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Milgrom SA, van Luijk P, Pino R, Ronckers CM, Kremer LC, Gidley PW, Grosshans DR, Laskar S, Okcu MF, Constine LS, Paulino AC. Salivary and Dental Complications in Childhood Cancer Survivors Treated With Radiation Therapy to the Head and Neck: A PENTEC Comprehensive Review. Int J Radiat Oncol Biol Phys 2024; 119:467-481. [PMID: 34074567 DOI: 10.1016/j.ijrobp.2021.04.023] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2020] [Revised: 03/14/2021] [Accepted: 04/21/2021] [Indexed: 12/24/2022]
Abstract
PURPOSE Radiation therapy (RT) to the head and neck (H&N) region is critical in the management of various pediatric malignancies; however, it may result in late toxicity. This comprehensive review from the Pediatric Normal Tissue Effects in the Clinic (PENTEC) initiative focused on salivary dysfunction and dental abnormalities in survivors who received RT to the H&N region as children. MATERIALS & METHODS This systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) method. RESULTS Of the 2,164 articles identified through a literature search, 40 were included in a qualitative synthesis and 3 were included in a quantitative synthesis. The dose-toxicity data regarding salivary function demonstrate that a mean parotid dose of 35 to 40 Gy is associated with a risk of acute and chronic grade ≥2 xerostomia of approximately 32% and 13% to 32%, respectively, in patients treated with chemo-radiation therapy. This risk increases with parotid dose; however, rates of xerostomia after lower dose exposure have not been reported. Dental developmental abnormalities are common after RT to the oral cavity. Risk factors include higher radiation dose to the developing teeth and younger age at RT. CONCLUSIONS This PENTEC task force considers adoption of salivary gland dose constraints from the adult experience to be a reasonable strategy until more data specific to children become available; thus, we recommend limiting the parotid mean dose to ≤26 Gy. The minimum toxic dose for dental developmental abnormalities is unknown, suggesting that the dose to the teeth should be kept as low as possible particularly in younger patients, with special effort to keep doses <20 Gy in patients <4 years old.
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Affiliation(s)
- Sarah A Milgrom
- Department of Radiation Oncology, University of Colorado, Aurora, Colorado
| | - Peter van Luijk
- Department of Radiation Oncology, University Medical Center Groningen, University of Groningen, Groningen, Netherlands
| | - Ramiro Pino
- Department of Radiation Oncology, Houston Methodist Hospital, Houston, Texas
| | - Cecile M Ronckers
- Princess Máxima Centrum for Pediatric Oncology, Utrecht, Netherlands; Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany
| | - Leontien C Kremer
- Institute of Biostatistics and Registry Research, Brandenburg Medical School-Theodor Fontane, Neuruppin, Germany; UMC Amsterdam, Location AMC, Department of Pediatrics, Amsterdam, Netherlands
| | - Paul W Gidley
- Department of Head and Neck Surgery, MD Anderson Cancer Center, Houston, Texas
| | - David R Grosshans
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
| | - Siddhartha Laskar
- Department of Radiation Oncgqtology, Tata Memorial Hospital, Mumbai, India
| | - M Fatih Okcu
- Department of Pediatrics, Baylor College of Medicine, Houston, Texas
| | - Louis S Constine
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas.
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Ben-Ami T. Nasopharyngeal Carcinoma in Children, Current Treatment Approach. J Pediatr Hematol Oncol 2024; 46:117-124. [PMID: 38447121 PMCID: PMC10956687 DOI: 10.1097/mph.0000000000002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 02/04/2024] [Indexed: 03/08/2024]
Abstract
Nasopharyngeal carcinoma (NPC) is a rare and locally aggressive form of childhood cancer. Treatment of pediatric NPC includes chemotherapy and radiotherapy. Most studies on the treatment of pediatric NPC are single-arm studies. With current treatment protocols survival rates for patients with nonmetastatic disease exceed 80%, although most children will have long-term treatment-related late effects. Efforts to reduce early and late toxicities include reduced radiotherapy doses in children with good responses to induction chemotherapy. Further studies are needed to evaluate the role of immunotherapy in both the primary setting and in children with progressive or relapsed disease. This review summarizes current clinical approaches to the treatment of pediatric NPC.
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Ollivier L, Laprie A, Jouglar E, Claude L, Martin V, Muracciole X, Padovani L, Supiot S, Escande A. [Characteristics of radiotherapy for adolescents and young adults]. Cancer Radiother 2023; 27:736-745. [PMID: 38652674 DOI: 10.1016/j.canrad.2023.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 08/02/2023] [Indexed: 04/25/2024]
Abstract
Radiotherapy for adolescents and young adults is complex in several aspects. The population is very heterogeneous and has characteristics derived from both paediatric and adult populations both in terms of pathology (anatomical pathology, response to treatment) and the patient's physical, biological and psychological characteristics. This article reviews the characteristics to be taken into account in adolescent and young adult patients radiotherapy and more particularly in some of the most common diseases.
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Affiliation(s)
- L Ollivier
- Département de radiothérapie, institut de cancérologie de l'Ouest (ICO), Saint-Herblain, France
| | - A Laprie
- Département d'oncologie-radiothérapie, oncopole institut Claudius-Regaud, institut universitaire du cancer de Toulouse, université Toulouse III, Toulouse, France
| | - E Jouglar
- Département de radiothérapie, institut Curie, université Paris Science et Lettres, Paris, France
| | - L Claude
- Département de radiothérapie, centre Léon-Bérard, Lyon, France
| | - V Martin
- Département d'oncologie-radiothérapie, Gustave-Roussy, Villejuif, France
| | - X Muracciole
- Département d'oncologie-radiothérapie, Assistance publique-hôpitaux de Marseille, CHU La Timone, CHU Nord, Marseille, France
| | - L Padovani
- Département d'oncologie-radiothérapie, Assistance publique-hôpitaux de Marseille, CHU La Timone, CHU Nord, Marseille, France
| | - S Supiot
- Département de radiothérapie, institut de cancérologie de l'Ouest (ICO), Saint-Herblain, France
| | - A Escande
- Département de radiothérapie, centre Léonard-de-Vinci, Dechy, France; Laboratoire CRIStAL, UMR 9186, université de Lille, Villeneuve-d'Ascq, France.
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Hamilton SN, Mahdavi S, Martinez IS, Afghari N, Howard F, Tran E, Goddard K. A cross-sectional assessment of long-term effects in adolescent and young adult head and neck cancer survivors treated with radiotherapy. J Cancer Surviv 2021; 16:1117-1126. [PMID: 34542836 DOI: 10.1007/s11764-021-01103-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
PURPOSE Adolescent and young adult (AYA) head and neck (H&N) cancer survivors are at risk of long-term complications. A cross-sectional study of survivors recalled for clinical evaluation was performed to evaluate late effects in this population. METHODS Surviving patients who had been diagnosed with H&N cancer between the ages of 15 and 39 years and treated with radiation therapy (RT) in British Columbia between 1970 and 2010 were invited to participate in this study. Survivors were assessed in consultation by a radiation oncologist for a complete history and physical exam. Comprehensive data collection of subjective and objective late effects of RT and screening investigations were completed. RESULTS Of 36 AYA H&N participants, the majority were female (61%), and the most common tumour sites were thyroid (28%), oropharynx (17%), salivary gland (14%) and larynx (14%). Dental extractions post treatment was performed for 33% and dental implants for 17%. The majority (72%) reported xerostomia, 50% had dysphagia to solids and 25% hearing loss. Of the non-thyroid cancer patients who underwent RT to their neck, 45% developed hypothyroidism. There were 28% of participants with asymptomatic carotid stenosis and 27% with thyroid nodules; all were diagnosed after recall screening. CONCLUSIONS Survivors of AYA H&N cancer treated with RT reported numerous long-term complications. Comprehensive follow-up and screening guidelines should be established for this at-risk population. IMPLICATIONS FOR CANCER SURVIVORS AYA H&N cancer survivors and their primary care practitioners should be educated on screening recommendations and the risk of late effects.
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Affiliation(s)
- Sarah Nicole Hamilton
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada. .,Univeristy of British Columbia, Vancouver, BC, Canada. .,, Vancouver, Canada.
| | - Sara Mahdavi
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada
| | | | - Narsis Afghari
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
| | | | - Eric Tran
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
| | - Karen Goddard
- BC Cancer - Vancouver Centre, Vancouver, BC, Canada.,Univeristy of British Columbia, Vancouver, BC, Canada
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Swain SK, Samal S, Mohanty JN, Choudhury J. Nasopharyngeal carcinoma among the pediatric patients in a non-endemic region: our experience at a tertiary care teaching hospital in Eastern India. EGYPTIAN PEDIATRIC ASSOCIATION GAZETTE 2020. [DOI: 10.1186/s43054-020-00036-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Nasopharyngeal carcinoma (NPC) is an extremely rare malignant lesion among the pediatric age group. The relative rarity of pediatric NPC makes the diagnosis difficult. This rarity is often associated with delayed diagnosis which may lead to advanced loco-regional disease. Here, we study the clinical presentations, investigations, and treatment of nasopharyngeal carcinoma in the pediatric age group in a non-endemic region.
Result
This is a retrospective study where 21 pediatric patients were enrolled with age under 18 years. They were managed at a tertiary care teaching hospital between December 2010 and January 2019. Majority of the patients in this study were boys (66.7%). All children diagnosed with NPC were treated with radiotherapy covering entire nasopharynx and some children with chemotherapy. Until the patient is in a late stage, most children diagnosed with NPC were presenting with symptoms of neck mass (90.5%), bleeding from the nose (66.7%), nasal blockage (57.1%), and hearing loss (47.6%). Pathological report revealed WHO type III in the majority of the patients. All patients were treated with radiotherapy to primary and enlarged neck nodes.
