Dados do Trabalho

Título

Moderate hypofractionated radiotherapy (RT-HIPO) in locally advanced head and neck cancer: a prospective cohort study with paired historical control using conventional radiotherapy (RT-CONV)

Introdução

In recent years, RT-HIPO has been used in several tumors. More recently, the results of some studies using the hypofractionated regimen demonstrate acceptable toxicity with similar oncologic results in the treatment of locally advanced CCP (CCP-LA).

Objetivo

The primary objective was to evaluate the initial results of a prospective cohort of patients with CCP-LA treated with definitive radiotherapy or adjuvant radiotherapy with RT-HYPO with or without platinum-based chemotherapy. Secondarily, overall survival was compared with a paired historical cohort treated with conventional dose RT.

Método

Prospective cohort study, with paired analysis with historical cohort. Inclusion criteria were diagnosis of CCP, age > 18 years, T3/T4 or N+ tumors, no distant metastases and no previous course of radiotherapy. Patients undergoing definitive RT with or without QT were treated with 64 Gy/25 fractions and 50 Gy/25 fractions in high- and low-risk CTV. Operated patients underwent 56 Gy/25 fractions and 50 Gy/25 fractions in high-risk and low-risk CTV. Overall survival analysis and local control were performed using the Kaplan-Meier method. A matched sample of patients treated by conventional RT (RT-CONV) for sex, age, site of injury, clinical staging and type of treatment was used for survival comparison.

Resultados

During the period 101 patients treated with the RT-HIPO scheme were included in the study, which were compared to the control group of 101 patients with conventional radiotherapy (RTCONV) for a total of 202 patients.The median follow-up was 28 months (9-38 months), the overall survival (OS) and the control location (CL) at 2 years was 51% and 67%. The 2-year OS per treatment group was 75%.64%, 56% and 65% (p=0.07) for surgery +RTHIPO, surgery +RTHIPO/QT, RT-HIPO and RT-HIPO/QT, respectively. The 2-year cancer-specific survival was 88%.85%.76%, and 81% for +RTHIPO surgery, +RTHIPO/QT surgery, RT-HIPO, and RT-HIPO/QT (p=0.221), respectively. Compared RT-HIPO with RT -CONV, the samples were well matched for age, type of surgery, chemotherapy and site of treatment. The 2-year overall survival did not differ statistically between groups (RT-HIPO 66% vs RT-CONV-58%, p=0.08).

Conclusão

Moderate fractionation RT-HYPO using IMRT combined with chemotherapy is feasible, with acceptable toxicity and favorable results in CCP-LA. Our data support the development of new studies using hypofractionated fractionations in CPP and the continued use of it in our clinical practice.

Palavras-chave

Radiotherapy, Head and neck cancer, Hypofractionated radiotherapy, IMRT