title: 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.
abstract: 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.
authors.affiliation: Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA. andre.konski@fccc.edu
authors.forename: Andre A
authors.initials: AA
authors.lastname: Konski
authors.forename: Kathryn
authors.initials: K
authors.lastname: Winter
authors.forename: Bernard F
authors.initials: BF
authors.lastname: Cole
authors.forename: Kie-Kian
authors.initials: KK
authors.lastname: Ang
authors.forename: Karen K
authors.initials: KK
authors.lastname: Fu
mesh_terms: 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