Conclusion
Children with NPC have excellent survival except for those with distant metastatic disease. NPC in the pediatric age is usually not suspected clinically until patient in late stage. The TNM staging has the most relevant prognostic factor. Unfortunately, NPC tends to be locally advanced at the time of diagnosis in the pediatric age group and is sometimes associated with distant metastasis. In our study, most children were diagnosed with NPC along with neck node enlargement and were treated with radiotherapy. The diagnosis of pediatric NPC should prompt timely treatment.
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Hasnaoui M, Lahmar R, Ben Mabrouk A, Masmoudi M, Mighri K, Driss N. Predictive epidemiological and clinical factors of nasopharyngeal carcinoma diagnosis: Adult versus pediatric population. Int J Pediatr Otorhinolaryngol 2020; 137:110203. [PMID: 32658801 DOI: 10.1016/j.ijporl.2020.110203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2020] [Revised: 06/12/2020] [Accepted: 06/12/2020] [Indexed: 11/30/2022]
Abstract
OBJECTIVE The objective of this study is to compare the clinical presentation and the cancer staging of nasopharyngeal carcinoma (NPC) between pediatric and adult populations to highlight the main characteristics of this disease within the two subgroups. MATERIEL AND METHODS It is a retrospective study including all patients with a primary diagnosis of NPC over a period of 19 years. The pediatric group included patients aged less then 16 years old. RESULTS A total of 80 patients were included. The pediatric population represented 22.5% of the cases. No difference in gender distribution was found (p˃.05). The most common presenting symptom was neck mass in children (77.8% vs. 48.4%, p = .02), and nasal obstruction in adult patients (64.5% vs. 16.7%, p < .01). The median time between the presenting symptom's onset and the diagnosis was 5 months. The diagnosis of NPC was delayed in pediatric patients compared to adults (<0.05). We noted a predominance of patients with stages III and IV (32.5% and 40%, respectively) with no difference between the two subgroups (p˃.05). CONCLUSION Our study showed some differences in NPC clinical features between pediatric patients and adults. Neck mass was the most common symptom in children. The initial presentation is sometimes misleading. NPC was mainly diagnosed in advanced locoregional stages in both pediatric and adult patients. Efforts toward early diagnosis are of great importance.
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Affiliation(s)
- Mehdi Hasnaoui
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Rihab Lahmar
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Asma Ben Mabrouk
- Pediatric Department, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Mohamed Masmoudi
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Khalifa Mighri
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
| | - Nabil Driss
- Department of Otolaryngology-Head and Neck Surgery, Tahar Sfar Hospital, Mahdia 5100, Tunisia.
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Pediatric Nasopharyngeal Carcinoma: A Rare Tumor in a Developing Country-What Do We Learn? J Pediatr Hematol Oncol 2020; 42:e140-e146. [PMID: 31789781 DOI: 10.1097/mph.0000000000001676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND/AIM Nasopharyngeal carcinoma (NPC) is rare in children, accounting for 1% of pediatric malignancies. The 5-fluorouracil Cisplatin regimen could be considered as a standard of care induction chemotherapy followed by concomitant chemoradiotherapy. This study aimed at detecting the survival outcome in correlation with different prognostic factors together with the toxicity of different treatment modalities. PATIENTS AND METHODS This was a retrospective study carried out from 2007 to 2016 that included all NPC patients below 18 years treated at the National Cancer Institute, Egypt. RESULTS A total of 21 patients were included with a median follow-up period of 33.9 months. The median age was 14.8 years (range: 9 to 18). All patients were treated by neoadjuvant chemotherapy with cisplatin and 5- fluorouracil, followed by concurrent radiotherapy (median dose: 61.2 Gy) and cisplatin as a radiosensitizer. After induction chemotherapy, the response rate was 53%. After completion of treatment, 67% had a complete response; partial response was seen in 14%; and progressive disease was seen in 19%. By the end of the study, 7 (33.3%) patients had progression/relapse; 4 of them died from disease. The 3-year overall survival and event-free survival were 85.7% and 66.7%, respectively. CONCLUSIONS Neoadjuvant chemotherapy followed by concurrent chemoradiotherapy was an effective strategy in the treatment of pediatric NPC with good overall survival and event-free survival. High systemic failure (33.3%) remains another challenge to solve. More efforts should be made to improve survival by developing more efficient systemic treatment modalities, especially for progressive/relapsed disease. Multicenter studies on a larger number of patients are needed to identify different prognostic factors and standardize treatment strategies.
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Qiu W, Lv X, Guo X, Yuan Y. Clinical Implications of Plasma Epstein-Barr Virus DNA in Children and Adolescent Nasopharyngeal Carcinoma Patients Receiving Intensity-Modulated Radiotherapy. Front Oncol 2020; 10:356. [PMID: 32296633 PMCID: PMC7136458 DOI: 10.3389/fonc.2020.00356] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2019] [Accepted: 02/28/2020] [Indexed: 12/20/2022] Open
Abstract
Background: Plasma Epstein–Barr virus (EBV) DNA has been determined as a prognostic factor in adult nasopharyngeal carcinoma (NPC) patients. This study was designed to evaluate the prognostic value of plasma pretreatment EBV DNA in children and adolescent NPC patients receiving intensity-modulated radiotherapy (IMRT). Methods: Pretreatment EBV DNA was retrospectively assessed in 147 children with newly diagnosed, non-metastatic NPC. All patients were treated using IMRT. Receiver operating characteristic (ROC) curve was used to identify the optimal EBV DNA cutoff point. Prognostic value was examined using a multivariate Cox proportional hazards model. Results: The median follow-up for the entire cohort was 58 months (range, 10–119 months), and the 5-year survival rates for all patients were as follows: overall survival (OS), 88.7%; locoregional relapse-free survival, 95.2%; distant metastasis-free survival (DMFS), 84.8%; and disease-free survival (DFS), 81.5%. For ROC curve analysis, the optimal cutoff value of pretreatment EBV DNA load for DFS was 40,000 copies/mL. High plasma EBV DNA was significantly associated with poorer 5-year DMFS (70.6 vs. 89.1%, P = 0.003) and DFS (63.9 vs. 86.9%, P < 0.001). In multivariate analysis, high plasma EBV DNA was an independent predictor for DMFS and DFS. Conclusions: Pretreatment EBV DNA level was a powerful prognostic discriminator for DMFS and DFS in children and adolescent NPC patients treated with IMRT.
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Affiliation(s)
- Wenze Qiu
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China.,State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xing Lv
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiang Guo
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center of Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Yawei Yuan
- Department of Radiation Oncology, Affiliated Cancer Hospital & Institute of Guangzhou Medical University, Guangzhou, China
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Comparison of Long-Term Outcomes and Sequelae Between Children and Adult Nasopharyngeal Carcinoma Treated With Intensity Modulated Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 106:848-856. [DOI: 10.1016/j.ijrobp.2019.11.035] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2019] [Revised: 10/29/2019] [Accepted: 11/26/2019] [Indexed: 12/24/2022]
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10
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Jouin A, Helfre S, Bolle S, Claude L, Laprie A, Bogart E, Vigneron C, Potet H, Ducassou A, Claren A, Riet FG, Castex MP, Faure-Conter C, Fresneau B, Defachelles AS, Orbach D. Adapted strategy to tumor response in childhood nasopharyngeal carcinoma: the French experience. Strahlenther Onkol 2019; 195:504-516. [PMID: 30963203 DOI: 10.1007/s00066-019-01461-6] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2018] [Accepted: 03/25/2019] [Indexed: 11/28/2022]
Abstract
PURPOSE The aim of this study was to retrospectively study survival and long-term morbidities of children with nasopharyngeal carcinoma (NPC) treated by induction chemotherapy and concurrent chemoradiation (CRT). The total dose of radiation was adapted to the response following neoadjuvant chemotherapy. METHODS Children with non-metastatic NPC treated in France between 1999 and 2015 were retrospectively included in the study. The strategy combined neoadjuvant platinum-based chemotherapy, followed by adapted CRT to tumor response. RESULTS In total, 95 patients (median age 15 years [range, 7-23 years], male-to-female ratio 1.8) with undifferentiated NPC were included; 59% of patients had TNM stage IV. Intensity-modulated radiotherapy (IMRT) was delivered to 57 patients (60%), while the other patients were treated with conformal RT (3D-RT). After a median follow-up of 4.5 years [range, 3.6-5.5 years], 13 relapses and seven deaths had occurred. The 3‑year overall and relapse-free survival (RFS) were 94% [95% CI, 85-97%] and 86% [77-92%], respectively. The locoregional failure rate was 6% [95% CI, 2-14]. Long-term treatment-related sequelae of grade 2+ were reported by 37 (50%) patients; odynophagia was significantly reduced treated by IMRT vs. conventional 3D-RT (7% vs. 55%, p = 0.015). Using a reduction dose of 59.4 Gy, 54 Gy, and 45 Gy, respectively, to the primary, involved, and uninvolved neck nodes, after a favorable tumor response, was not associated with an increased locoregional failure rate. CONCLUSIONS The survival rates for NPC have been considerably improved by means of multimodal therapy, but long-term locoregional morbidity remains common. Use of IMRT may induce less residual odynophagia. Radiation dose reduction adapted to chemotherapy response does not have a negative impact on outcome. These findings support the use of an RT protocol adapted to the tumor response to neoadjuvant chemotherapy for a long-lasting improvement in the patient's quality of life.
