Why is accelerated hyperfractionated RT still being performed in NRG trials such as HN005?

To go back a little bit in history, RTOG 1016 was designed prior to the results of RTOG 0129 were available. In the Bonner trial, most patients were treated with accelerated fractionation + cetuximab, and seemed to have better outcomes than those with conventional fractionation. Therefore, in the absence of knowledge and for scientific comparison purposes (that is, only one variable tested), both arms of 1016 had radiation 70 Gy in 6 weeks.

RTOG 1016 had excellent outcomes, and since it is almos...

I agree with all the points made by my colleagues in their posts.

I sparingly use 72 Gy concomitant boost MDACC regimen. I prefer hyperfractionation 1.2 Gy BID (UF style) over 72 Gy concomitant boost because of the results of RTOG 9003. However, it is sometimes difficult for patients to come twice a day 5 days a week for radiation.

So, I use 72 Gy concomitant boost MDACC regimen for patients with non HPV OPSCC cancers who do not have indications for chemotherapy (or cannot receive chemotherapy...

Much has been written regarding the proof that AFX (and I lump all forms here unless specifically noted) is PROVEN to be no better than SFX in the context of q3wk cisplatin. But I ask for a deeper education from those with the knowledge on how we have excused some facts on the way to categorical statements about AFX for all H&N patients. First, let us understand that the AFX arm for RTOG 0129 was selected at a time when RTOG 9003 suggested equivalence to AHFX (120 BID to 8120), and since it was ...

Not only did 129 show no survival benefit to AFX, but there was a suggestion of greater toxicity. The 5-y rate of feeding tube was 13% vs 6% (p=.08). Subsequently, 522 used AFX in both arms, and a recent update presented at the combo HN meeting showed long term results of feeding tube rates > 10% in the AFX-cis arm.

One of the reasons for staying with AFX in 1016 was there was a subgroup analysis of the seminal Bonner et al trial that suggested that cetuximab worked better when AFX was used. Sin...

From a clinical trial standpoint, there is strong logic to using two cycles of bolus cisplatin in both arms. In this way, the only difference between the 70 Gy and 60 Gy arms is the total dose. The chemotherapy is literally identical, and thus the only difference—if any—would be related to the total dose (of course, one cannot give 3 cycles of bolus cisplatin over a 6 week de-escalated treatment). Whether or not bolus cisplatin should have been used instead of a weekly schedule will probably be ...