KEY POINTS
- ARTSCAN 2 was a Swedish multicentre randomized trial involving 240 patients with resectable oral cavity cancer. The per-protocol quality-of-life analysis included 218 patients, and the cost-utility analysis included 204.
- Preoperative accelerated radiotherapy delivered 68 Gy in 43 twice-daily fractions before surgery. Postoperative conventional radiotherapy delivered 60 or 66 Gy in 30 or 33 fractions, with weekly cisplatin added for selected high-risk disease.
- Preoperative treatment produced greater head-and-neck symptom burden during the first 2 years. At 6 months, mean differences favouring postoperative treatment included 20.3 points for mouth opening, 10.7 for swallowing, and 25.4 for feeding-tube use.
- Most between-group quality-of-life differences were no longer significant at 5 years. Five-year QALYs were 3.2 with preoperative treatment versus 3.4 with postoperative treatment.
- Mean costs were €67,863 versus €60,778, respectively. Preoperative accelerated radiotherapy was more costly and slightly less effective, with 71% of bootstrap estimates indicating that it was dominated by postoperative treatment.
CLINICAL TAKEAWAY
For resectable oral cavity cancer requiring surgery and radiotherapy, these results further support postoperative conventional radiotherapy as the preferred sequence. This is high-relevance, practice-affirming randomized evidence, although the per-protocol analysis, mapped rather than directly measured utilities, missing baseline questionnaires, and Sweden-specific healthcare costs limit broader economic generalizability.