Before and after.

Top Line: Does neoadjuvant radiation using accelerated fractionation improve outcomes for resectable oral cavity squamous cell carcinoma.

The Study: This question goes way back to RTOG 7303, which found improved locoregional control with 60 Gy post-op compared to 50 Gy pre-op RT. ARTSCAN 2 was a randomized phase 3 trial from Sweden that sought to determine if neoadjuvant RT using accelerated fractionation (AF) could improve locoregional control compared to conventionally fractionated (CF) adjuvant RT. Patients (n=240) had resectable oral cavity SCC anticipated to require adjuvant RT. In the neoadjuvant AF arm, they received a total of 68 Gy in 43 fractions using a concomitant boost technique, which delivers an extra fraction to the boost volume each day. Surgery was done 4-6 weeks after RT. Post-op patients received 60 Gy or 66 Gy with chemo as indicated for high risk features (21% of post-op patients). There was no difference in the rate of locoregional control at 2 years (81% AF v 76% CF) and at 5 years (73% both AF and CF). There was no statistical difference in overall survival at 5 years, which was 57% with AF and 69% with CF. Neoadjuvant AF caused significantly more acute and late toxicity including double the rate of feeding tubes (59% v 28%).

TBL: Neoadjuvant radiation using concomitant boost technique increases toxicity without improving locoregional control for patients with resectable oral cavity SCC. | Wennerberg, Radiother Oncol 2021