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Comprehensive Overview: Definitive Radiotherapy and Concurrent Chemoradiation in Locally Advanced Head and Neck Cancer

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Book cover Critical Issues in Head and Neck Oncology

Abstract

Until today, radiotherapy and concomitant chemoradiation are considered standard of care for locally advanced and inoperable HNSCC. Altered fractionation versus standard fractionation led to a small but significant absolute OS benefit of 3.4 % at 5 years in patients with LAD-HNSCC corresponding to a HR reduction for death of 8 %. Hyperfractionation as a specific subtype of altered fractionation led to a highly significant absolute OS and LRC benefit of 8.2 % and 9.4 %, respectively, compared with standard fractionation corresponding to a HR reduction for death of 22 %. Hyperfractionation is a good alternative for definitive treatment of LAD-HNSCC in patients who are not fit for concurrent chemoradiation or who have a high Charlson comorbidity score.

All types of chemoradiation (induction, concurrent and adjuvant) versus radiation alone led to a general absolute overall survival benefit of 4.5 % corresponding to a HR reduction of death of 12 % (p = .0001) at 5 years. For 50 trials of concurrent chemoradiation, the absolute benefit was 6.5 % at 5 years with a corresponding HR reduction of death of 19 % (p < .0001). Platinum/5-FU-based chemoradiation versus radiation alone showed a reduction in local and distant failure rates of 13.5 % and 2.9 %, respectively, corresponding to HR reductions of about 25 % for death at 5 years. Mitomycin C-based chemoradiation is a reasonable alternative for elderly frail patients with large and hypoxic tumours, who are not candidates for platinum-based chemotherapy. Patients above the age of 70 years generally do not or only marginally benefit from altered fractionation or chemoradiation.

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Author information

Authors and Affiliations

  1. Department for Radiation Oncology, Charité University Medicine, Augustenburger Platz 1, Berlin, 13353, Germany

    Volker Budach MD, PhD (Professor and Chairman)

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  1. Volker Budach MD, PhD
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Correspondence to Volker Budach MD, PhD .

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Editors and Affiliations

  1. Department of Medical Oncology, Antwerp University Hospital, Edegem, Belgium

    Jan B. Vermorken

  2. Departments for Radiation Oncology, Charité University Medicine, Berlin, Germany

    Volker Budach

  3. Department of Otolaryngology, VU University Medical Center, Amsterdam, The Netherlands

    C. René Leemans

  4. Department of Medical Oncology, Université catholique de Louvain, Brussels, Belgium

    Jean-Pascal Machiels

  5. Department of Otorhinolarynology, University of Brescia, Brescia, Italy

    Piero Nicolai

  6. Princess Margaret Hospital, Toronto, Canada

    Brian O'Sullivan

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Budach, V. (2017). Comprehensive Overview: Definitive Radiotherapy and Concurrent Chemoradiation in Locally Advanced Head and Neck Cancer. In: Vermorken, J., Budach, V., Leemans, C., Machiels, JP., Nicolai, P., O'Sullivan, B. (eds) Critical Issues in Head and Neck Oncology. Springer, Cham. https://doi.org/10.1007/978-3-319-42909-0_9

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  • DOI: https://doi.org/10.1007/978-3-319-42909-0_9

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