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Affiliation(s)
- Anaïs Jouin
- Radiotherapy department, Centre Oscar Lambret, Lille, France
| | - Sylvie Helfre
- Radiotherapy department, Institut Curie, Paris, France
| | - Stéphanie Bolle
- Gustave Roussy, Department of Radiotherapy Oncology, Université Paris-Saclay, 94805, Villejuif, France
| | - Line Claude
- Radiotherapy department, Centre Lyon Bérard, Lyon, France
| | - Anne Laprie
- Radiotherapy department, IUCT Oncopole, Toulouse, France
| | - Emilie Bogart
- Biostatistics department, Centre Oscar Lambret, Lille, France
| | - Céline Vigneron
- Radiotherapy department, Centre Paul Strauss, Strasbourg, France
| | - Hélène Potet
- Radiotherapy department, Centre Antoine Lacassagne, Nice, France
| | - Anne Ducassou
- Radiotherapy department, IUCT Oncopole, Toulouse, France
| | - Audrey Claren
- Radiotherapy department, Centre Antoine Lacassagne, Nice, France
| | - François Georges Riet
- Gustave Roussy, Department of Radiotherapy Oncology, Université Paris-Saclay, 94805, Villejuif, France
| | | | | | - Brice Fresneau
- Gustave Roussy-Grand Campus, Pediatric department, University Paris-Saclay, Villejuif, France
- CESP, INSERM, Paris-Saclay University, Paris-Sud University, Villejuif, France
| | | | - Daniel Orbach
- SIREDO Oncology Center (Care, Innovation and Research for Children, Adolescents and Young Adults with cancer), PSL Research University, French Pediatric Rare Tumor group (Fracture group), Institut Curie, 26, rue d'Ulm, 75005, Paris, France.
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Lu S, Wei J, Sun F, Xiao W, Cai R, Zhen Z, Zhu J, Wang J, Huang J, Lu L, Sun X, Gao Y. Late Sequelae of Childhood and Adolescent Nasopharyngeal Carcinoma Survivors After Radiation Therapy. Int J Radiat Oncol Biol Phys 2019; 103:45-51. [DOI: 10.1016/j.ijrobp.2018.09.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 09/10/2018] [Accepted: 09/11/2018] [Indexed: 11/25/2022]
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12
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Liu L, Fei Z, Chen M, Zhao L, Su H, Gu D, Lin B, Cai X, Lu L, Gao M, Ye X, Jin X, Xie C. Induction chemotherapy plus concurrent chemoradiotherapy versus induction chemotherapy plus volumetric modulated arc therapy alone in the treatment of stage II-IVB nasopharyngeal carcinoma patients: a retrospective controlled study. Radiat Oncol 2018; 13:148. [PMID: 30103765 PMCID: PMC6090803 DOI: 10.1186/s13014-018-1092-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2018] [Accepted: 08/02/2018] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND In the era of intensity-modulated radiotherapy (IMRT), the role of additional concurrent chemotherapy (CC) to radiotherapy (RT) after induction chemotherapy (IC) compared to IC followed by RT alone remains unclear for stage II-IVB nasopharyngeal carcinoma (NPC) patients. The aim of this study was to evaluate the efficacy and toxicities of IC/RT and IC/CCRT in the treatment of NPC with volumetric modulated arc therapy (VMAT). METHODS From January 2012 to March 2016, a total of 217 NPC patients were retrospectively assessed. Of the 217 patients, 139 patients received IC followed by VMAT alone and 78 patients received IC plus CCRT. Overall survival (OS), progression-free survival (PFS) and toxicities were assessed. RESULTS The 5-year OS, PFS rates were 57.5%, 41.8% and 47.8%, 38.4% for the IC/RT and IC/CCRT arms, respectively, without significant difference in survival between the two groups (both p > 0.05). Multivariate analysis indicated that treatment modality (IC/RT vs. IC/CCRT) was not an independent prognostic factor for OS or PFS. Grade 3-4 leukopenia/neutropenia (3.60% vs. 20.51%, p < 0.001), gastrointestinal disorder (nausea/vomiting/diarrhea, 2.16% vs. 41.03%, p < 0.001), mucositis (29.50% vs. 47.44%, p = 0.01) and xerostomia (34.53% vs. 48.72%, p = 0.04) were more frequent in the IC/ CCRT arm than in the IC/RT arm during VMAT. CONCLUSIONS No significant difference in OS and PFS was observed between IC plus VMAT alone and IC/CCRT in the treatment of stage II-IVB NPC patients, however, more side effects were observed in the IC/CCRT arm.
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Affiliation(s)
- Linger Liu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Zhenghua Fei
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Mengfeng Chen
- Department of Oncology Medicine, Yueqing 3rd People’s Hospital, Wenzhou, 325600 China
| | - Lihao Zhao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Huafang Su
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Dianna Gu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Baochai Lin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xiaona Cai
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Lihuai Lu
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Mengdan Gao
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xuxue Ye
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Xiance Jin
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
| | - Congying Xie
- Department of Radiation and Medical Oncology, The First Affiliated Hospital of Wenzhou Medical University, No.2 Fuxue Lane, Wenzhou, 325000 China
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Ono T, Azuma K, Kawahara A, Sasada T, Matsuo N, Kakuma T, Kamimura H, Maeda R, Hattori C, On K, Nagata K, Sato F, Chitose SI, Shin B, Aso T, Akiba J, Umeno H. Prognostic stratification of patients with nasopharyngeal carcinoma based on tumor immune microenvironment. Head Neck 2018; 40:2007-2019. [DOI: 10.1002/hed.25189] [Citation(s) in RCA: 34] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2017] [Revised: 01/06/2018] [Accepted: 03/02/2018] [Indexed: 12/30/2022] Open
Affiliation(s)
- Takeharu Ono
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Koichi Azuma
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Akihiko Kawahara
- Department of Diagnostic Pathology; Kurume University Hospital; Kurume Fukuoka Japan
| | - Tetsuro Sasada
- Cancer Vaccine Center; Kanagawa Cancer Center Research Institute; Yokohama Japan
| | - Norikazu Matsuo
- Division of Respirology, Neurology, and Rheumatology, Department of Internal Medicine; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Tatsuyuki Kakuma
- Biostatistics Center; Kurume University School of Medicine; Kurume Fukuoka Japan
| | | | - Ririko Maeda
- Department of Otolaryngology; Omuta City Hospital; Omuta Fukuoka Japan
| | - Chikayuki Hattori
- Department of Radiology; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Kotaro On
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
- Department of Otolaryngology; St. Mary's Hospital; Kurume Fukuoka Japan
| | - Kei Nagata
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
- Department of Otolaryngology; Yame General Hospital; Yame Fukuoka Japan
| | - Fumihiko Sato
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Shun-ich Chitose
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Buichiro Shin
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
| | - Takeichiro Aso
- Department of Otolaryngology; Iizuka Hospital; Iizuka Fukuoka Japan
| | - Jun Akiba
- Department of Diagnostic Pathology; Kurume University Hospital; Kurume Fukuoka Japan
| | - Hirohito Umeno
- Department of Otolaryngology - Head and Neck Surgery; Kurume University School of Medicine; Kurume Fukuoka Japan
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14
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Li C, Wang Y. Factors associated with early diagnosis in pediatric vs adult nasopharyngeal carcinoma. Acta Otolaryngol 2018; 138:56-59. [PMID: 28875765 DOI: 10.1080/00016489.2017.1371330] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
OBJECTIVE To improve understanding of the initial symptom between pediatric and adult nasopharyngeal carcinoma (NPC) and to improve the early diagnosis of NPC. METHODS This retrospective cohort study included all 353 patients with a primary diagnosis of NPC in the First Affiliated Hospital of Zhengzhou University from January 2010 to December 2016. Of these, 34 patients were 21 years or younger (pediatric); 319 patients, older than 21 years (adult). Data were analyzed after data collection. RESULTS We found no difference between pediatric and adult patients in terms of their sex distribution (p > .05).Type III, undifferentiated carcinoma is the most common subtype in Pediatric patients, while adult patients had more squamous cell tumors (p < .01). Pediatric patients were more likely to present with stage IV disease (p < .05). Of the 353 patients, 120 (34.0%) had only one presenting symptom initially; however, most patients presented two or more episodes. Neck mass was the most common presenting symptom initially in children and adolescents, while multiple ear symptoms in adult patients (p = .003). The median time from onset of the presenting symptom to diagnosis is three months, adult patient presented longer history (64.7% vs 44.55, p < .05). Of the 319 adult patients, there were 142 which the time from onset of the presenting symptom to diagnosis is less than 3 months and there were 177 more than 3 months, the difference was significant between the two groups (p < .05). There were no differences in the misdiagnosis rate between pediatric and adult (35.1 vs 31.0, p > .05). Among pediatric patients, 31 (91.2%) had positive EBV DNA in peripheral plasma. EBV DNA was significantly associated with stage (p < .05). CONCLUSIONS Although uncommon, pediatric NPC appears to affect a different patient demographic relative to adult NPC. NPC in children is associated with undifferentiated carcinoma and more advanced disease presentation.
