The Potential of Adaptive Radiotherapy For Patients With Head and Neck Cancer—Too Much or Not Enough?

Mené en France entre 2013 et 2018 sur 132 patients atteints d'un cancer de la tête et du cou de stade localement avancé (durée médiane de suivi : 26,4 mois), cet essai randomisé multicentrique de phase III évalue l'intérêt, du point de vue de la fréquence des xérostomies, d'une radiothérapie adaptative par rapport à une radiothérapie avec modulation d'intensité standard

Résumé en anglais

Patients treated with definitive radiotherapy for head and neck cancer are still affected by long-term toxic effects, even with modern methods of treatment, specifically intensity-modulated radiotherapy (IMRT). One of the most notable adverse effects is xerostomia, which can affect quality of life, dental health, and swallowing. In this issue of JAMA Oncology, Castelli and colleagues report results for a phase 3 randomized clinical trial (ARTIX) of weekly adaptive radiotherapy (ART) compared with standard IMRT for patients with oropharyngeal cancer, which is a highly curable cancer in which long-term toxic effects reduction is crucial. The hypothesis was that ART could improve salivary function, with a primary end point of salivary quantification 12 months after the end of treatment; secondary end points included salivary gland excretory function by scintigraphy, patient-reported outcomes, early and late toxic effects, and cancer-specific outcomes. From 2013 to 2018, 132 patients were randomized between ART and standard IMRT. With a median follow-up time of 26.4 months, there was no difference in the primary outcome of salivary flow. Furthermore, patient-reported xerostomia was not different between the arms. The only measured outcome that differed between the groups was mean parotid excretory function as estimated by scintigraphy, in which those patients treated with ART did show benefit.