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Wennerberg J, Gebre-Medhin M, Nilsson P, et al. Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity - The ARTSCAN 2 study. Radiother Oncol. 2021;166:26-32doi: 10.1016/j.radonc.2021.11.008.
Wennerberg, J., Gebre-Medhin, M., Nilsson, P., Brun, E., Kjellén, E., Carlwig, K., Reizenstein, J., Kristiansson, S., Söderkvist, K., Wahlgren, M., Zackrisson, B. (2021). Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity - The ARTSCAN 2 study. Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology, 16626-32. https://doi.org/10.1016/j.radonc.2021.11.008
Wennerberg, Johan, et al. "Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity - The ARTSCAN 2 study." Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology vol. 166 (2021): 26-32. doi: https://doi.org/10.1016/j.radonc.2021.11.008
Wennerberg J, Gebre-Medhin M, Nilsson P, Brun E, Kjellén E, Carlwig K, Reizenstein J, Kristiansson S, Söderkvist K, Wahlgren M, Zackrisson B. Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity - The ARTSCAN 2 study. Radiother Oncol. 2021 Nov 16;166:26-32. doi: 10.1016/j.radonc.2021.11.008. Epub 2021 Nov 16. PMID: 34793864.
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Radiother Oncol. 2021 Nov 16;166:26-32. doi: 10.1016/j.radonc.2021.11.008. Epub 2021 Nov 16.

Results from a prospective, randomised study on (accelerated) preoperative versus (conventional) postoperative radiotherapy in treatment of patients with resectable squamous cell carcinoma of the oral cavity - The ARTSCAN 2 study.

Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology

Johan Wennerberg, Maria Gebre-Medhin, Per Nilsson, Eva Brun, Elisabeth Kjellén, Kristin Carlwig, Johan Reizenstein, Stefan Kristiansson, Karin Söderkvist, Magnus Wahlgren, Björn Zackrisson,

Affiliations

  1. Department of ORL, Head & Neck Surgery, Skåne University Hospital, Lund University, Sweden.
  2. Department of Hematology, Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden.
  3. Department of Oncology, Örebro University Hospital, Sweden.
  4. Department of Otolaryngology, Örebro University Hospital, Sweden.
  5. Department of Radiation Sciences, Oncology, Umeå University, Sweden.
  6. Department of Clinical Sciences, Otolaryngology Umeå University, Sweden.
  7. Department of Radiation Sciences, Oncology, Umeå University, Sweden. Electronic address: [email protected].

PMID: 34793864 DOI: 10.1016/j.radonc.2021.11.008

Abstract

BACKGROUND AND PURPOSE: An earlier prospective randomised multicentre study (ARTSCAN) in head and neck cancer patients that compared conventionally fractionated radiotherapy (CF) with accelerated radiotherapy (AF) was inconclusive. In the subgroup of oral cavity squamous cell cancer (OCSCC) a large absolute, but not statistically significant, difference in local control was seen in favour of AF. This difference was more pronounced in resectable tumours. The finding raised the hypothesis that AF could be beneficial for OCSCC patients. In addition, the longstanding controversy on pre- or postoperative radiotherapy was addressed.

MATERIALS AND METHODS: Patients with OCSCC, judged to withstand and likely benefit from combined therapy, were recruited. Subjects were randomised to either preoperative AF with 43 fractions given as a concomitant boost with two fractions/day to the tumour bearing volume to a total dose of 68 Gy in 4.5 weeks followed by surgery, or primary surgery with postoperative CF, total dose 60 or 66 Gy in 6-7 weeks. For patients whose tumours had high-risk features, 66 Gy and concomitant cisplatin was prescribed.

RESULTS: 250 patients were randomised. Median follow-up was 5 years for locoregional control (LRC) and 9 years for overall survival (OS). There were no statistically significant differences between the two treatment arms regarding LRC and OS. LRC at five years was 73% (95% CI, 65-82) in preoperative AF and 78% (95% CI, 70-85) in postoperative CF. Toxicity was more pronounced in preoperative AF.

CONCLUSION: This study does not support that AF prior to surgery improves outcome in oral cavity cancer compared with postoperative CF.

Copyright © 2021 The Authors. Published by Elsevier B.V. All rights reserved.

Keywords: Head and neck cancer; Oral cancer; Preoperative and postoperative radiotherapy; Randomised trial; Squamous cell carcinoma

Conflict of interest statement

Conflict of interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

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