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Affiliation(s)
- Chang Li
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
| | - Ying Wang
- Department of Otolaryngology, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, PR China
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Induction Methotrexate, Cisplatin, and 5-Fluorouracil Versus Cisplatin and 5-Fluorouracil Followed by Radiotherapy in Pediatric Nasopharyngeal Carcinoma: A Retrospective Analysis in a Tertiary Cancer Center. J Pediatr Hematol Oncol 2017; 39:e437-e442. [PMID: 28816803 DOI: 10.1097/mph.0000000000000933] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The purpose of this study is to compare treatment outcomes of methotrexate, cisplatin, and 5-fluorouracil (MPF) or cisplatin and 5-fluorouracil (PF) in pediatric NPC patients treated with sequential chemoradiotherapy. PATIENTS AND METHODS A total of 25 patients aged 18 years or below with stage II-IV NPC treated with IC using PF (n=16) or MPF (n=9) followed by radiotherapy between 2003 and 2009 were retrospectively reviewed. Radiotherapy dose was 61.2 to 66.6 Gy to the gross disease. Age, stage, radiation dose, and chemotherapy regimen were tested as prognostic factors for event-free survival (EFS) and overall survival (OS) on univariate and multivariate analyses. RESULTS The median age at diagnosis was 13.3 years. All patients completed planned chemotherapy. All patients who received MPF achieved PR whereas 15 patients (93.8%) who received PF achieved PR (P=1). There were no differences in EFS (68.75% vs. 66.67%; P=0.84) and OS (81.25% vs. 66.67%; P=0.39) at 5 years between PF and MPF, respectively. On multivariate analysis, only tumor stage (IV vs. II-III) predicted worse OS (hazard ratio, 10.3; 95% confidence interval, 1.197-88.974) but not EFS (hazard ratio, 4.805; 95% confidence interval, 0.95-24.336). Distant metastases was the predominant site of failure, seen in 5 patients (20%). CONCLUSIONS Omission of methotrexate from the induction chemotherapy regimen did not affect treatment outcome.
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Das A, Mallick I, Arun P, Midha D, Sen S, Krishnan S, Bhattacharyya A. Encouraging Outcomes With Manageable Toxicity Using Neoadjuvant Chemotherapy and Intensity-modulated Radiotherapy in Advanced Pediatric Nasopharyngeal Carcinoma: Single-Center Experience From a Developing Country. J Pediatr Hematol Oncol 2017; 39:318-319. [PMID: 28234743 DOI: 10.1097/mph.0000000000000794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Affiliation(s)
- Anirban Das
- Departments of *Pediatric Hematology-Oncology †Radiation Oncology ‡Head and Neck Surgery §Histopathology ∥Radiology, Tata Medical Center Kolkata, India
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A retrospective study comparing the outcomes and toxicities of intensity-modulated radiotherapy versus two-dimensional conventional radiotherapy for the treatment of children and adolescent nasopharyngeal carcinoma. J Cancer Res Clin Oncol 2017; 143:1563-1572. [PMID: 28342002 PMCID: PMC5504129 DOI: 10.1007/s00432-017-2401-y] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2017] [Accepted: 03/17/2017] [Indexed: 11/25/2022]
Abstract
Purpose To compare the clinical outcomes and toxicities of two-dimensional conventional radiotherapy (2D-CRT) and intensity-modulated radiotherapy (IMRT) for the treatment of children and adolescent nasopharyngeal carcinoma (NPC). Methods A total of 176 children with non-metastatic NPC treated at Sun Yat-sen University Cancer Center between October 2003 and September 2013 were included in this study. Of the 176 patients, 74 received 2D-CRT and 102 were treated with IMRT. The clinical outcomes and acute and late toxicities were determined and compared. Results The IMRT group achieved significantly higher overall survival (OS) (90.4% vs. 76.1% at 5 year, P = 0.007) and disease-free survival (DFS) (85.7% vs. 71.2%, P = 0.029) mainly due to an improvement in locoregional relapse-free survival (LRRFS) (97.9 vs. 88.3%, P = 0.049). After stratification by disease stage, IMRT provided significant benefits for patients with stage III–IV disease in terms of OS, LRRFS and DFS. Multivariate analyses indicated that the treatment group (2D-CRT vs. IMRT) was a prognostic factor for OS, LRRFS and DFS. A significant reduction in Grade 2–4 xerostomia (52.7 vs. 34.3%, P = 0.015) and hearing loss (40.5 vs. 22.5%, P = 0.010) was observed in patients treated by IMRT. Conclusion IMRT provides better locoregional relapse-free survival and overall survival, especially in late-stage children and adolescent NPC patients, and is associated with a lower incidence of Grade 2–4 xerostomia as well as hearing loss compared with 2D-CRT. Distant metastasis remains a challenge in the treatment of children and adolescent NPC.
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18
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Paulino AC. The promise of intensity modulated radiation therapy. Pediatr Blood Cancer 2016; 63:1513-4. [PMID: 27231828 DOI: 10.1002/pbc.26081] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2016] [Accepted: 05/02/2016] [Indexed: 12/25/2022]
Affiliation(s)
- Arnold C Paulino
- Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas
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Lu S, Chang H, Sun X, Zhen Z, Sun F, Zhu J, Wang J, Huang J, Liao R, Guo X, Lu L, Gao Y. Long-Term Outcomes of Nasopharyngeal Carcinoma in 148 Children and Adolescents. Medicine (Baltimore) 2016; 95:e3445. [PMID: 27124036 PMCID: PMC4998699 DOI: 10.1097/md.0000000000003445] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
The aim of this study was to investigate the survival and long-term morbidities of nasopharyngeal carcinoma (NPC) in children and adolescents.We retrospectively reviewed children and adolescents with NPC treated at Sun Yat-sen University Cancer Center from February 1991 to October 2010, where the prognostic factors and long-term effects of therapy were analyzed.A total of 148 patients were identified. The median age was 15 years old (range, 5-18 years) and the male to female ratio was 3.6:1. Most of the tumor histopathology was undifferentiated nonkeratinizing carcinoma (97.3%). The number of patients staged with IVa, IVb, IVc, III, and II were 45 (30.4%), 12 (8.1%), 5 (3.4%), 70 (47.3%), and 16 (10.8%), respectively. For the whole series with a median follow-up of 81 months (range, 6-282 months), the 5-year overall survival (OS) and disease-free survival (DFS) ratios were 79.3% and 69.7%, respectively. We observed significant differences in the 5-year OS (81.1% vs 25.0%, P = 0.002) and the DFS rates (72.2% vs 0.0%, P = 0.000) between patients with stage II to IVb disease and stage IVc disease. For patients with stage II, III, IVa, and IVb disease, we found a high radiation dose (dose > 66 Gy to the primary lesion) would not significantly improve the survival compared to the sub-high radiation dose group (dose = 60-66 Gy to the primary lesion), even considering the type of radiation therapy technologies. However, the incidences of sequelae (grades I-IV) in patients with high radiation dose were apparently higher than those in patients with low radiation dose.Considering the late sequelae, a dose of 60 to 66 Gy to the primary lesions seems to be enough for children and adolescents with NPC.
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Affiliation(s)
- Suying Lu
- From the State Key Laboratory of Oncology in South China (SL, HC, XS, ZZ, FS, JZ, JW, JH, RL, XG, LL, YG); Collaborative Innovation Center of Cancer Medicine (SL, HC, XS, ZZ, FS, JZ, JW, JH, RL, XG, LL, YG); and Departments of Pediatric Oncology (SL, XS, ZZ, FS, JZ, JW, JH, RL, XG) and Radiation Oncology (HC, LL, YG), Sun Yat-sen University Cancer Center, Guangzhou, Guangdong, China
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20
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Khalil EM, Anwar MM. Treatment results of pediatric nasopharyngeal carcinoma, NCI, Cairo University experience. J Egypt Natl Canc Inst 2015; 27:119-28. [DOI: 10.1016/j.jnci.2015.06.004] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2015] [Revised: 06/19/2015] [Accepted: 06/20/2015] [Indexed: 10/23/2022] Open
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21
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Guo Q, Cui X, Lin S, Lin J, Pan J. Locoregionally advanced nasopharyngeal carcinoma in childhood and adolescence: Analysis of 95 patients treated with combined chemotherapy and intensity-modulated radiotherapy. Head Neck 2015; 38 Suppl 1:E665-72. [PMID: 25867086 DOI: 10.1002/hed.24066] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2014] [Revised: 01/30/2015] [Accepted: 04/10/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND The purpose of this study was to evaluate the treatment outcomes and toxicities of intensity-modulated radiation therapy (IMRT) for children and adolescents with locoregionally advanced nasopharyngeal carcinoma (NPC). METHODS Ninety-five patients of <25 years old in locoregionally advanced NPC (stage III-IVB) were analyzed. All were given neoadjuvant chemotherapy followed by IMRT with or without concurrent chemotherapy/adjuvant chemotherapy. RESULTS The 4-year overall survival (OS), locoregional relapse-free survival, progression-free survival (PFS), and distant metastasis-free survival (DMFS) were 90.8%, 94.9%, 79.1%, and 84.0%, respectively. N classification was the only significant predicting factor for OS, PFS, and DMFS, with the p value of .017, .015, and 0.054, respectively. The main long-term complications were xerostomia, hearing impairment, and neck fibrosis. CONCLUSION Neoadjuvant chemotherapy followed by IMRT with or without concurrent/adjuvant chemotherapy produced a superb treatment outcome in children and adolescents with stage III to IVB disease. Distant metastasis was the main failure. More effective treatment strategies are urgently needed to further improve the long-term survival. © 2015 Wiley Periodicals, Inc. Head Neck 38: E665-E672, 2016.
