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Gobbo M, Arany PR, Merigo E, Bensadoun RJ, Santos-Silva AR, Gueiros LA, Ottaviani G. Quality assessment of PBM protocols for oral complications in head and neck cancer patients: part 2. Support Care Cancer 2023; 31:306. [PMID: 37115315 DOI: 10.1007/s00520-023-07749-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2022] [Accepted: 04/12/2023] [Indexed: 04/29/2023]
Abstract
PURPOSE To investigate the role of photobiomodulation (PBM) in patients undergoing head and neck cancer (HNC) treatment. We focused on the consequences of the main complications, such as quality of life (QoL), analgesia, functional impairment, and nutritional status, as well as on the impact on survival/ recurrences, radiotherapy (RT) interruption, adherence, cost-effectiveness, safety, feasibility, and tolerability. METHODS An electronic search in PubMed and Scopus databases was performed. Full texts were carefully assessed, and data were assimilated into a tabular form for discussion and consensus among the expert panel. RESULTS A total of 22 papers were included. Overall, a beneficial effect of PBM was evidenced in the amelioration of QoL, nutritional status, the reduction of pain, and functional impairment. Preventive PBM may reduce the incidence and duration of RT interruptions, potentially contributing to improved cancer treatment outcomes. PBM treatments are safe and recommended for routine use, with the caveat of avoiding direct tumor exposures where feasible. However, it does not appear to impact cancer survivorship/recurrences directly. Despite additional clinical efforts involving routine PBM use, the individual and public health benefits will positively impact oncology care. CONCLUSIONS Quality of life, pain and functional impairment, nutritional status, and survival may be effectively improved with PBM. Given its established efficacy also in reducing RT interruptions and its safety, feasibility, and tolerability, PBM should be included in the field of supportive cancer care in HNC patients. Improved understanding of PBM mechanisms and precise dose parameters is enabling the generation of more robust, safe, and reproducible protocols; thus, it is imperative to support further clinical implementation as well as both applied and basic science research in this novel field.
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Affiliation(s)
- Margherita Gobbo
- Unit of Oral and Maxillofacial Surgery, Ca' Foncello Hospital, Treviso, Italy
| | - Praveen R Arany
- Oral Biology, Surgery and Biomedical Engineering, University at Buffalo, Buffalo, NY, USA
| | | | | | - Alan Roger Santos-Silva
- Oral Diagnosis Department, Piracicaba Dental School, University of Campinas, São Paulo, Brazil
| | - Luiz Alcino Gueiros
- Department of Clinic and Preventive Dentistry, Federal University of Pernambuco, Pernambuco, Brazil
| | - Giulia Ottaviani
- Department of Surgical, Medical and Health Sciences, University of Trieste, Trieste, Italy.
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Inal A, Duman E. Adaptive time management for patients who have non-small cell lung cancer and underwent definitive radiotherapy: a dosimetric study of different gap duration scenarios. Int J Radiat Biol 2020; 97:219-227. [PMID: 33211612 DOI: 10.1080/09553002.2021.1853846] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE The purpose of this study was to evaluate the tumor control probability (TCP), normal tissue complication probability (NTCP) and adaptive time management (ATM) in patients who had non-small cell lung cancer (NSCLC) and underwent radiotherapy with same gap length at different treatment weeks. MATERIAL AND METHODS Twenty patients' definitive radiotherapy treatments, completed in 6.5 weeks, were evaluated retrospectively. Three different scenarios with gaps in 5 fractions at different weeks of treatment (2nd, 4th, and 6th week) were planned. Three ATM models (biologically effective dose (CBED), time-dose-fractionation (CTDF) and in-house developed (CInH)) were calculated for each scenario. TCP and NTCP were calculated and compared with the dose-volume histogram (DVH) of each model. RESULTS TCP was accepted as 100% in uninterrupted treatments. When treatment was interrupted and not compensated with ATM, the highest TCP difference was determined as 23.46% in the 4th week (p<.001). Based on comparisons of ATM models, the lowest TCP decrease was found in CInH. Increasing the fraction size by CInH and CBED provided more TCP improvement than increasing the number of fractions by CTDF. CONCLUSION The treatment gap to be given in the middle of the treatment is more challenging in terms of tumor control. Adaptive approaches that maintain overall treatment time while increasing fractional dose offer increased TCP.
