Accelerated Chemoradiation vs. Conventional Chemoradiation in Locally Advanced Head and Neck Cancer: A Retrospective Study

doi:10.21608/ejhm.2025.440598

Accelerated Chemoradiation vs. Conventional Chemoradiation in Locally Advanced Head and Neck Cancer: A Retrospective Study

10.21608/ejhm.2025.440598

Abstract

Background: Head and neck squamous cell carcinoma (HNSCC) is the seventh most diagnosed malignancy worldwide. The standard approach for treating locally advanced HNSCC consists of concurrent chemoradiotherapy (CRT) utilizing a fractionated radiotherapy regimen, typically delivering 70 Gy over seven weeks, this conventional schedule is associated with extended overall treatment time (OTT), significant acute and late toxicities, and suboptimal locoregional control (LRC) outcomes. RTOG 90-03 and the DAHANCA protocols, as well as meta-analyses such as MARCH, supports the use of altered fractionation schedules compared to conventional once-daily radiotherapy, demonstrating modest but statistically significant improvements in LRC and overall survival (OS).
Objective: Our aim was to compare accelerated chemoradiation vs. conventional chemoradiation regarding late toxicity, recurrence rate, disease-free survival (DFS), progression-free survival (PFS), OS, and prognostic factors affecting survival.
Patients and Methods: Our study is a retrospective comparative study in which data were collected from 2012 to 2022. Patients were grouped into two arms: one (Arm A) for 60 patients who received accelerated radiotherapy with 1.8-2 Gy per fraction, 5 fractions per week, and a second (Arm B) for 50 patients who received conventional radiotherapy with 2 Gy per fraction, 6 fraction per week.
Results: There was a statistically significant lower percentage of RT interruption in arm A compared to arm B (3.3% vs. 18.0%, respectively). However, there was no statistically significant difference between the two arms regarding cranial nerve affection, taste alteration, trismus, hearing impairment, and RT completion. There was no statistically significant difference between the two arms regarding response to treatment. There was a statistically significant lower mortality rate in arm A compared to arm B (43.3% vs. 68.0%, respectively). There was a statistically significant higher median OS in arm A compared to arm B.
Conclusion: These findings suggest that accelerated radiotherapy offers a potential advantage in improving survival outcomes, with comparable toxicity profiles to conventional treatment.

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