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Affiliation(s)
- Qiaojuan Guo
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Xiaofei Cui
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Shaojun Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Jin Lin
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
| | - Jianji Pan
- Department of Radiation Oncology, Fujian Provincial Cancer Hospital, Fuzhou, Fujian, China.,Provincial Clinical College, Fujian Medical University, Fuzhou, Fujian, China.,Fujian Provincial Key Laboratory of Translational Cancer Medicine, Fuzhou, Fujian, China
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22
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Liu W, Tang Y, Gao L, Huang X, Luo J, Zhang S, Wang K, Qu Y, Xiao J, Xu G, Yi J. Nasopharyngeal carcinoma in children and adolescents - a single institution experience of 158 patients. Radiat Oncol 2014; 9:274. [PMID: 25477058 PMCID: PMC4264314 DOI: 10.1186/s13014-014-0274-7] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2014] [Accepted: 11/24/2014] [Indexed: 11/23/2022] Open
Abstract
Background To evaluate the clinical features, treatment results, prognostic factors and late toxicities of nasopharyngeal carcinoma in children and adolescents. Methods Between January 1990 and January 2011, 158 NPC patients younger than 20 years old were treated in our institution, and the patient’s clinical characteristics, treatment modalities, outcomes and prognostic factors were retrospectively analyzed. Results There were 9 (5.7%) patients in stage II, 60 (38.0%) in stage III and 89 (56.3%) in stage IV according to the UICC2002 staging system. Neck mass (32.3%), headache (21.5%) and nasal obstruction (15.2%) were the most common chief complaints. With a median follow-up time of 62.5 months (range 2.0-225.0 months), the 5-year overall survival (OS) rate, local-regional control (LRC) rate and distant metastasis-free survival (DMFS) rate were 82.6%, 94.9% and 76.4%, respectively. There were 43 (27.2%) patients failed during the follow up, with seven local-regional recurrences and 38 distant metastases. In univariate analysis, the 5-year OS of T4 and T1-3 were 75% and 87.9%, p = 0.01, stage IV and stage II-III were 77.1% and 90%, p = 0.04, respectively. In multivariate analysis, T4 (p = 0.02) and stage IV (p = 0.04) were the independent adverse prognostic factors for OS. Significant reduction in trismus (27.3% v 3.6%, p = 0.03) and G2 xerostomia (37.9% v 10.3%, p = 0.02) was observed in patients treated by IMRT. Conclusions Most childhood and adolescence nasopharyngeal carcinoma patients were locally advanced diseases at first diagnosed. The treatment results of radiotherapy, with or without chemotherapy, are excellent in our institution. Reducing distant metastasis with new strategies and late toxicities with intensity-modulated radiotherapy are the future directions for the treatment of adolescent nasopharyngeal carcinoma.
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Affiliation(s)
- Weixin Liu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Yuan Tang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Li Gao
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Xiaodong Huang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Jingwei Luo
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Shiping Zhang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Kai Wang
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Yuan Qu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Jianping Xiao
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Guozhen Xu
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
| | - Junlin Yi
- Department of Radiation Oncology, Cancer Hospital, Chinese Academy of Medical Sciences. No 17, Panjiayuannanli, Chaoyang District, Beijing, 100021, China.
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Ferrari A, Casanova M, Massimino M, Sultan I. Peculiar features and tailored management of adult cancers occurring in pediatric age. Expert Rev Anticancer Ther 2014; 10:1837-51. [DOI: 10.1586/era.10.105] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Tao CJ, Liu X, Tang LL, Mao YP, Chen L, Li WF, Yu XL, Liu LZ, Zhang R, Lin AH, Ma J, Sun Y. Long-term outcome and late toxicities of simultaneous integrated boost-intensity modulated radiotherapy in pediatric and adolescent nasopharyngeal carcinoma. CHINESE JOURNAL OF CANCER 2013; 32:525-32. [PMID: 24016394 PMCID: PMC3845542 DOI: 10.5732/cjc.013.10124] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The application of simultaneous integrated boost-intensity modulated radiotherapy (SIB-IMRT) in pediatric and adolescent nasopharyngeal carcinoma (NPC) is underevaluated. This study aimed to evaluate long-term outcome and late toxicities in pediatric and adolescent NPC after SIB-IMRT combined with chemotherapy. Thirty-four patients (aged 8–20 years) with histologically proven, non-disseminated NPC treated with SIB-IMRT were enrolled in this retrospective study. The disease stage distribution was as follows: stage I, 1 (2.9%); stage III, 14 (41.2%); and stage IV, 19 (55.9%). All patients underwent SIB-IMRT and 30 patients also underwent cisplatin-based chemotherapy. The prescribed dose of IMRT was 64–68 Gy in 29–31 fractions to the nasopharyngeal gross target volume. Within the median follow-up of 52 months (range, 9–111 months), 1 patient (2.9%) experienced local recurrence and 4 (11.8%) developed distant metastasis (to the lung in 3 cases and to multiple organs in 1 case). Four patients (11.8%) died due to recurrence or metastasis. The 5-year locoregional relapse–free survival, distant metastasis–free survival, disease-free survival, and overall survival rates were 97.1%, 88.2%, 85.3%, and 88.2%, respectively. The most common acute toxicities were grades 3–4 hematologic toxicities and stomatitis. Of the 24 patients who survived for more than 2 years, 16 (66.7%) and 15 (62.5%) developed grades 1–2 xerostomia and ototoxicity, respectively. Two patients (8.3%) developed grade 3 ototoxicity; no grade 4 toxicities were observed. SIB-IMRT combined with chemotherapy achieves excellent long-term locoregional control in pediatric and adolescent NPC, with mild incidence of late toxicities. Distant metastasis is the predominant mode of failure.
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Affiliation(s)
- Chang-Juan Tao
- State Key Laboratory of Oncology in South China; Department of Radiation Oncology, Sun Yat-sen University Cancer Center, Guangzhou, Guangdong 510060, P. R. China. ,
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Yan Z, Xia L, Huang Y, Chen P, Jiang L, Zhang B. Nasopharyngeal carcinoma in children and adolescents in an endemic area: a report of 185 cases. Int J Pediatr Otorhinolaryngol 2013; 77:1454-60. [PMID: 23830224 DOI: 10.1016/j.ijporl.2013.06.005] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2013] [Revised: 06/02/2013] [Accepted: 06/04/2013] [Indexed: 10/26/2022]
Abstract
BACKGROUND This study aimed to demonstrate the clinical and therapeutic features of nasopharyngeal carcinoma (NPC) in children and adolescents in Southern China, an endemic area. PATIENTS AND METHODS A total of 185 newly diagnosed NPC patients younger than 21 years old in the Sun Yat-sen University Cancer Center from 1993 to 2011 were retrospectively analyzed. Overall survival (OS) rate estimates and Kaplan-Meier survival curves were calculated. Cox proportional hazard ratios (HRs) were used to identify independent prognostic factors for survival. Chi-square test was used to compare the incidence of sequelae and the stage distribution between different subgroups. RESULTS Most patients were male (71.4%). The main presenting symptoms were neck mass (44.9%), tinnitus/hearing loss (36.2%), bloody nasal discharge (22.7%), headache (22.2%), and nasal obstruction (20.0%). Stage I, II, III, and IV patients accounted for 1.1%, 8.1%, 43.8%, and 47.0%, respectively, of the total number of patients included in the study. All patients were treated by radiotherapy: 39 Gy-84 Gy to primary tumors (median, 68 Gy) and 36 Gy-74 Gy to cervical lymph nodes (median, 60 Gy); 84.3% of the patients were treated by chemotherapy either. The complete response rate was 94.1%. The 5-, 10-, and 15-year survival rates were 78% ± 4%, 70% ± 5%, and 66% ± 6%, respectively. Tumor node metastasis (TNM) stage was the statistically significant predictor of distal metastasis and OS. Distal metastasis was the major pattern of treatment failure. The main long-term complications of therapy were xerostomia (47.0%), hearing loss (28.1%), neck fibrosis (24.3%), trismus (12.4%), glossolalia (7.0%), and radiation encephalopathy (5.4%). The incidences of these morbidities were significantly higher in the high radiation dose (more than the median) group than in the low radiation dose group (less than or equal to the median), while no differences in survival were observed. CONCLUSIONS In spite of the majority of patients diagnosed at the advanced stage, children and adolescents with NPC had excellent survival except metastatic disease. The TNM stage was the most relevant prognostic factor. A higher radiation dose (>68 Gy) could not improve survival but could increase long-term morbidities.
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Affiliation(s)
- Zheng Yan
- VIP Region, Sun Yat-sen University Cancer Center, 651 Dongfeng East Road, Guangzhou 510060, China
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Hu S, Xu X, Xu J, Xu Q, Liu S. Prognostic factors and long-term outcomes of nasopharyngeal carcinoma in children and adolescents. Pediatr Blood Cancer 2013; 60:1122-7. [PMID: 23303571 DOI: 10.1002/pbc.24458] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/23/2012] [Accepted: 12/04/2012] [Indexed: 11/08/2022]
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is a rare malignancy in children and adolescents, and the optimal treatment modality in youths has not been established. The aim of this study was to evaluate the long-term treatment outcomes and complications associated with childhood and adolescent NPC. PROCEDURE From January 1985 to December 2004, the records of 95 patients with NPC and younger than 20 years of age were reviewed. All of the records were confirmed based on pathology via biopsy. The radiation doses to the primary tumors ranged from 64 to 80 Gy. The radiation doses to the metastatic cervical lymph nodes ranged from 60 to 74 Gy. The fractionated doses ranged from 1.8 to 2.0 Gy at 5 fractions/week. A total of 36 patients received chemotherapy before radiotherapy. RESULTS The 1-, 3-, 5-, 10-, and 15-year overall survival (OS) rates were 92.6%, 63.2%, 54.7%, 46.8%, and 42.6%, respectively. The 1-, 3-, 5-, 10-, and 15-year disease-free survival (DFS) rates were 73.7%, 51.3%, 49.1%, 44.6%, and 42.6%, respectively. The clinical stage had a significant impact on OS (P = 0.007) and DFS (P = 0.012). Complete responders to therapy had superior OS (P < 0.001) and DFS (P < 0.001). Patients >12 years of age had better OS (P = 0.026) and DFS (P = 0.037). CONCLUSIONS Children and adolescents with advanced NPC had a relatively good rate of long-term survival. However, 28% of the survivors had serious long-term treatment-related morbidities. In addition to clinical stage and complete response or partial response, age was an independent prognostic factor in pediatric and adolescent NPC.
