Σάββατο, 28 Ιανουαρίου 2017

HYPERFRACTIONATED RT BETTER FOR HEAD AND NECK CANCERS

Treating patients with head and neck cancer with hyperfractionated twice-daily radiation therapy combined with chemotherapy could potentially reduce mortality, according to new research presented by Petit et al at the 2017 European Cancer Congress (ECCO) (Abstract 823).
The study, led by Claire Petit, PhD, a resident in radiation oncology from Institut Gustave Roussy, included patients with tumors in their mouths, throats, or larynges that had already begun to locally metastasize. These patients tend to have lower rates of survival than those whose cancer was diagnosed at an earlier stage.
By splitting the daily radiotherapy in two portions, a higher and more effective dose can be given to patients. The researchers hope that this can be achieved without increasing side effects.
Study Results
The researchers used the relatively new technique of network meta-analysis to bring together data from 117 different trials, including 28,804 patients from around the world. This allowed them to compare 16 different treatments to find out which was best at reducing the spread of cancer and deaths from the disease.
They discovered that the twice-daily radiation treatment, when combined with chemotherapy, cut deaths by 20% compared to the best standard treatment of once-daily radiotherapy with chemotherapy. It also reduced the risk of cancer progression by 23%.
Dr. Petit told the Congress, “There are a number of new treatments that have shown promise in head and neck cancer trials. This large study has enabled us to compare several of these treatments to see which is best overall in terms of reducing mortality.”
Dr. Petit cautioned that she has not yet studied the side effects experienced by patients, either during treatment or in the longer term, and that more research is needed to examine this and to confirm the results. “Some of the studies we looked at did not include data on side effects; others did not follow patients long enough to pick up long-term side effects. This will be the focus of more research over the next year.”
She added, “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.”
Commentary
Philip Poortmans, MD, PhD, President-Elect of ECCO and Head of the Radiation Oncology Department at Radboud University Medical Center in Nijmegen, the Netherlands, commented, “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 to one or even none of these separately. 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 side effects. This is of 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,” he continued. “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 multicenter databases so that they are available later on for analysis.”

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