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Affiliation(s)
- Aysun Inal
- Department of Radiation Oncology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
| | - Evrim Duman
- Department of Radiation Oncology, University of Health Sciences Antalya Training and Research Hospital, Antalya, Turkey
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Borras JM, Font R, Solà J, Macia M, Tuset V, Arenas M, Eraso A, Verges R, Farré N, Pedro A, Mollà M, Algara M, Solé JM, Mira M, Espinàs JA. Impact of non-adherence to radiotherapy on 1-year survival in cancer patients in Catalonia, Spain. Radiother Oncol 2020; 151:200-205. [PMID: 32771615 DOI: 10.1016/j.radonc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aims to assess the effects of non-adherence to external beam radiation therapy in cancer patients receiving treatment with a curative. METHODS This retrospective cohort study collected health records data for all cancer patients treated with external beam radiotherapy with curative intent in 2016 in Catalonia, Spain. Adherence was defined as having received at least 90% of the total dose prescribed. A logistic regression model was used to assess factors related to non-adherence, and its association with one-year survival was evaluated using Cox regression. RESULTS The final sample included 8721 patients (mean age 63.6 years): breast cancer was the most common tumour site (38.1%), followed by prostate and colon/rectum. Treatment interruptions prolonged the total duration of therapy in 70.7% of the patients, and 1.0% were non-adherent. Non-adherence was associated with advanced age, female gender, and some localization of primary tumour (head and neck, urinary bladder, and haematological cancers). The risk of death in non-adherent patients was higher than in adherent patients (hazard ratio [HR] 1.63, 95% confidence interval 0.97-2.74), after adjusting for the potential confounding effect of age, gender, tumour site and comorbidity. CONCLUSION Non-adherence to radiotherapy, as measured by the received dose, is very low in our setting, and it may have an impact on one-year survival.
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Affiliation(s)
- Josep M Borras
- Department of Clinical Sciences, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Spain.
| | - Rebeca Font
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Judit Solà
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Miquel Macia
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain
| | - Victòria Tuset
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Meritxell Arenas
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Spain; Faculty of Medicine, University of Rovira i Virgili, Spain
| | - Arantxa Eraso
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Trueta, Girona, Spain
| | - Ramona Verges
- Radiation Oncology Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Nuria Farré
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustin Pedro
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic de Barcelona, Spain
| | - Manel Algara
- Radiation Oncology Department, Hospital del Mar, Radiation Oncology Research Group, IMIM and Universitat Autònoma de Barcelona, Spain
| | - Josep M Solé
- Radiation Oncology Department, Consorci Sanitari Terrassa- Hospital General Catalunya- Hospital Manresa, Barcelona, Spain
| | - Moises Mira
- Radiation Oncology Department, H.U. Arnau de Vilanova, Lleida, Spain
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Morais MO, Martins AFL, de Jesus APG, de Sousa Neto SS, da Costa AWF, Pereira CH, Oton-Leite AF, de Freitas NMA, Leles CR, Mendonça EF. A prospective study on oral adverse effects in head and neck cancer patients submitted to a preventive oral care protocol. Support Care Cancer 2020; 28:4263-4273. [DOI: 10.1007/s00520-019-05283-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Accepted: 12/23/2019] [Indexed: 01/05/2023]
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Pozo G, Pérez-Escutia MA, Ruíz A, Ferrando A, Milanés A, Cabello E, Díaz R, Prado A, Pérez-Regadera JF. Management of interruptions in radiotherapy treatments: Adaptive implementation in high workload sites. Rep Pract Oncol Radiother 2019; 24:239-244. [PMID: 30858768 DOI: 10.1016/j.rpor.2019.02.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2018] [Revised: 11/24/2018] [Accepted: 02/07/2019] [Indexed: 01/11/2023] Open
Abstract
Owing to predictable or unpredictable causes, interruptions may arise during therapy. On average, the extension of fractionated radiotherapy treatments is prone to be delayed by several weeks and interruptions can come up extending overall treatment time (OTT). Clonogenic cells of aggressive tumors might benefit from this situation, modifying local control (LC). Preserving treatment quality in radiotherapy is an essential issue for the treatment outcome, and our institution is increasingly concerned about this line of work. Establishing some objective criteria to schedule patients that have suffered interruptions along their treatments is of capital importance and not a trivial issue. Publications strongly encourage departments to minimize the effect of lag periods during treatments. Therefore, in July 2017, our facility implemented the so called 'Protocol to Manage Interruptions in Radiotherapy', based on a scoring system for patient categorization that considers not only histology but also associated comorbidity and sequence of the therapy.