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Affiliation(s)
- Songliu Hu
- Department of Radiation Oncology, The Third Affiliated Hospital of Harbin Medical University, Harbin, China
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Avanzo M, Drigo A, Ren Kaiser S, Roggio A, Sartor G, Chiovati P, Franchin G, Mascarin M, Capra E. Dose to the skin in helical tomotherapy: Results of in vivo measurements with radiochromic films. Phys Med 2013; 29:304-11. [DOI: 10.1016/j.ejmp.2012.04.004] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/02/2011] [Revised: 04/10/2012] [Accepted: 04/14/2012] [Indexed: 12/21/2022] Open
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Ji X, Xie C, Hu D, Fan X, Zhou Y, Zheng Y. Survival benefit of adding chemotherapy to intensity modulated radiation in patients with locoregionally advanced nasopharyngeal carcinoma. PLoS One 2013; 8:e56208. [PMID: 23441169 PMCID: PMC3575472 DOI: 10.1371/journal.pone.0056208] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2012] [Accepted: 01/07/2013] [Indexed: 11/18/2022] Open
Abstract
Background To evaluate the contribution of chemotherapy for patients with locoregionally advanced nasopharyngeal carcinoma (NPC) treated by intensity modulated radiotherapy (IMRT) and to identify the optimal combination treatment strategy. Patients and Methods Between 2006 and 2010, 276 patients with stage II-IVb NPC were treated by IMRT alone or IMRT plus chemotherapy. Cisplatin-based chemotherapy included neoadjuvant or concurrent, or neoadjuvant plus concurrent protocols. The IMRT alone and chemoradiotherapy groups were well-matched for prognostic factors, except N stage, with more advanced NPC in the chemoradiotherapy arm. Results With a mean follow-up of 33.8 months, the 3-year actuarial rates of overall survival (OS), metastasis-free survival (MFS), relapse-free survival (RFS), and disease-free survival (DFS) were 90.3%, 84.2%, 80.3%, and 69.2% for all of the patients, respectively. Compared with the IMRT alone arm, patients treated by concurrent chemoradiotherapy had a significantly better DFS (HR = 2.64; 95% CI, 1.12−6.22; P = 0.03), patients with neoadjuvant-concurrent chemoradiotherapy had a significant improvement in RFS and DFS (HR = 4.03; 95% CI, 1.35−12.05; P = 0.01 and HR = 2.43; 95% CI, 1.09−5.44; P = 0.03), neoadjuvant chemoradiotherapy provided no significant benefit in OS, MFS, RFS, and DFS. Stage group and alcohol consumption were prognostic factors for OS and N stage was a significant predictor for DFS. Conclusions Addition of concurrent or neoadjuvant-concurrent chemotherapy to IMRT is available to prolong RFS or DFS for locoregionally advanced NPC. Such work could be helpful to guide effective individualized therapy.
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Affiliation(s)
- Xuemei Ji
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
- * E-mail: (XJ); (CX)
| | - Conghua Xie
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
- * E-mail: (XJ); (CX)
| | - Desheng Hu
- Department of Radiation Oncology, Tumor Hosptal of Hubei Province, Wuhan, China
| | - Xia Fan
- Department of Radiation and Medical Oncology, Zhongnan Hospital, Wuhan University, Wuhan, China
| | - Yajuan Zhou
- Department of Radiation Oncology, Tumor Hosptal of Hubei Province, Wuhan, China
| | - Yingjie Zheng
- Department of Radiation Oncology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
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Paediatric nasopharyngeal carcinoma: an 8-year study from a tertiary care cancer centre in South India. Indian J Otolaryngol Head Neck Surg 2013; 65:131-4. [PMID: 24427629 DOI: 10.1007/s12070-013-0622-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2012] [Accepted: 01/25/2013] [Indexed: 10/27/2022] Open
Abstract
Nasopharyngeal carcinoma (NPC) accounts for less than 1 % of all paediatric cancers. Advances in imaging, radiation delivery, chemotherapy and improvement in multidisciplinary care have resulted in drastic changes in the outcome of this disease. Since NPC is extremely rare in paediatric population and there is paucity of data in Indian patients, we conducted the present study to analyze the outcome of paediatric NPC. Eighteen patients aged 18 years or less, who had pathologically proven diagnosis of NPC and had received treatment at our institute from 2003 to 2010 was included for analysis. These patients were treated with radiotherapy and chemotherapy. Event free survival, local and systemic relapse and progression were analysed. These outcomes were correlated with age, radiation dose and the stage of disease. Majority of patients presented with advanced stage and poor histological grade (94.4 % had WHO Type III disease). The median follow up was 38 months (range 3-91 months). The estimated event free survival at a follow up of 5 years was 64.28 %. Distant metastasis at presentation and lower radiation dose were predictive of poor outcome. Paediatric NPC usually presents in an advanced stage. Our results are comparable to studies which have used only chemoradiotherapy, are far inferior to studies which have used chemoradiotherapy and adjuvant immunotherapy. Larger prospective studies are required to define the role of adjuvant immunotherapy, the optimum dose and schedule of chemoradiotherapy and role of new agents like cetuximab in Indian paediatric patients.
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Nguyen NP, Ceizyk M, Vinh-Hung V, Sroka T, Jang S, Khan R, Locke A, Albala G, Truong C, Godinez J, Vo R, Smith-Raymond L. Feasibility of tomotherapy to reduce cochlea radiation dose in patients with locally advanced nasopharyngeal cancer. TUMORI JOURNAL 2012; 98:709-14. [DOI: 10.1177/030089161209800606] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims and background To evaluate the effectiveness of tomotherapy-based image-guided radiotherapy (IGRT) on the radiation dose to the cochlea in patients with nasopharyngeal cancer. Methods and study design A retrospective review of five patients undergoing concurrent chemoradiation with tomotherapy for locally advanced nasopharyngeal cancer was performed. Results The mean dose to the right and left cochlea was 25 Gy and 35.3 Gy respectively, while the dose to the gross tumor ranged from 70 to 75 Gy. All patients had excellent clinical response to the treatment at a median follow-up of five months. Conclusions IGRT for head and neck cancer delivered by tomotherapy can significantly decrease the radiation dose to the cochlea without sacrificing target volume coverage.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Misty Ceizyk
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, University Hospitals of Geneva, Geneva, Switzerland
| | - Thomas Sroka
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Siyoung Jang
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Rihan Khan
- Department of Radiology, University of Arizona, Tucson, AZ, USA
| | - Angela Locke
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Gabby Albala
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Christina Truong
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA
| | - Juan Godinez
- Florida Radiation Oncology Group, Palatka, FL, USA
| | - Richard Vo
- University of Galveston Medical School, Galveston, TX, USA
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Kalapurakal JA, Pokhrel D, Gopalakrishnan M, Zhang Y. Advantages of whole-liver intensity modulated radiation therapy in children with Wilms tumor and liver metastasis. Int J Radiat Oncol Biol Phys 2012; 85:754-60. [PMID: 22763026 DOI: 10.1016/j.ijrobp.2012.05.024] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2012] [Revised: 05/09/2012] [Accepted: 05/14/2012] [Indexed: 11/28/2022]
Abstract
PURPOSE To demonstrate the dosimetric advantages of intensity modulated radiation therapy (IMRT) in children with Wilms tumor (WT) undergoing whole-liver (WL) RT. METHODS AND MATERIALS Computed tomography simulation scans of 10 children, either 3 (3D) or 4-dimensional (4D), were used for this study. The WL PTV was determined by the 3D or 4D liver volumes, with a margin of 1 cm. A total of 40 WL RT plans were performed: 10 each for left- and right-sided WT with IMRT and anteroposterior-posteroanterior (AP-PA) techniques. The radiation dose-volume coverage of the WL planning target volume (PTV), remaining kidney, and other organs were analyzed and compared. RESULTS The 95% dose coverage to WL PTV for left and right WT were as follows: 97% ± 4% (IMRT), 83% ± 8% (AP-PA) (P<.01) and 99% ± 1% (IMRT), 94% ± 5% (AP-PA) (P<.01), respectively. When 3D WL PTV was used for RT planning, the AP-PA technique delivered 95% of dose to only 78% ± 13% and 88% ± 8% of 4D liver volume. For left WT, the right kidney V15 and V10 for IMRT were 29% ± 7% and 55% ± 8%, compared with 61% ± 29% (P<.01) and 78% ± 25% (P<.01) with AP-PA. For right WT, the left kidney V15 and V10 were 0 ± 0 and 2% ± 3% for IMRT, compared with 25% ± 19% (P<.01) and 40% ± 31% (P<.01) for AP-PA. CONCLUSIONS The use of IMRT and 4D treatment planning resulted in the delivery of a higher RT dose to the liver compared with the standard AP-PA technique. Whole-liver IMRT also delivered a significantly lower dose to the remaining kidney.
