Similar long-term swallowing outcomes for accelerated, mildly-hypofractionated radiotherapy compared to conventional fractionation in oropharyngeal cancer: A multi-centre study

• Published in: Radiotherapy and oncology 2022-07, Vol.172, p.111-117
• Main Authors: Price, James M., West, Catharine M., Dixon, Lynne M., Iyizoba-Ebozue, Zsuzsanna, Garcez, Kate, Lee, Lip Wai, McPartlin, Andrew, Slevin, Fin, Sykes, Andrew, Prestwich, Robin J.D., Thomson, David J.
• Format: Article
• Language: English
• Subjects: Fractionation; Hypofractionation; Late effects; Oropharyngeal cancer; Patient reported outcomes; Radiotherapy
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2022.05.013

•Similar long-term swallow outcomes for oropharyngeal cancer treated with accelerated, mildly-hypofractionated radiotherapy over six weeks or standard fractionation radiotherapy over seven weeks.•Rates of locoregional control and overall survival also similar.•Swallow outcomes relatively poor compared to chemo-radiotherapy cohorts, suggesting negative contribution of increasing patient age and poor physical condition. There is renewed interest in hypofractionated radiotherapy, but limited data and a lack of consensus to support use for head and neck cancer. In this multicentre analysis we compared outcomes for patients with oropharyngeal squamous cell carcinoma (OPSCC) treated with conventional and accelerated, mildly hypofractionated radiotherapy without chemotherapy. A multi-centre, observational study of consecutive OPSCCs treated between 2015 and 2018. Patients underwent curative-intent radiotherapy (oropharyngeal and bilateral neck) using conventionally fractionated (70 Gy in 35 fractions over 7 weeks, n = 97) or accelerated, mildly hypofractionated (65–66 Gy in 30 fractions over 6 weeks, n = 136) radiotherapy without chemotherapy. Locoregional control (LRC) and overall survival (OS) were compared. Patients alive and cancer-free at a minimum of 2 years post-radiotherapy (n = 151, 65%) were sent an MD Anderson Dysphagia Inventory (MDADI) questionnaire to assess swallow function. LRC and OS were similar across schedules (p = 0.78 and 0.95 respectively, log-rank test). Enteral feeding rates during radiotherapy appeared higher in the 7-week group though this did not reach statistical significance (59% vs 48%, p = 0.08). Feeding rates were similar at 1 year post radiotherapy for both groups (10% vs 6%, p = 0.27). 107 patients returned MDADI questionnaires (71%); there were no differences between the 6- and 7-week groups for median global (60.0 vs 60.0, p = 0.99) and composite (65.8 vs 64.2, p = 0.44) MDADI scores. Patients with OPSCC treated with radiotherapy alone have similar swallowing outcomes, LRC and OS following accelerated, mild hypofractionation and standard fractionation schedules, supporting its use as a standard-of-care option for patients unsuitable for concurrent chemotherapy.