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Affiliation(s)
- Gustavo Pozo
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | | | - Ana Ruíz
- Department of Radiation Oncology, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Ferrando
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Ana Milanés
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Eduardo Cabello
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Raul Díaz
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
| | - Alejandro Prado
- Department of Medical Physics, Hospital Universitario 12 de Octubre, Madrid, Spain
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Yom SS, Harari PM. When Disaster Strikes: Mitigating the Adverse Impact on Head and Neck Cancer Patients. Int J Radiat Oncol Biol Phys 2019; 100:838-840. [PMID: 29485057 DOI: 10.1016/j.ijrobp.2017.12.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2017] [Revised: 12/04/2017] [Accepted: 12/06/2017] [Indexed: 01/14/2023]
Affiliation(s)
- Sue S Yom
- Department of Radiation Oncology, University of California, San Francisco, San Francisco, California.
| | - Paul M Harari
- Department of Human Oncology, Carbone Cancer Center, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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The "rocky treatment course": identifying a high-risk subgroup of head and neck cancer patients for supportive interventions. Support Care Cancer 2016; 25:719-727. [PMID: 27815711 DOI: 10.1007/s00520-016-3450-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2016] [Accepted: 10/10/2016] [Indexed: 01/14/2023]
Abstract
PURPOSE We aim to identify the risk factors for a "rocky" treatment course (RTC) in head and neck cancer. METHODS A retrospective case-control study was conducted utilizing data from a prospective study. We defined the RTC as a composite of adverse outcomes including G-tube dependence and increased nursing interventions. Statistically associative variables were included in a multivariable logistic regression. We also evaluated whether the RTC, or its components, associated with worse cancer outcomes. RESULTS Being single, unemployed, having N2/3 disease and receiving chemoradiotherapy were associated with a RTC. In turn, G-tube dependence was associated with worse 3-year OS (73 vs 91 %; p = 0.02) and increased nursing interventions with worse 3-year locoregional recurrence-free survival (LRFS) (85 vs 92 %; p = 0.03) and locoregional recurrence (LRR) (14 vs 7 %; p = 0.03). CONCLUSIONS We identified baseline factors associated with a RTC for head and neck cancer patients. Future supportive care interventions could be evaluated using the RTC as a marker of benefit.
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Abstract
Chemoradiotherapy is the standard-of-care treatment of squamous-cell carcinoma of the anus (SCCA), and this has not changed in decades. Radiation doses of 50-60 Gy, as used in many phase III trials, result in substantial late morbidities and fail to control larger and node-positive tumours. Technological advances in radiation therapy are improving patient outcomes and quality of life, and should be applied to patients with SCCA. Modern techniques such as intensity-modulated radiotherapy (IMRT), rotational IMRT, image-guided radiotherapy using cone-beam CT, and stereotactic techniques have enabled smaller margins and highly conformal plans, resulting in decreased radiation doses to the organs at risk and ensuring a shorter overall treatment time. In this Perspectives article, the use of novel approaches to target delineation, optimized radiotherapy techniques, adaptive radiotherapy, dose-escalation with external-beam radiotherapy (EBRT) or brachytherapy, and the potential for modified fractionation are discussed in the context of SCCA.
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9
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Compliance to radiation therapy of head and neck cancer patients and impact on treatment outcome. Clin Transl Oncol 2015; 18:677-84. [DOI: 10.1007/s12094-015-1417-5] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2015] [Accepted: 09/25/2015] [Indexed: 01/14/2023]
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10
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Arenas M, Sabater S, Gascón M, Henríquez I, Bueno MJ, Rius À, Rovirosa À, Gómez D, Lafuerza A, Biete A, Colomer J. Quality assurance in radiotherapy: analysis of the causes of not starting or early radiotherapy withdrawal. Radiat Oncol 2014; 9:260. [PMID: 25472662 PMCID: PMC4263009 DOI: 10.1186/s13014-014-0260-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2014] [Accepted: 11/12/2014] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND The aim of this study was to analyse the reasons for not starting or for early of radiotherapy at the Radiation Oncology Department. METHODS All radiotherapy treatments from March 2010 to February 2012 were included. Early withdrawals from treatment those that never started recorded. Clinical, demographic and dosimetric variables were also noted. RESULTS From a total of 3250 patients treated and reviewed, 121 (4%) did not start or complete the planned treatment. Of those, 63 (52%) did not receive any radiotherapy fraction and 58 (48%) did not complete the course, 74% were male and 26% were female. The mean age was 67 ± 13 years. The most common primary tumour was lung (28%), followed by rectum (16%). The aim of treatment was 62% radical and 38% palliative, 44% of patients had metastases; the most common metastatic site was bone, followed by brain. In 38% of cases (46 patients) radiotherapy was administered concomitantly with chemotherapy (10 cases (22%) were rectal cancers). The most common reason for not beginning or for early withdrawal of treatment was clinical progression (58/121, 48%). Of those, 43% died (52/121), 35 of them because of the progression of the disease and 17 from other causes. Incomplete treatment regimens were due to toxicity (12/121 (10%), of which 10 patients underwent concomitant chemotherapy for rectal cancer). CONCLUSIONS The number of patients who did not complete their course of treatment is low, which shows good judgement in indications and patient selection. The most common reason for incomplete treatments was clinical progression. Rectal cancer treated with concomitant chemotherapy was the most frequent reason of the interruption of radiotherapy for toxicity.