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Affiliation(s)
- John A Kalapurakal
- Department of Radiation Oncology, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois, USA.
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De Neve W, De Gersem W, Madani I. Rational use of intensity-modulated radiation therapy: the importance of clinical outcome. Semin Radiat Oncol 2012; 22:40-9. [PMID: 22177877 DOI: 10.1016/j.semradonc.2011.09.003] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
During the last 2 decades, intensity-modulated radiation therapy (IMRT) became a standard technique despite its drawbacks of volume delineation, planning, robustness of delivery, challenging quality assurance, and cost as compared with non-IMRT. The theoretic advantages of IMRT dose distributions are generally accepted, but the clinical advantages remain debatable because of the lack of clinical assessment of the effort that is required to overshadow the disadvantages. Rational IMRT use requires a positive advantage/drawback balance. Only 5 randomized clinical trials (RCTs), 3 in the breast and 2 in the head and neck, which compare IMRT with non-IMRT (2-dimensional technique in four fifths of the trials), have been published (as of March 2011), and all had toxicity as the primary endpoint. More than 50 clinical trials compared results of IMRT-treated patients with a non-IMRT group, mostly historical controls. RCTs systematically showed a lower toxicity in IMRT-treated patients, and the non-RCTs confirmed these findings. Toxicity reduction, counterbalancing the drawbacks of IMRT, was convincing for breast and head and neck IMRT. For other tumor sites, the arguments favoring IMRT are weaker because of the inability to control bias outside the randomized setting. For anticancer efficacy endpoints, like survival, disease-specific survival, or locoregional control, the balance between advantages and drawbacks is fraught with uncertainties because of the absence of robust clinical data.
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Affiliation(s)
- Wilfried De Neve
- Department of Radiotherapy, Ghent University Hospital, Ghent, Belgium.
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Buehrlen M, Zwaan CM, Granzen B, Lassay L, Deutz P, Vorwerk P, Staatz G, Gademann G, Christiansen H, Oldenburger F, Tamm M, Mertens R. Multimodal treatment, including interferon beta, of nasopharyngeal carcinoma in children and young adults. Cancer 2012; 118:4892-900. [DOI: 10.1002/cncr.27395] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2011] [Revised: 11/10/2011] [Accepted: 11/18/2011] [Indexed: 11/08/2022]
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Mascarin M, Giugliano FM, Coassin E, Drigo A, Chiovati P, Dassie A, Franchin G, Minatel E, Trovò MG. Helical tomotherapy in children and adolescents: dosimetric comparisons, opportunities and issues. Cancers (Basel) 2011; 3:3972-90. [PMID: 24213120 PMCID: PMC3763405 DOI: 10.3390/cancers3043972] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2011] [Revised: 10/07/2011] [Accepted: 10/17/2011] [Indexed: 01/26/2023] Open
Abstract
Helical Tomotherapy (HT) is a highly conformal image-guided radiation technique, introduced into clinical routine in 2006 at the Centro di Riferimento Oncologico Aviano (Italy). With this new technology, intensity-modulated radiotherapy (IMRT) is delivered using a helicoidal method. Here we present our dosimetric experiences using HT in 100 children, adolescents and young adults treated from May 2006 to February 2011. The median age of the patients was 13 years (range 1-24). The most common treated site was the central nervous system (50; of these, 24 were craniospinal irradiations), followed by thorax (22), head and neck (10), abdomen and pelvis (11), and limbs (7). The use of HT was calculated in accordance to the target dose conformation, the target size and shape, the dose to critical organs adjacent to the target, simultaneous treatment of multiple targets, and re-irradiation. HT has demonstrated to improve target volume dose homogeneity and the sparing of critical structures, when compared to 3D Linac-based radiotherapy (RT). In standard cases this technique represented a comparable alternative to IMRT delivered with conventional linear accelerator. In certain cases (e.g., craniospinal and pleural treatments) only HT generated adequate treatment plans with good target volume coverage. However, the gain in target conformality should be balanced with the spread of low-doses to distant areas. This remains an open issue for the potential risk of secondary malignancies (SMNs) and longer follow-up is mandatory.
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Affiliation(s)
- Maurizio Mascarin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Author to whom correspondence should be addressed; E-Mail: ; Tel.: +39-0434-659-523; Fax: +39-0434-659-524
| | - Francesca Maria Giugliano
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
- Seconda Università di Napoli, Napoli 80138, Italy
| | - Elisa Coassin
- Pediatric Radiotherapy Unit, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (F.M.G.); (E.C.)
| | - Annalisa Drigo
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Paola Chiovati
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Andrea Dassie
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
- Department of Medical Physics, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy
| | - Giovanni Franchin
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
| | - Emilio Minatel
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
| | - Mauro Gaetano Trovò
- Department of Radiation Therapy, Centro di Riferimento Oncologico- National Cancer Institute/Via Franco Gallini, 2 33081 Aviano (PN) Italy; E-Mails: (A.D.); (P.C.); (A.D.); (G.F.); (E.M.); (M.G.T.)
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Casanova M, Bisogno G, Gandola L, Cecchetto G, Di Cataldo A, Basso E, Indolfi P, D'Angelo P, Favini F, Collini P, Potepan P, Ferrari A. A prospective protocol for nasopharyngeal carcinoma in children and adolescents: the Italian Rare Tumors in Pediatric Age (TREP) project. Cancer 2011; 118:2718-25. [PMID: 21918965 DOI: 10.1002/cncr.26528] [Citation(s) in RCA: 61] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 08/02/2011] [Accepted: 08/02/2011] [Indexed: 01/17/2023]
Abstract
BACKGROUND Nasopharyngeal carcinoma (NPC) is very rare in childhood. It differs from its adult counterpart in the prevalence of the nonkeratinizing, undifferentiated subtype and by an advanced clinical stage at onset and better chances of survival. The risk of long-term treatment-related toxicity also may be a more important issue in younger individuals. METHODS A prospective chemoradiotherapy protocol for pediatric NPC was started in Italy in 2000 within the framework of the Rare Tumors in Pediatric Age (TREP) project. Three courses of cisplatin/5-fluorouracil induction chemotherapy were followed by radiotherapy (doses up to 65 grays) with concomitant cisplatin. RESULTS Forty-six patients (ages 9-17 years) were considered eligible for the study over a 10-year period. The ratio of observed to expected cases based on epidemiological data was approximately 1 for both children and adolescents. All but 1 patient had lymph node involvement, and 5 patients had distant metastases. The rate of response to primary chemotherapy was 90%. The 5-year overall and progression-free survival rates were 80.9% and 79.3%, respectively (median follow-up, 62 months). The only statistically significant prognostic variable was the presence or absence of distant metastases. A 65% incidence of late sequelae was reported. CONCLUSIONS This study demonstrates the feasibility and efficacy of a prospective protocol even for such rare tumors as pediatric NPC. The use of lower radiotherapy doses than those used in adults did not affect locoregional failure rates. Long-term follow-up will be needed to obtain more information on both survival and treatment sequelae. The next objective will be to establish broader, international prospective cooperation schemes.
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Affiliation(s)
- Michela Casanova
- Foundation for the Research and Cure of Cancer, National Cancer Institute, Milan, Italy
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Mesbah L, Matute R, Usychkin S, Marrone I, Puebla F, Mínguez C, García R, García G, Beltrán C, Marsiglia H. Helical tomotherapy in the treatment of pediatric malignancies: a preliminary report of feasibility and acute toxicity. Radiat Oncol 2011; 6:102. [PMID: 21871078 PMCID: PMC3224656 DOI: 10.1186/1748-717x-6-102] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2011] [Accepted: 08/26/2011] [Indexed: 01/08/2023] Open
Abstract
Background Radiation therapy plays a central role in the management of many childhood malignancies and Helical Tomotherapy (HT) provides potential to decrease toxicity by limiting the radiation dose to normal structures. The aim of this article was to report preliminary results of our clinical experience with HT in pediatric malignancies. Methods In this study 66 consecutive patients younger than 14 years old, treated with HT at our center between January 2006 and April 2010, have been included. We performed statistical analyses to assess the relationship between acute toxicity, graded according to the RTOG criteria, and several clinical and treatment characteristics such as a dose and irradiation volume. Results The median age of patients was 5 years. The most common tumor sites were: central nervous system (57%), abdomen (17%) and thorax (6%). The most prevalent histological types were: medulloblastoma (16 patients), neuroblastoma (9 patients) and rhabdomyosarcoma (7 patients). A total of 52 patients were treated for primary disease and 14 patients were treated for recurrent tumors. The majority of the patients (72%) were previously treated with chemotherapy. The median prescribed dose was 51 Gy (range 10-70 Gy). In 81% of cases grade 1 or 2 acute toxicity was observed. There were 11 cases (16,6%) of grade 3 hematological toxicity, two cases of grade 3 skin toxicity and one case of grade 3 emesis. Nine patients (13,6%) had grade 4 hematological toxicity. There were no cases of grade 4 non-hematological toxicities. On the univariate analysis, total dose and craniospinal irradiation (24 cases) were significantly associated with severe toxicity (grade 3 or more), whereas age and chemotherapy were not. On the multivariate analysis, craniospinal irradiation was the only significant independent risk factor for grade 3-4 toxicity. Conclusion HT in pediatric population is feasible and safe treatment modality. It is characterized by an acceptable level of acute toxicity that we have seen in this highly selected pediatric patient cohort with clinical features of poor prognosis and/or aggressive therapy needed. Despite of a dosimetrical advantage of HT technique, an exhaustive analysis of long-term follow-up data is needed to assess late toxicity, especially in this potentially sensitive to radiation population.
