Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 4:11:5465-5483.
doi: 10.2147/OTT.S172018. eCollection 2018.

Altered fractionation radiotherapy with or without chemotherapy in the treatment of head and neck cancer: a network meta-analysis

Yingyu Liu  1 , Changgui Kou  1 , Wei Bai  1 , Xinyu Liu  1 , Yan Song  1 , Lili Zhang  1 , Mohan Wang  1 , Yangyu Zhang  1 , Yueyue You  1 , Yue Yin  2 , Xin Jiang  3 , Ying Xin  4
Affiliations

Altered fractionation radiotherapy with or without chemotherapy in the treatment of head and neck cancer: a network meta-analysis

Yingyu Liu et al. Onco Targets Ther. .

Abstract

Objectives: A Bayesian network meta-analysis (NMA) was conducted in patients with head and neck cancers (HNCs) to estimate the efficacy and safety of treatment with conventional fractionation radiotherapy (CF), conventional fractionation chemoradiotherapy (CF_CRT), hyperfractionated radiotherapy (HF), hyperfractionated chemoradiotherapy (HF_CRT), accelerated fractionation radiotherapy, accelerated fractionation chemoradiotherapy, accelerated hyperfractionated radiotherapy (HART) or accelerated hyperfractionated chemoradiotherapy (HACRT) to identify superior treatments to aid in clinical decisions.

Methods: PubMed, EMBASE and the Cochrane Central Register of Controlled Trials (CENTRAL) were searched for potentially eligible randomized controlled trials up to December 2016. Overall survival (OS), disease-free survival (DFS) and locoregional control (LRC) were considered efficacy outcomes, whereas acute toxicity and late toxicity on skin and mucosa were considered safety outcomes. The surface under the cumulative ranking curve (SUCRA) was calculated to rank each treatment in each index.

Results: Data from 72 trials with 21,868 participants were included in the analysis. Concerning OS, all treatments were associated with a significant advantage compared to CF alone, with HR effect sizes ranging from 0.64 to 0.83, and HACRT was significantly more effective than all the other treatments. The network comparisons of both HACRT vs HART and HF_CRT vs HF demonstrated a higher OS benefit, with an HR of 0.78 (95% credible interval [CrI]: 0.64-0.95) and 0.78 (95% CrI: 0.61-0.99), respectively. The results of SUCRA indicated that HACRT had the best ranking for OS and LRC, HF_CRT for DFS, HART for acute and late skin toxicity, CF_CRT for acute mucosal toxicity and HF_CRT for late mucosal toxicity.

Conclusion: The NMA results support the notion that HACRT is the preferable treatment modality for HNCs because it has better rankings in all three efficacy indexes, although it does present a high risk of acute mucosal toxicity.

Keywords: altered fractionation radiotherapy; head and neck cancer; network meta-analysis; randomized controlled trials.

PubMed Disclaimer

Conflict of interest statement

Disclosure The authors report no conflicts of interest in this work.

Figures

Figure 1
Figure 1
PRISMA flow diagram. Abbreviations: HNCs, head and neck cancers; RCTs, randomized controlled trials.
Figure 2
Figure 2
Network plot for all the treatments included in the network meta-analysis. Abbreviations: CF, conventional fractionation radiotherapy; CF_CRT, conventional fractionation chemoradiotherapy; HF, hyperfractionated radiotherapy; HF_CRT, hyperfractionated chemoradiotherapy; AF, accelerated fractionation radiotherapy; AF_CRT, accelerated fractionation chemoradiotherapy; HART, accelerated hyperfractionated radiotherapy; HACRT, accelerated hyperfractionated chemo radiotherapy.
Figure 3
Figure 3
Forest plots of efficacy of different treatments compared with conventional fractionation radiotherapy: (A) overall survival; (B) disease-free survival; and (C) locoregional control. Abbreviations: CrI, credible interval; CF_CRT, conventional fractionation chemoradiotherapy; HF, hyperfractionated radiotherapy; HF_CRT, hyperfractionated chemoradiotherapy; AF, accelerated fractionation radiotherapy; AF_CRT, accelerated fractionation chemoradiotherapy; HART, accelerated hyperfractionated radiotherapy; HACRT, accelerated hyperfractionated chemoradiotherapy; SURCA, surface under the cumulative ranking curve.
Figure 4
Figure 4
Forest plots of safety of different treatments compared to conventional fractionation radiotherapy: (A) acute skin toxicity; (B) acute mucosal toxicity; (C) late skin toxicity; and (D) late mucosal toxicity. Abbreviations: CrI, credible interval; CF_CRT, conventional fractionation chemoradiotherapy; HF, hyperfractionated radiotherapy; HF_CRT, hyperfractionated chemoradiotherapy; AF, accelerated fractionation radiotherapy; AF_CRT, accelerated fractionation chemoradiotherapy; HART, accelerated hyperfractionated radiotherapy; HACRT, accelerated hyperfractionated chemoradiotherapy; SUCRA, surface under the cumulative ranking curve.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Marcial VA, Pajak TF, Chang C, Tupchong L, Stetz J. Hyperfractionated photon radiation therapy in the treatment of advanced squamous cell carcinoma of the oral cavity, pharynx, larynx, and sinuses, using radiation therapy as the only planned modality: (preliminary report) by the Radiation Therapy Oncology Group (RTOG) Int J Radiat Oncol Biol Phys. 1987;13(1):41–47. - PubMed
    1. Sanchiz F, Milla A, Torner J, et al. Single fraction per day versus two fractions per day versus radiochemotherapy in the treatment of head and neck cancer. Int J Radiat Oncol Biol Phys. 1990;19(6):1347–1350. - PubMed
    1. Pinto LHJ, Canary PCV, Araujo CMM, Bacelar SC, Souhami L. Prospective randomized trial comparing hyperfractionated versus conventional radiotherapy in stages III and IV oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 1991;21(3):557–562. - PubMed
    1. Horiot JC, Fur R, N’Guyen T, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol J Eur Soc Ther Radiol Oncol. 1992;25(4):231–241. Available from: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/983/CN-0008.... - PubMed
    1. Bogaert W, Schueren E, Horiot JC, et al. The EORTC randomized trial on three fractions per day and misonidazole (trial no. 22811) in advanced head and neck cancer: long-term results and side effects. Radiother Oncol J Eur Soc Ther Radiol Oncol. 1995;35(2):91–99. Available from: http://onlinelibrary.wiley.com/o/cochrane/clcentral/articles/578/CN-0011.... - PubMed