title: Mature results from a Swedish comparison study of conventional versus accelerated radiotherapy in head and neck squamous cell carcinoma - The ARTSCAN trial.
abstract: OBJECTIVE
  This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers.
  
  
  METHODS
  Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma.
  
  
  RESULTS
  There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours.
  
  
  CONCLUSIONS
  This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
authors.affiliation: Department of Radiation Sciences - Oncology, Umeå University, Sweden. Electronic address: bjorn.zackrisson@umu.se.
authors.forename: Björn
authors.initials: B
authors.lastname: Zackrisson
authors.affiliation: Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kjellén
authors.affiliation: Department of Radiation Sciences - Oncology, Umeå University, Sweden.
authors.forename: Karin
authors.initials: K
authors.lastname: Söderström
authors.affiliation: Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
authors.forename: Eva
authors.initials: E
authors.lastname: Brun
authors.affiliation: Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Jan
authors.initials: J
authors.lastname: Nyman
authors.affiliation: Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Signe
authors.initials: S
authors.lastname: Friesland
authors.affiliation: Department of Oncology, Örebro University Hospital, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Reizenstein
authors.affiliation: Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Helena
authors.initials: H
authors.lastname: Sjödin
authors.affiliation: Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Ekberg
authors.affiliation: Department of Oncology, Central Hospital, Karlstad, Sweden.
authors.forename: Britta
authors.initials: B
authors.lastname: Lödén
authors.affiliation: Department of Radiation Sciences - Oncology, Umeå University, Sweden.
authors.forename: Lars
authors.initials: L
authors.lastname: Franzén
authors.affiliation: Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Ask
authors.affiliation: Department of Oncology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: Gun
authors.initials: G
authors.lastname: Wickart-Johansson
authors.affiliation: Department of Oncology, Ryhov Hospital, Jönköping, Sweden.
authors.forename: Freddi
authors.initials: F
authors.lastname: Lewin
authors.affiliation: Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Thomas
authors.initials: T
authors.lastname: Björk-Eriksson
authors.affiliation: Department of Oncology, Örebro University Hospital, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Lundin
authors.affiliation: Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Tina
authors.initials: T
authors.lastname: Dalianis
authors.affiliation: Department of ORL/Head & Neck Surgery, Skåne University Hospital, Lund, Sweden.
authors.forename: Johan
authors.initials: J
authors.lastname: Wennerberg
authors.affiliation: Department of Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
authors.forename: Karl-Axel
authors.initials: KA
authors.lastname: Johansson
authors.affiliation: Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
authors.forename: Per
authors.initials: P
authors.lastname: Nilsson
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000473:pathology / Q000532:radiotherapy* / Q000821:virology; D052162:Human papillomavirus 16 / Q000302:isolation & purification; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009959:Oropharyngeal Neoplasms / Q000473:pathology / Q000532:radiotherapy / Q000821:virology; D030361:Papillomavirus Infections / Q000150:complications; D011379:Prognosis; D012189:Retrospective Studies; D000077195:Squamous Cell Carcinoma of Head and Neck
keywords: Accelerated fractionation; HNSCC; HPV; Radiotherapy; p16