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Affiliation(s)
- Latifa Mesbah
- Radiotherapy Department, Instituto Madrileño de Oncología (Grupo IMO), Madrid, Spain
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Nguyen NP, Smith-Raymond L, Vinh-Hung V, Sloan D, Davis R, Vos P, Abraham D, Stevie M, Krafft SP, Ly BH, Ries T, Karlsson U, Ceizyk M. Feasibility of Tomotherapy to spare the cochlea from excessive radiation in head and neck cancer. Oral Oncol 2011; 47:414-9. [DOI: 10.1016/j.oraloncology.2011.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 11/27/2022]
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Intensity modulated radiotherapy (IMRT) in bilateral retinoblastoma. Radiol Oncol 2010; 44:194-8. [PMID: 22933915 PMCID: PMC3423696 DOI: 10.2478/v10019-010-0013-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2009] [Accepted: 12/04/2009] [Indexed: 12/05/2022] Open
Abstract
Background External beam radiotherapy (EBRT) for retinoblastoma has traditionally been done with conventional radiotherapy techniques which resulted high doses to the surrounding normal tissues. Case report A 20 month-old girl with group D bilateral retinoblastoma underwent intensity modulated radiotherapy (IMRT) to both eyes after failing chemoreduction and focal therapies including cryotherapy and transpupillary thermotherapy. In this report, we discuss the use of IMRT as a method for reducing doses to adjacent normal tissues while delivering therapeutic doses to the tumour tissues compared with 3-dimensional conformal radiotherapy (3DCRT). At one year follow-up, the patient remained free of any obvious radiation complications. Conclusions Image guided IMRT provides better dose distribution than 3DCRT in retinoblastoma eyes, delivering the therapeutic dose to the tumours and minimizing adjacent tissue damage.
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Cheuk DKL, Billups CA, Martin MG, Roland CR, Ribeiro RC, Krasin MJ, Rodriguez-Galindo C. Prognostic factors and long-term outcomes of childhood nasopharyngeal carcinoma. Cancer 2010; 117:197-206. [PMID: 20737561 DOI: 10.1002/cncr.25376] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2009] [Revised: 02/09/2010] [Accepted: 03/03/2010] [Indexed: 11/12/2022]
Abstract
BACKGROUND The authors studied the survival and long-term morbidities of children with nasopharyngeal carcinoma (NPC). METHODS This was a retrospective review of children with NPC who were treated at St. Jude Children's Research Hospital between 1961 and 2004. Prognostic factors and long term effects of therapy were analyzed. RESULTS Fifty-nine patients (median age, 14.1 years) were identified. Most were male (66.1%) and black (54.2%) and had lymphoepithelioma (93.2%). Thirty-five patients had stage IV disease (59.3%), 20 patients had stage III disease (33.9%), and 4 patients had stage II disease (6.8%). All patients received radiotherapy (RT) to the primary tumor, and most received cervical RT (98.3%) and chemotherapy (88.1%). The 15-year survival and event-free survival (EFS) rates were 67.2% ± 7.5% and 63.5% ± 7.8%, respectively. Five patients (8.5%) developed subsequent malignancies 8.6 to 27 years after NPC diagnosis. EFS was improved in patients who were diagnosed after 1980 (74.8% ± 10% vs 45.5% ± 10.1%; P = .031), in patients who had stage III disease compared with patients who had stage IV disease (79.3% ± 9.6% vs 56.2% ± 11.8%; P = .049), in patients who received cisplatin (81% ± 10.7% vs 45.8% ± 9.7%; P = .013), and in patients who received ≥ 50 grays of RT (71.4% ± 9.3% vs 43.8% ± 11.6%; P = .048). White patients had higher distant failure rates than black patients (41.7% ± 10.4% vs 15.6 ± 6.5%; P = .045). The 15-year cumulative incidence (CI) of any morbidity was 83.7% ± 5.4%, the CI of sensorineural hearing loss was 52.9% ± 6.7%, the CI of primary hypothyroidism was 42.7% ± 6.6%, and the CI of growth hormone deficiency (GHD) was 14.1% ± 4.7%. Dose-response relations were observed between the RT dose and primary hypothyroidism and GHD. CONCLUSIONS The outcome of children with NPC improved over the past 4 decades with the use of cisplatin-based chemotherapy and higher RT doses. However, many survivors had long-term treatment-related morbidities.
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Affiliation(s)
- Daniel Ka Leung Cheuk
- Department of Oncology, St. Jude Children's Research Hospital, Memphis, Tennessee, USA
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A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol (R Coll Radiol) 2010; 22:643-57. [PMID: 20673708 DOI: 10.1016/j.clon.2010.06.013] [Citation(s) in RCA: 166] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 03/03/2010] [Accepted: 06/23/2010] [Indexed: 02/07/2023]
Abstract
AIMS Intensity-modulated radiotherapy (IMRT) is a development of three-dimensional conformal radiotherapy that offers improvements in dosimetry in many clinical scenarios. Here we review the clinical evidence for IMRT and present ongoing or unpublished randomised controlled trials (RCTs). METHODS We identified randomised and non-randomised comparative studies of IMRT and conventional radiotherapy using MEDLINE, hand-searching Radiotherapy and Oncology and the International Journal of Radiation Oncology, Biology and Physics and the proceedings of the American Society for Therapeutic Radiology and Oncology and the European Society for Therapeutic Radiology and Oncology annual meetings. The metaRegister of Controlled Trials was searched to identify completed-unpublished, ongoing and planned RCTs. RESULTS Sixty-one studies comparing IMRT and conventional radiotherapy were identified. These included three RCTs in head and neck cancer (205 patients) and three in breast cancer (664 patients) that had reported clinical outcomes; these were all powered for toxicity-related end points, which were significantly better with IMRT in each trial. There were 27 additional non-randomised studies in head and neck (1119 patients), 26 in prostate cancer (>5000 patients), four in breast cancer (875 patients) and nine in other tumour sites. The results of these studies supported those of the RCTs with benefits reported in acute and late toxicity, health-related quality of life and tumour control end points. Twenty-eight completed-unpublished, ongoing or planned RCTs incorporating IMRT were identified, including at least 12,310 patients, of which 15 compared conventional radiotherapy within IMRT as a randomisation or pre-planned stratification. DISCUSSION Inverse-planned IMRT maintains parotid saliva production and reduces acute and late xerostomia during radiotherapy for locally advanced head and neck cancer, reduces late rectal toxicity in prostate cancer patients allowing safe dose escalation and seems to reduce toxicity in several other tumour sites. Forward-planned IMRT reduces acute toxicity and improves late clinician-assessed cosmesis compared with conventional tangential breast radiotherapy.
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Marcus KJ, Tishler RB. Head and Neck Carcinomas Across the Age Spectrum: Epidemiology, Therapy, and Late Effects. Semin Radiat Oncol 2010; 20:52-7. [PMID: 19959031 DOI: 10.1016/j.semradonc.2009.09.004] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Karen J Marcus
- Division of Radiation Oncology, Children's Hospital Boston, Boston, MA 02115, USA.
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Carcinoma of the Nasopharynx in Young Patients: a Single Institution Experience. Clin Oncol (R Coll Radiol) 2009; 21:617-22. [DOI: 10.1016/j.clon.2009.07.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2008] [Revised: 07/03/2009] [Accepted: 07/13/2009] [Indexed: 11/21/2022]
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Sterzing F, Stoiber EM, Nill S, Bauer H, Huber P, Debus J, Münter MW. Intensity modulated radiotherapy (IMRT) in the treatment of children and adolescents--a single institution's experience and a review of the literature. Radiat Oncol 2009; 4:37. [PMID: 19775449 PMCID: PMC2760561 DOI: 10.1186/1748-717x-4-37] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2009] [Accepted: 09/23/2009] [Indexed: 11/22/2022] Open
Abstract
Background While IMRT is widely used in treating complex oncological cases in adults, it is not commonly used in pediatric radiation oncology for a variety of reasons. This report evaluates our 9 year experience using stereotactic-guided, inverse planned intensity-modulated radiotherapy (IMRT) in children and adolescents in the context of the current literature. Methods Between 1999 and 2008 thirty-one children and adolescents with a mean age of 14.2 years (1.5 - 20.5) were treated with IMRT in our department. This heterogeneous group of patients consisted of 20 different tumor entities, with Ewing's sarcoma being the largest (5 patients), followed by juvenile nasopharyngeal fibroma, esthesioneuroblastoma and rhabdomyosarcoma (3 patients each). In addition a review of the available literature reporting on technology, quality, toxicity, outcome and concerns of IMRT was performed. Results With IMRT individualized dose distributions and excellent sparing of organs at risk were obtained in the most challenging cases. This was achieved at the cost of an increased volume of normal tissue receiving low radiation doses. Local control was achieved in 21 patients. 5 patients died due to progressive distant metastases. No severe acute or chronic toxicity was observed. Conclusion IMRT in the treatment of children and adolescents is feasible and was applied safely within the last 9 years at our institution. Several reports in literature show the excellent possibilities of IMRT in selective sparing of organs at risk and achieving local control. In selected cases the quality of IMRT plans increases the therapeutic ratio and outweighs the risk of potentially increased rates of secondary malignancies by the augmented low dose exposure.
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Affiliation(s)
- Florian Sterzing
- Department of Radiation Oncology, University of Heidelberg, Heidelberg, Germany.
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