• Tejpal Gupta, Sadhana Kannan, Sarbani Ghosh-Laskar, and Jai Prakash Agarwal.
• Department of Radiation Oncology, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Hospital Centre, Kharghar, Navi Mumbai, India; Epidemiology and Clinical Trials Unit, Advanced Centre for Treatment Research and Education in Cancer, Tata Memorial Hospital Centre, Kharghar, Navi Mumbai, India.
• Head Neck. 2015 May 1; 37 (5): 670-6.

BackgroundTreatment intensification by using chemoradiotherapy (CRT) or altered fractionation radiotherapy (RT) improves outcomes in locoregionally advanced head and neck squamous cell carcinoma (HNSCC).MethodsTwo comprehensive meta-analyses with similar control arms (conventionally fractionated RT) were compared indirectly.ResultsThe hazard ratio (HR) of death with 95% confidence interval (CI) for the overall comparison of altered fractionation RT with concomitant CRT was 1.13 (95% CI, 0.97-1.29; p = .07) suggesting no significant difference between both approaches. Compared to concomitant CRT, the HR for death was 1.01 (95% CI, 0.89-1.15; p = .82); 1.22 (95% CI, 0.94-1.59; p = .13); and 1.22 (95% CI, 1.07-1.39; p = .002) for hyperfractionated RT; accelerated RT without total dose reduction; and accelerated RT with total dose reduction, respectively.ConclusionConcomitant CRT and hyperfractionated RT are comparable to one another on indirect comparison in the radiotherapeutic management of locoregionally advanced HNSCC. Any form of acceleration (with or without total dose reduction) may not compensate fully for lack of chemotherapy.© 2014 Wiley Periodicals, Inc.

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