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Affiliation(s)
- Meritxell Arenas
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - Sebastià Sabater
- Department of Radiation Oncology, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.
| | - Marina Gascón
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - Ivan Henríquez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - M José Bueno
- Department of Quality, Hospital Universitari Sant Joan de Reus, Tarragona, Spain.
| | - Àngels Rius
- Department of Statistics, Hospital Universitari Sant Joan de Reus, Tarragona, Spain.
| | - Àngels Rovirosa
- Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Barcelona, Spain.
| | - David Gómez
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - Anna Lafuerza
- Department of Radiation Oncology, Hospital Universitari Sant Joan de Reus, Institut d'Investigacions Sanitàries Pere Virgili (IISPV), Universitat Rovira i Virgili (URV), Tarragona, Spain.
| | - Albert Biete
- Department of Radiation Oncology, Hospital Universitari Clínic de Barcelona, Barcelona, Spain.
| | - Jordi Colomer
- Hospital Universitari Sant Joan de Reus and Group SAGESSA (Assistència Sanitària i Social), Tarragona, Spain.
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Bell BC, Butler EB. Management of predictable pain using fentanyl pectin nasal spray in patients undergoing radiotherapy. J Pain Res 2013; 6:843-8. [PMID: 24376361 PMCID: PMC3864880 DOI: 10.2147/jpr.s54788] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Studies report the need for improved pain management in the radiation oncology setting. Many patients with well controlled background pain experience breakthrough pain in cancer (BTPc) that can interrupt their treatment schedule with a potentially negative impact on outcomes. BTPc can be unpredictable and predictable; both types of pain can be managed with fast-acting analgesics, but predictable pain lends itself to anticipatory management. Methods Five consecutive cases are described in which fentanyl pectin nasal spray (FPNS) was used to manage BTPc, with an emphasis on the anticipatory management of predictable pain in cancer patients receiving radiotherapy. Results Patients (four men, one woman), age range 32–84 years, were diagnosed with various cancers. All patients were receiving opioid treatment for chronic pain, and experienced predictable pain with radiotherapy which included pain associated with lying on a treatment table for a sustained time during an average of 29 radiotherapy treatments; pain associated with radiation simulation and radiotherapy; pain associated with odynophagia related to increasing mucositis during treatment, resulting in decreased nutritional intake; pain associated with the customized immobilization mask for head and neck cancer patients; and pain associated with defecation. Some patients also reported pain awakening them randomly at night (eg, sleep interruption). All patients attained lower pain intensity scores (2/10 to 3/10), reduced from approximately 7/10, when they were treated with FPNS 20 minutes before a predictable pain event. No patient experienced any pain-related interruptions to their course of radiotherapy. The average number of radiotherapy sessions was 29 per patient, excluding one short-course treatment for one patient. Conclusion FPNS offers a good solution to the management of BTPc because its fast onset of action makes it very suitable for the anticipatory treatment of predictable pain, which is likely to minimize interruptions to the radiotherapy schedule.
