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

Background. 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. Methods. 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] x [time spent in toxicity]) + ([weight for relapse] x (time spent in relapse]). Results. 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. Conclusion. Q-TWiST analysis identified patient groups that would benefit from more aggressive therapy. Further investigation with patient-generated utilities is needed. (C) 2008 Wiley Periodicals, Inc. Head Neck 31: 207-212. 2009