgaard J" first="Jens" last="Overgaard">Jens Overgaard</name></noRegion></country><country name="États-Unis"><noRegion><name sortKey="Ang, Kian K" sort="Ang, Kian K" uniqKey="Ang K" first="Kian K." last="Ang">Kian K. Ang</name></noRegion><name sortKey="Fu, Karen K" sort="Fu, Karen K" uniqKey="Fu K" first="Karen K." last="Fu">Karen K. Fu</name><name sortKey="Pajak, Thomas F" sort="Pajak, Thomas F" uniqKey="Pajak T" first="Thomas F." last="Pajak">Thomas F. Pajak</name></country><country name="Royaume-Uni"><noRegion><name sortKey="Sounders, Michele" sort="Sounders, Michele" uniqKey="Sounders M" first="Michele" last="Sounders">Michele Sounders</name></noRegion><name sortKey="Dobrowsky, Werner" sort="Dobrowsky, Werner" uniqKey="Dobrowsky W" first="Werner" last="Dobrowsky">Werner Dobrowsky</name></country><country name="Suisse"><region name="Canton de Genève"><name sortKey="Bernier, Jacques" sort="Bernier, Jacques" uniqKey="Bernier J" first="Jacques" last="Bernier">Jacques Bernier</name></region></country><country name="Australie"><noRegion><name sortKey="Poulsen, Michael G" sort="Poulsen, Michael G" uniqKey="Poulsen M" first="Michael G." last="Poulsen">Michael G. Poulsen</name></noRegion></country><country name="Canada"><noRegion><name sortKey="O Sullivan, Brian" sort="O Sullivan, Brian" uniqKey="O Sullivan B" first="Brian" last="O'Sullivan">Brian O'Sullivan</name></noRegion><name sortKey="Hay, John H" sort="Hay, John H" uniqKey="Hay J" first="John H." last="Hay">John H. Hay</name></country><country name="Pologne"><noRegion><name sortKey="Hliniak, Andrzej" sort="Hliniak, Andrzej" uniqKey="Hliniak A" first="Andrzej" last="Hliniak">Andrzej Hliniak</name></noRegion><name sortKey="Skladowske, Krzysztof" sort="Skladowske, Krzysztof" uniqKey="Skladowske K" first="Krzysztof" last="Skladowske">Krzysztof Skladowske</name></country><country name="Brésil"><region name="État de Rio de Janeiro"><name sortKey="Pinto, Luiz H J" sort="Pinto, Luiz H J" uniqKey="Pinto L" first="Luiz H. J." last="Pinto">Luiz H. J. Pinto</name></region></country><country name="Italie"><region name="Lombardie"><name sortKey="Fallai, Carlo" sort="Fallai, Carlo" uniqKey="Fallai C" first="Carlo" last="Fallai">Carlo Fallai</name></region></country><country name="Belgique"><region name="Région de Bruxelles-Capitale"><name sortKey="Sylvester, Richard" sort="Sylvester, Richard" uniqKey="Sylvester R" first="Richard" last="Sylvester">Richard Sylvester</name></region></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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