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Affiliation(s)
- Brent C Bell
- Department of Radiation Oncology, Houston Methodist Hospital, The Texas Medical Center, Houston, TX, USA
| | - E Brian Butler
- Department of Radiation Oncology, Houston Methodist Hospital, The Texas Medical Center, Houston, TX, USA
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O'Connor P. The impact of missed fractions in head and neck radiotherapy and how they can be minimised. Radiography (Lond) 2013. [DOI: 10.1016/j.radi.2013.07.006] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
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Sreeraman R, Vijayakumar S, Chen AM. Correlation of radiation treatment interruptions with psychiatric disease and performance status in head and neck cancer patients. Support Care Cancer 2013; 21:3301-6. [DOI: 10.1007/s00520-013-1907-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2013] [Accepted: 07/12/2013] [Indexed: 01/14/2023]
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Martínez Carrillo M, Tovar Martín I, Martínez Lara I, Ruiz de Almodóvar Rivera JM, Del Moral Ávila R. Selective use of postoperative neck radiotherapy in oral cavity and oropharynx cancer: a prospective clinical study. Radiat Oncol 2013; 8:103. [PMID: 23621873 PMCID: PMC3653704 DOI: 10.1186/1748-717x-8-103] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2012] [Accepted: 02/16/2013] [Indexed: 12/19/2022] Open
Abstract
Background In cervical postoperative radiotherapy, the target volume is usually the same as the extension of the previous dissection. We evaluated a protocol of selective irradiation according to the risk estimated for each dissected lymph node level. Methods Eighty patients with oral/oropharyngeal cancer were included in this prospective clinical study between 2005 and 2008. Patients underwent surgery of the primary tumor and cervical dissection, with identification of positive nodal levels, followed by selective postoperative radiotherapy. Three types of selective nodal clinical target volume (CTV) were defined: CTV0, CTV1, and CTV2, with a subclinical disease risk of <10%, 10-25%, and 25% and a prescribed radiation dose of <35 Gy, 50 Gy, and 66–70 Gy, respectively. The localization of node failure was categorized as field, marginal, or outside the irradiated field. Results A consistent pattern of cervical infiltration was observed in 97% of positive dissections. Lymph node failure occurred within a high-risk irradiated area (CTV1-CTV2) in 12 patients, marginal area (CTV1/CTVO) in 1 patient, and non-irradiated low-risk area (CTV0) in 2 patients. The volume of selective lymph node irradiation was below the standard radiation volume in 33 patients (mean of 118.6 cc per patient). This decrease in irradiated volume was associated with greater treatment compliance and reduced secondary toxicity. The three-year actuarial nodal control rate was 80%. Conclusion This selective postoperative neck irradiation protocol was associated with a similar failure pattern to that observed after standard neck irradiation and achieved a significant reduction in target volume and secondary toxicity.
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Affiliation(s)
- Miguel Martínez Carrillo
- Department of Radiation Oncology, Virgen de las Nieves University Hospital, Avda, Fuerzas Armadas 4, Granada 18014, Spain.
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Bütof R, Baumann M. Time in radiation oncology – Keep it short! Radiother Oncol 2013; 106:271-5. [DOI: 10.1016/j.radonc.2013.03.007] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Accepted: 03/04/2013] [Indexed: 12/25/2022]
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16
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Giddings A. Treatment Interruptions in Radiation Therapy for Head-and-Neck Cancer: Rates and Causes. J Med Imaging Radiat Sci 2010; 41:222-229. [PMID: 31051883 DOI: 10.1016/j.jmir.2010.08.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2010] [Revised: 08/12/2010] [Accepted: 08/18/2010] [Indexed: 12/26/2022]
Abstract
BACKGROUND AND PURPOSE Extending the period over which a course of radiation therapy is delivered can have detrimental effects on treatment success. This is especially true for fast growing tumors of the head-and-neck region. The goal of this study was to establish the rates and causes of treatment interruptions for head-and-neck patients at the Vancouver Cancer Centre of the BC Cancer Agency, and to explore the link between emotional distress and missed appointments. METHODS Head-and-neck patients who had missed treatments other than public holidays were identified using the Oncology Reporting System. The charts of these patients were pulled and examined for cause of treatment interruption. The Psychosocial Screen for Cancer (PSSCAN) found in these patients' charts was used to establish anxiety and depression levels. A random sample of PSSCANs from the charts of patients who had not missed appointments was recorded for comparison. RESULTS Of the 471 head-and-neck patients included in our analysis, 74% had interruptions in treatment. Gaps of greater than three days were present in 11% of treatment courses. The most common cause of treatment breaks was statutory holidays, responsible for 69% of interruptions. The anxiety and depression scores of patients who had missed appointments for reasons other than holidays were not significantly higher than patients who had not missed appointments. CONCLUSION Rates of treatment time extension in Vancouver were higher than expected, given rates reported from other parts of the world. Policies aimed at reducing or compensating for treatment interruptions have been successful elsewhere, and could also be instituted here. Although many published studies have shown emotional distress can lead to noncompliance in health care, this link was not found here. Several weaknesses in our study design may have contributed to the lack of correlation between anxiety and depression and missed appointments.
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Affiliation(s)
- Alison Giddings
- Vancouver Cancer Centre, BC Cancer Agency, Vancouver, British Columbia, Canada.
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