title: Two-year results from a Swedish study on conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma--the ARTSCAN study.
abstract: OBJECTIVE
  Studies on accelerated fractionation (AF) in head and neck cancer have shown increased local control and survival compared with conventional fractionation (CF), while others have been non-conclusive. In 1998 a national Swedish group decided to perform a randomised controlled clinical study of AF.
  
  
  METHODS
  Patients with verified squamous cell carcinoma of the oral cavity, oropharynx, larynx (except glottic T1-T2, N0) and hypopharynx were included. Patients with prior chemotherapy or surgery were excluded. Patients were randomised to either CF (2Gy/day, 5days/week for 7 weeks, total dose 68Gy) or to AF (1.1Gy+2.0Gy/day, 5days/week for 4.5weeks, total dose 68Gy). An extensive quality assurance protocol was followed throughout the study. The primary end point was loco-regional tumour control (LRC) at two years after treatment.
  
  
  RESULTS
  The study was closed in 2006 when 750 patients had been randomised. Eighty-three percent of the patients had stages III-IV disease. Forty eight percent had oropharyngeal, 21% laryngeal, 17% hypopharyngeal and 14% oral cancers. There were no significant differences regarding overall survival (OS) or LRC between the two regimens. The OS at two years was 68% for AF and 67% for CF. The corresponding figures for LRC were 71% and 67%, respectively. There was a trend towards improved LRC for oral cancers treated (p=0.07) and for large tumours (T3-T4) (p=0.07) treated with AF. The AF group had significantly worse acute reactions, while there was no significant increase in late effects.
  
  
  CONCLUSIONS
  Overall the AF regimen did not prove to be more efficacious than CF. However, the trend towards improved results in AF for oral cancers needs to be further investigated.
authors.affiliation: Umeå University Hospital, Sweden. bjorn.zackrisson@onkologi.umu.se
authors.forename: Björn
authors.initials: B
authors.lastname: Zackrisson
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kjellén
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.forename: Hans
authors.initials: H
authors.lastname: Modig
authors.forename: Eva
authors.initials: E
authors.lastname: Brun
authors.forename: Jan
authors.initials: J
authors.lastname: Nyman
authors.forename: Signe
authors.initials: S
authors.lastname: Friesland
authors.forename: Johan
authors.initials: J
authors.lastname: Reizenstein
authors.forename: Helena
authors.initials: H
authors.lastname: Sjödin
authors.forename: Lars
authors.initials: L
authors.lastname: Ekberg
authors.forename: Britta
authors.initials: B
authors.lastname: Lödén
authors.forename: Claes
authors.initials: C
authors.lastname: Mercke
authors.forename: Jan-Olof
authors.initials: JO
authors.lastname: Fernberg
authors.forename: Lars
authors.initials: L
authors.lastname: Franzén
authors.forename: Anders
authors.initials: A
authors.lastname: Ask
authors.forename: Essie
authors.initials: E
authors.lastname: Persson
authors.forename: Gun
authors.initials: G
authors.lastname: Wickart-Johansson
authors.forename: Freddi
authors.initials: F
authors.lastname: Lewin
authors.forename: Lena
authors.initials: L
authors.lastname: Wittgren
authors.forename: Ove
authors.initials: O
authors.lastname: Björ
authors.forename: Thomas
authors.initials: T
authors.lastname: Björk-Eriksson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000532:radiotherapy*; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D000077195:Squamous Cell Carcinoma of Head and Neck; D013548:Sweden