Quality-adjusted survival analysis of Radiation Therapy Oncology Group (RTOG) 90-03: Phase III randomized study comparing altered fractionation to standard fractionation radiotherapy for locally advanced head and neck squamous cell carcinoma




To evaluate quality-adjusted survival (QAS) of patients with locally advanced squamous cell carcinoma of the head and neck treated with 4 different radiation fractionation schedules.


QAS was calculated using the quality-adjusted time without toxicity or relapse (Q-TWiST) methodology. Utilities (patient preferences for certain health states) were obtained by threshold analysis. Q-TWiST therefore equaled TWiST + ([weight for toxicity] × [time spent in toxicity]) + ([weight for relapse] × [time spent in relapse]).


A statistically significant increase in QAS existed for patients treated with hyperfractionated radiotherapy compared with standard fractionated radiotherapy (SFX) with a toxicity utility ≥0.57 and relapse utility ≤0.72. No statistically significant difference was observed for patients treated with the other 2 fractionation schedules compared with SFX.


Q-TWiST analysis identified patient groups that would benefit from more aggressive therapy. Further investigation with patient-generated utilities is needed. © 2008 Wiley Periodicals, Inc. Head Neck, 2009