Asia–Pacific Journal of Clinical OncologyCochrane Highlightsajco_1440 318..320

These highlights are produced with permission from the Cochrane Collaboration. To read the fullfindings and any updates, please visit: http://www.thecochranelibrary.com

Erythropoietin as an additionaltreatment with (chemo)radiation therapy for headand neck cancer

Severe anaemia in cancer patientsis linked with decreased tumouroxygen supply (hypoxia), which isassociated with more rapid tumourprogression, poor response totherapy and consequently has anegative impact on prognosis.Erythropoietin (EPO), a hormonewhich controls red blood cellproduction, is widely used tocorrect anaemia. It was thereforethought logical that usingerythropoietin to correct anaemia,before or during chemotherapy,radiotherapy (or both), wouldimprove tumour oxygenation andas a result improve prognosis.

The authors of this review foundstrong suggestions based on fiverandomised controlled trials (1397patients) that for head and neckcancer, radiotherapy pluserythropoietin compared toradiotherapy alone negativelyaffects patient outcome in terms ofoverall survival and local-regionalprogression free survival.

Lambin P, Ramaekers BLT, vanMastrigt GAPG, Van den Ende P,de Jong J, De Ruysscher DKM,Pijls-Johannesma M. Erythropoietinas an adjuvant treatment with(chemo) radiation therapy for head

and neck cancer. CochraneDatabase of Systematic Reviews2009, Issue 3. Art. No.:CD006158. DOI: 10.1002/14651858.CD006158.pub2.

Hyperfractionated oraccelerated radiotherapyfor head and neck cancer

Radiotherapy is often used to treathead and neck cancers. The dosageof radiation is measured in Gray(Gy). When radiotherapy is givenalone, the most commonly usedschedule is 2 Gy in a single fractionper day, five days a week, for sevenweeks. However, alternativeradiotherapy regimens to reduce thetotal treatment time for head andneck cancers have been assessed.‘Acceleration’ of the treatment(delivering the same total dose ina shorter time) should reduce theregrowth of the tumour betweensessions, resulting in improvedlocal control of the disease. In‘hyperfractionated’ regimens, twoto three fractions are delivered eachday, with a reduced dose perfraction equal to 1.1 to 1.2 Gy. Thereduction of the dose per fractionmay reduce the risk of late toxicity,despite an increased total dose.Acceleration and hyperfractionationcan be combined, in particular forregimens in which overall treatmenttime is reduced.

This Cochrane Review is anindividual patient data basedmeta-analysis and the aim wasto assess whether this type ofradiotherapy could improvesurvival. We identified randomisedtrials comparing conventionalradiotherapy with hyperfractionatedor accelerated radiotherapy, orboth, in patients with non-metastatic head and neck cancersand grouped trials into threepre-specified categories:hyperfractionated, acceleratedwithout total dose reduction andaccelerated with total dosereduction. The results of thismeta-analysis suggest that alteredfractionation radiotherapy improvessurvival in patients with headand neck cancer. Comparison ofthe different types of alteredfractionation radiotherapy suggeststhat hyperfractionation providesthe greatest benefit.

Individual patient datameta-analysis is a long process andthis review included all eligibletrials which had completedrecruiting patients by 1998.A major update of the analysis,including data from more recenttrials, is currently underway.

Baujat B, Bourhis J, Blanchard P,Overgaard J, Ang KK, Saunders M,Le Maître A, Bernier J, Horiot JC,Maillard E, Pajak TF, Poulsen MG,

Asia–Pacific Journal of Clinical Oncology 2011; 7: 318–320 doi:10.1111/j.1743-7563.2011.01440.x

© 2011 Blackwell Publishing Asia Pty Ltd

Bourredjem A, O’Sullivan B,Dobrowsky W, Andrzej H,Skladowski K, Hay JH, Pinto LHJ,Fu KK, Fallai C, Sylvester R,Pignon JP, MARCH CollaborativeGroup. Hyperfractionated oraccelerated radiotherapy for headand neck cancer. CochraneDatabase of Systematic Reviews2010, Issue 12. Art. No.:CD002026. DOI: 10.1002/14651858.CD002026.pub2.

