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Quality of life and cost-effectiveness of preoperative accelerated versus postoperative conventional radiotherapy for oral cavity cancer : Results from the randomised ARTSCAN 2 trial

Carlwig, Kristin LU ; Jarl, Johan LU orcid ; Nilsson, Per LU orcid ; Rasmusson, Elisabeth LU ; Sjövall, Johanna LU ; Silfverschiöld, Maria LU orcid ; Zackrisson, Björn ; Gebre-Medhin, Maria LU and Greiff, Lennart LU (2026) In Radiotherapy and Oncology 222.
Abstract

BACKGROUND AND PURPOSE: The ARTSCAN 2 randomised controlled trial compares accelerated fractionation (AF) radiotherapy (RT) in a preoperative setting with conventional fractionation (CF) RT postoperatively for oral cavity cancer (OCC). Current results indicate no advantage for preoperative AF RT, thereby reinforcing postoperative CF RT as the "gold standard" of care. This analysis of the trial focuses on health-related quality of life (HRQoL) and conducts a health-economic evaluation from a societal perspective.

MATERIALS AND METHODS: 240 patients formed the intention-to-treat population. Preoperative AF RT was given twice daily during 4.5 weeks to a total dose of 68 Gy followed by surgery 4-6 weeks later. Postoperative CF RT was... (More)

BACKGROUND AND PURPOSE: The ARTSCAN 2 randomised controlled trial compares accelerated fractionation (AF) radiotherapy (RT) in a preoperative setting with conventional fractionation (CF) RT postoperatively for oral cavity cancer (OCC). Current results indicate no advantage for preoperative AF RT, thereby reinforcing postoperative CF RT as the "gold standard" of care. This analysis of the trial focuses on health-related quality of life (HRQoL) and conducts a health-economic evaluation from a societal perspective.

MATERIALS AND METHODS: 240 patients formed the intention-to-treat population. Preoperative AF RT was given twice daily during 4.5 weeks to a total dose of 68 Gy followed by surgery 4-6 weeks later. Postoperative CF RT was given to a total dose of 60 or 66 Gy during 6-7 weeks. In the per protocol population, HRQoL was assessed with the EORTC QLQ-C30, QLQ-H&N35, and HADS questionnaires at five occasions during the five-year follow-up period. Direct and indirect costs were retrieved, and a cost-utility analysis (CUA) was conducted using quality-adjusted life years (QALYs) as outcome measure.

RESULTS: HRQoL was analysed in 218 patients (i.e., the per-protocol population), of whom 204 were included in the CUA. Up until two years after treatment, the preoperative AF RT-group featured significantly worse HRQoL in a few of the QLQ-H&N35 scales compared to the postoperative CF RT-group. In the CUA, preoperative AF RT was less effective and more expensive than postoperative CF RT.

CONCLUSION: Postoperative CF RT is associated with fewer symptoms in selected head-and-neck-specific domains and is more cost-effective than preoperative AF RT in the treatment of OCC.

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author
; ; ; ; ; ; ; and
organization
publishing date
type
Contribution to journal
publication status
published
subject
keywords
Adult, Aged, Female, Humans, Male, Middle Aged, Cost-Effectiveness Analysis, Dose Fractionation, Radiation, Mouth Neoplasms/radiotherapy, Preoperative Care, Quality of Life
in
Radiotherapy and Oncology
volume
222
article number
111688
publisher
Elsevier
external identifiers
  • scopus:105044819232
  • pmid:42431267
ISSN
1879-0887
DOI
10.1016/j.radonc.2026.111688
language
English
LU publication?
yes
additional info
Copyright © 2026 The Author(s). Published by Elsevier B.V. All rights reserved.
id
4dfc63d7-b151-4015-b519-88501a21c897
date added to LUP
2026-09-08 15:09:08
date last changed
2026-09-23 04:51:46
@article{4dfc63d7-b151-4015-b519-88501a21c897,
  abstract     = {{<p>BACKGROUND AND PURPOSE: The ARTSCAN 2 randomised controlled trial compares accelerated fractionation (AF) radiotherapy (RT) in a preoperative setting with conventional fractionation (CF) RT postoperatively for oral cavity cancer (OCC). Current results indicate no advantage for preoperative AF RT, thereby reinforcing postoperative CF RT as the "gold standard" of care. This analysis of the trial focuses on health-related quality of life (HRQoL) and conducts a health-economic evaluation from a societal perspective.</p><p>MATERIALS AND METHODS: 240 patients formed the intention-to-treat population. Preoperative AF RT was given twice daily during 4.5 weeks to a total dose of 68 Gy followed by surgery 4-6 weeks later. Postoperative CF RT was given to a total dose of 60 or 66 Gy during 6-7 weeks. In the per protocol population, HRQoL was assessed with the EORTC QLQ-C30, QLQ-H&amp;N35, and HADS questionnaires at five occasions during the five-year follow-up period. Direct and indirect costs were retrieved, and a cost-utility analysis (CUA) was conducted using quality-adjusted life years (QALYs) as outcome measure.</p><p>RESULTS: HRQoL was analysed in 218 patients (i.e., the per-protocol population), of whom 204 were included in the CUA. Up until two years after treatment, the preoperative AF RT-group featured significantly worse HRQoL in a few of the QLQ-H&amp;N35 scales compared to the postoperative CF RT-group. In the CUA, preoperative AF RT was less effective and more expensive than postoperative CF RT.</p><p>CONCLUSION: Postoperative CF RT is associated with fewer symptoms in selected head-and-neck-specific domains and is more cost-effective than preoperative AF RT in the treatment of OCC.</p>}},
  author       = {{Carlwig, Kristin and Jarl, Johan and Nilsson, Per and Rasmusson, Elisabeth and Sjövall, Johanna and Silfverschiöld, Maria and Zackrisson, Björn and Gebre-Medhin, Maria and Greiff, Lennart}},
  issn         = {{1879-0887}},
  keywords     = {{Adult; Aged; Female; Humans; Male; Middle Aged; Cost-Effectiveness Analysis; Dose Fractionation, Radiation; Mouth Neoplasms/radiotherapy; Preoperative Care; Quality of Life}},
  language     = {{eng}},
  month        = {{07}},
  publisher    = {{Elsevier}},
  series       = {{Radiotherapy and Oncology}},
  title        = {{Quality of life and cost-effectiveness of preoperative accelerated versus postoperative conventional radiotherapy for oral cavity cancer : Results from the randomised ARTSCAN 2 trial}},
  url          = {{http://dx.doi.org/10.1016/j.radonc.2026.111688}},
  doi          = {{10.1016/j.radonc.2026.111688}},
  volume       = {{222}},
  year         = {{2026}},
}