Quality-adjusted survival analysis of Radiation Therapy Oncology Group (RTOG) 90-03: phase III randomized study comparing altered fractionation to standard fractionation radiotherapy for locally advanced head and neck squamous cell carcinoma.
BACKGROUND
To evaluate quality-adjusted survival (QAS) of patients with locally advanced squamous cell carcinoma of the head and neck treated with 4 different radiation fractionation schedules.


METHODS
QAS was calculated using the quality-adjusted time without toxicity or relapse (Q-TWiST) methodology. Utilities (patient preferences for certain health states) were obtained by threshold analysis. Q-TWiST therefore equaled TWiST + ([weight for toxicity] x [time spent in toxicity]) + ([weight for relapse] x [time spent in relapse]).


RESULTS
A statistically significant increase in QAS existed for patients treated with hyperfractionated radiotherapy compared with standard fractionated radiotherapy (SFX) with a toxicity utility > or = 0.57 and relapse utility < or = 0.72. No statistically significant difference was observed for patients treated with the other 2 fractionation schedules compared with SFX.


CONCLUSIONS
Q-TWiST analysis identified patient groups that would benefit from more aggressive therapy. Further investigation with patient-generated utilities is needed.
Konski
Andre A
AA
Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. andre.konski@fccc.edu
Winter
Kathryn
K
Cole
Bernard F
BF
Ang
Kie-Kian
KK
Fu
Karen K
KK
D002294:Carcinoma, Squamous Cell / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D011788:Quality of Life; D016019:Survival Analysis; D016896:Treatment Outcome