Interventions for the treatmentof oral and oropharyngealcancers: surgical treatment

Oral cancer and oropharyngealcancer are significant worldwidediseases with over 400,000 peopledeveloping them every year andwith an increasing incidence.Two common symptoms of oralcancer are an ulcer that will notheal, or persistent pain anddiscomfort in the mouth. Survivalfrom the cancers is poor with onlyjust over half of the patientssurviving. In many countriessurgery remains the first line oftreatment for oral cancer, althoughradiotherapy, chemotherapy andimmunotherapy/biotherapy arealso used (either alone or incombination). The aim of thisreview is to establish whichtreatments involving a surgicalprocedure alone or in combinationwith any other treatment typeare the most effective for oraland oropharyngeal cancers andprovide the best outcomes interms of survival and qualityof life of the patient. The reviewfound weak evidence that surgeryin combination with othertreatment options (chemotherapyand radiotherapy) can benefitpatients in terms of overallsurvival and disease-free survival.However, few trials report on

adverse events associated withthe treatment or subsequentquality of life.

Oliver R, Clarkson JE, Conway D,Glenny AM, Macluskey M, PavittS, Sloan P, The CSROC ExpertPanel, Worthington HV.Interventions for the treatment oforal and oropharyngeal cancers:surgical treatment. CochraneDatabase of Systematic Reviews2007, Issue 4. Art. No.:CD006205. DOI: 10.1002/14651858.CD006205.pub2.

Interventions for thetreatment of oral cavity andoropharyngeal cancer:chemotherapy

Oral cavity (mouth) cancer isusually detected earlier and treatedwith surgery and radiotherapy.Oropharyngeal (throat) cancer maybe advanced when it is found and istreated with radiotherapy. Bothtreatments may be associated withdisfigurement and decreased abilityto eat, drink and talk. Treatmentwith chemotherapy (drugs whichkill cancer cells), in addition toradiotherapy (and surgery wherepossible) offers prolonged survival.Chemotherapy given at the sametime as radiotherapy, is moreeffective than chemotherapy givenbefore radiotherapy, and mayreduce the need for surgery. Theimprovement in overall survivalwith the use of chemotherapy isestimated to be between 8% and22%. The additional side effectsof combined chemoradiotherapy(nausea, vomiting, diarrhoea,hair loss, and infections) werenot measured.

Furness S, Glenny AM,Worthington HV, Pavitt S, Oliver

R, Clarkson JE, Macluskey M,Chan KKW, Conway DI.Interventions for the treatment oforal cavity and oropharyngealcancer: chemotherapy. CochraneDatabase of Systematic Reviews2011, Issue 4. Art. No.:CD006386. DOI: 10.1002/14651858.CD006386.pub3.

Radiotherapy versus opensurgery versus endolaryngealsurgery (with or without laser)for early laryngeal squamouscell cancer

Cancer of the larynx (voice box)usually begins in the glottis(vocal cords) as a squamous cellcancer (cancer in the membranes).Most people survive these cancerswhen they get treatment early(before the cancer spreads furtherinto the larynx and surroundingarea). Options include radiotherapy,open surgery (through the neck)or, more commonly now,endolaryngeal excision (surgeryreaching the throat via the mouth,sometimes with a laser). The reviewof trials found there is not enoughevidence to show which form oftreatment might be better forpeople with early stage laryngealsquamous cell carcinoma. Suchevidence may come from newtrials comparing radiotherapyand endolaryngeal excision, whichhave started.

Dey P, Arnold D, Wight R, KellyCG, McKenzie K. Radiotherapyversus open surgery versusendolaryngeal surgery (with orwithout laser) for early laryngealsquamous cell cancer.CochraneDatabase of Systematic Reviews2002, Issue 2. Art. No.:CD002027. DOI: 10.1002/14651858.CD002027.

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© 2011 Blackwell Publishing Asia Pty LtdAsia–Pac J Clin Oncol 2011; 7: 318–320

Chemotherapy as an adjunctto radiotherapy in locallyadvanced nasopharyngealcarcinoma

Eight trials (1753 patients) met thecriteria for inclusion in this review.The addition of chemotherapy tostandard radiotherapy provides asmall but significant benefit inpatients with nasopharyngeal

cancer, especially whenchemotherapy is administered at thesame time as radiotherapy. The roleof chemotherapy given before orafter the radiotherapy is morequestionable.

Baujat B, Audry H, Bourhis J,Chan ATC, Onat H, Chua DTT,Kwong DLW, Al-Sarraf M, ChiKH, Hareyama M, Leung SF,

Thephamongkhol K, Pignon JP,MAC-NPC Collaborative Group.Chemotherapy as an adjunct toradiotherapy in locally advancednasopharyngeal carcinoma.Cochrane Database of SystematicReviews 2006, Issue 4. Art.No.: CD004329. DOI: 10.1002/14651858.CD004329.pub2.

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© 2011 Blackwell Publishing Asia Pty Ltd Asia–Pac J Clin Oncol 2011; 7: 318–320