Björn Zackrisson1, Elisabeth Kjellén2, Karin Söderström3, Eva Brun2, Jan Nyman4, Signe Friesland5, Johan Reizenstein6, Helena Sjödin5, Lars Ekberg2, Britta Lödén7, Lars Franzén3, Anders Ask2, Gun Wickart-Johansson5, Freddi Lewin8, Thomas Björk-Eriksson4, Erik Lundin6, Tina Dalianis9, Johan Wennerberg10, Karl-Axel Johansson11, Per Nilsson2. 1. Department of Radiation Sciences - Oncology, Umeå University, Sweden. Electronic address: bjorn.zackrisson@umu.se. 2. Department of Oncology and Radiation Physics, Skåne University Hospital, Lund University, Sweden. 3. Department of Radiation Sciences - Oncology, Umeå University, Sweden. 4. Department of Oncology, Sahlgrenska University Hospital, Gothenburg, Sweden. 5. Department of Oncology, Karolinska University Hospital, Stockholm, Sweden. 6. Department of Oncology, Örebro University Hospital, Sweden. 7. Department of Oncology, Central Hospital, Karlstad, Sweden. 8. Department of Oncology, Ryhov Hospital, Jönköping, Sweden. 9. Department of Oncology-Pathology, Karolinska Institutet, Stockholm, Sweden. 10. Department of ORL/Head & Neck Surgery, Skåne University Hospital, Lund, Sweden. 11. Department of Radiation Physics, Sahlgrenska University Hospital, Gothenburg, Sweden.
Abstract
BACKGROUND AND PURPOSE: This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. MATERIAL AND METHODS:Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. RESULTS: There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours. CONCLUSION: This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
RCT Entities:
BACKGROUND AND PURPOSE: This report contains the mature five-year data from the Swedish ARTSCAN trial including information on the influence of p16 positivity (p16+) for oropharyngeal cancers. MATERIAL AND METHODS:Patients with previously untreated squamous cell carcinoma without distant metastases of the oral cavity, oropharynx, larynx (except T1-2, N0 glottic cancers) and hypopharynx were included. Patients were randomised between accelerated fractionation (AF) (1.1Gy+2Gy per day, 5days/week for 4.5weeks, total dose 68Gy) and conventional fractionation (CF) (2Gy per day, 5days/week for 7weeks, total dose 68Gy). Human papillomavirus (HPV)-associated p16-expression was assessed retrospectively in tumour tissues from patients with oropharyngeal carcinoma. RESULTS: There was no significant difference in loco-regional control (LRC) between AF and CF (log-rank test p=0.75). LRC at 5years was 65.5% for AF and 64.9% for CF. Overall survival (OS) was similar in both arms (p=0.99). The estimated cancer specific survival (CSS) at 5years was 62.2% (AF) and 63.3% (CF) (p=0.99). 206 specimens were analysed for p16 with 153 specimens (74%) identified as p16+. P16 status did not discriminate for response to AF vs. CF with regard to LRC, OS or CSS. Patients with p16+ tumours had a statistically significant better overall prognosis compared with p16- tumours. CONCLUSION: This update confirms the results of the 2-year report. We failed to identify a positive effect resulting from AF with regards to LRC, OS and CSS. The addition of information on the HPV-associated p16 overexpression did not explain this lack of effect.
Authors: Gabriel Adrian; Henrik Carlsson; Elisabeth Kjellén; Johanna Sjövall; Björn Zackrisson; Per Nilsson; Maria Gebre-Medhin Journal: Radiat Oncol Date: 2022-06-14 Impact factor: 4.309