Headline: Hypofractionation appears comparable to conventional fractionation for locally advanced head and neck cancer.
The Study: While some patients with LA-HNSCC are treated with accelerated fractionation, moderate hypofractionation isn’t commonly used outside of laryngeal cancer. HYPNO was a randomized non-inferiority trial that compared hypofractionated and normofractionated definitive radiation for LA-HNSCC. The trial was specifically designed for and run in 10 low and middle income countries that may have more resource and logistical challenges with prolonged radiation regimens. A total of 792 patients planned to receive either definitive radiation alone or chemoradiation were randomized to either 55 Gy in 20 fractions given over 4 weeks or 66 Gy in 33 fractions, 6 fractions per week, given over 5.5 weeks. The decision regarding RT v CRT (75.8%) was determined before randomization, and the latter consisted of weekly cisplatin. The most common sites were oropharynx (50.5%), larynx (24.5%), and hypopharynx (13.5%). Most (72.7%) had T3-4 tumors, and 49.1% had N2-3 disease. At the 3 year mark, locoregional control was deemed non-inferior with hypofractionation (50.7% v 51.2%). PFS (44% v 45.3%) and OS (54.1% v 55.5%) were likewise similar with hypofractionation. Finally, hypofractionation did not significantly increase the rate of grade 3+ mucositis (18.8% v 20.2%).
TBL: In the HYPNO trial, 55 Gy in 20 fractions resulted in non-inferior locoregional control and grade 3 mucositis at 3 years compared to normal fractionation. | Bentzen, ASTRO 2023
The Study: While some patients with LA-HNSCC are treated with accelerated fractionation, moderate hypofractionation isn’t commonly used outside of laryngeal cancer. HYPNO was a randomized non-inferiority trial that compared hypofractionated and normofractionated definitive radiation for LA-HNSCC. The trial was specifically designed for and run in 10 low and middle income countries that may have more resource and logistical challenges with prolonged radiation regimens. A total of 792 patients planned to receive either definitive radiation alone or chemoradiation were randomized to either 55 Gy in 20 fractions given over 4 weeks or 66 Gy in 33 fractions, 6 fractions per week, given over 5.5 weeks. The decision regarding RT v CRT (75.8%) was determined before randomization, and the latter consisted of weekly cisplatin. The most common sites were oropharynx (50.5%), larynx (24.5%), and hypopharynx (13.5%). Most (72.7%) had T3-4 tumors, and 49.1% had N2-3 disease. At the 3 year mark, locoregional control was deemed non-inferior with hypofractionation (50.7% v 51.2%). PFS (44% v 45.3%) and OS (54.1% v 55.5%) were likewise similar with hypofractionation. Finally, hypofractionation did not significantly increase the rate of grade 3+ mucositis (18.8% v 20.2%).
TBL: In the HYPNO trial, 55 Gy in 20 fractions resulted in non-inferior locoregional control and grade 3 mucositis at 3 years compared to normal fractionation. | Bentzen, ASTRO 2023