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Chen HMN, Anzela A, Hetherington E, Buddle N, Vignarajah D, Hogan D, Fowler A, Forstner D, Chua B, Gowda R, Min M. A proposed framework for the implementation of head and neck cancer treatment at a new cancer center from a radiation oncology perspective. Asia Pac J Clin Oncol 2024; 20:168-179. [PMID: 37186498 DOI: 10.1111/ajco.13963] [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: 11/01/2022] [Revised: 03/18/2023] [Accepted: 03/29/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Establishing a new head and neck cancer (HNC) treatment center requires multidisciplinary team management and expertise. To our knowledge, there are no clear recommendations or guidelines in the literature for the commencement of HNC radiation therapy (RT) at a new cancer center. We propose a novel framework outlining the necessary components required to set-up a new radiation therapy HNC treatment. METHODS We reviewed the infrastructure and methodology in the commencement of HNC radiation therapy in our cancer care center and invited several external, experienced metropolitan head and neck radiation oncologists to develop a novel consensus guideline that may be used by new RT centers to treat HNC. Recommendations were presented to our internal and external staff specialists using a survey questionnaire with ratings utilized to determine consensus using pre-defined thresholds as per the American Society of Clinical Oncology Guidelines Methodology Manual. CONCLUSION This consensus recommendation aims to improve RT utilization whilst advocating for optimal patient outcomes by presenting a framework for new radiation therapy centers ready to step up and manage the treatment of head and neck cancer patients. We propose these evidence-based consensus guidelines endorsed by external HNC radiation oncologists.
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Affiliation(s)
- Hon Ming N Chen
- Illawarra Cancer Care Centre, Wollongong Hospital, Wollongong, Australia
| | - Anzela Anzela
- Central Coast Cancer Centre, Gosford Hospital, Gosford, Australia
| | - Ebony Hetherington
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Nicole Buddle
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - Dinesh Vignarajah
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
| | - David Hogan
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
| | - Allan Fowler
- Liverpool Cancer Therapy Centre, Liverpool Hospital, Liverpool, Australia
| | - Dion Forstner
- GenesisCare, St Vincents Hospital, Sydney, Australia
- School of Clinical Medicine, University of New South Wales, Sydney, Australia
| | - Benjamin Chua
- Cancer Care Services, Royal Brisbane & Women's Hospital, Queensland, Australia
- Faculty of Medicine, University of Queensland, Brisbane, Australia
| | - Raghu Gowda
- Department of Radiation Oncology, Royal Adelaide Hospital, Adelaide, Australia
| | - Myo Min
- Adem Crosby Cancer Centre, Sunshine Coast University Hospital, Sunshine Coast, Australia
- School of Medicine, Griffith University, Brisbane, Australia
- School of Health, University of Sunshine Coast, Sunshine Coast, Australia
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2
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Achard V, Jaccard M, Vanhoutte F, Siva S, Heikkilä R, Dirix P, Liefhooghe N, Otte FX, Gomez-Iturriaga A, Berghen C, Shelan M, Conde-Moreno A, Campos FL, Papachristofilou A, Guckenberger M, Meersschout S, Putora PM, Zwahlen D, Couñago F, Scorsetti M, Eito C, Barrado M, Zapatero A, Muto P, Van De Voorde L, Lamanna G, Koutsouvelis N, Dipasquale G, Ost P, Zilli T. Oligorecurrent nodal prostate cancer: radiotherapy quality assurance of the randomized PEACE V-STORM phase II trial. Radiother Oncol 2022; 172:1-9. [PMID: 35476942 DOI: 10.1016/j.radonc.2022.04.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 12/28/2022]
Abstract
PURPOSE Aim of this study is to report the results of the radiotherapy quality assurance program of the PEACE V-STORM randomized phase II trial for pelvic nodal oligorecurrent prostate cancer (PCa). MATERIAL AND METHODS A benchmark case (BC) consisting of a postoperative case with 2 nodal recurrences was used for both stereotactic body radiotherapy (SBRT, 30 Gy/3 fx) and whole pelvic radiotherapy (WPRT, 45 Gy/25 fx + SIB boost to 65 Gy). RESULTS BC of 24 centers were analyzed. The overall grading for delineation variation of the 1st BC was rated as 'UV' (Unacceptable Variation) or 'AV' (Acceptable Variation) for 1 and 7 centers for SBRT (33%), and 3 and 8 centers for WPRT (46%), respectively. An inadequate upper limit of the WPRT CTV (n=2), a missing delineation of the prostate bed (n=1), and a missing nodal target volume (n=1 for SBRT and WPRT) constituted the observed 'UV'. With the 2nd BC (n=11), the overall delineation review showed 2 and 8 'AV' for SBRT and WPRT, respectively, with no 'UV'. For the plan review of the 2nd BC, all treatment plans were per protocol for WPRT. SBRT plans showed variability in dose normalization (Median D90% = 30.1 Gy, range 22.9-33.2Gy and 30.6 Gy, range 26.8-34.2Gy for nodes 1 and 2 respectively). CONCLUSIONS Up to 46% of protocol deviations were observed in delineation of WPRT for nodal oligorecurrent PCa, while dosimetric results of SBRT showed the greatest disparities between centers. Repeated BC resulted in an improved adherence to the protocol, translating in an overall acceptable contouring and planning compliance rate among participating centers.
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Affiliation(s)
- Vérane Achard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Maud Jaccard
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Frederik Vanhoutte
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium
| | - Shankar Siva
- EJ Whitten Foundation Prostate Cancer Research Centre, Epworth Healthcare and Sir Peter MacCallum Department of Oncology, University of Melbourne, Melbourne, Australia
| | - Reino Heikkilä
- Department of Oncology, Oslo University Hospital, Oslo, Norway
| | - Piet Dirix
- Department of Radiation Oncology, Iridium Kankernetwerk, Antwerp, Belgium and University of Antwerp, Faculty of Medicine and Health Sciences, Antwerp, Belgium
| | - Nick Liefhooghe
- Department of Radiation Oncology, AZ Groeninge, Kortrijk, Belgium
| | - François-Xavier Otte
- Department of Radiation Oncology, Jules Bordet Institute and Hôpital Erasme, University Clinics of Brussels, Université Libre de Bruxelles, Brussels, Belgium
| | - Alfonso Gomez-Iturriaga
- Department of Radiation Oncology, Cruces University Hospital (Biocruces Health Research Institute), Barakaldo, Spain
| | - Charlien Berghen
- Department of Radiation Oncology, University Hospitals Leuven, Leuven, Belgium
| | - Mohamed Shelan
- Department of Radiation Oncology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Antonio Conde-Moreno
- Department of Radiation Oncology, Hospital Universitari i Politècnic la Fe, Valencia, Spain
| | - Fernando López Campos
- Department of Radiation Oncology, Hospital Universitario Ramón y Cajal, Madrid, Spain
| | | | - Matthias Guckenberger
- Department of Radiation Oncology, University Hospital Zürich, University of Zürich, Zürich, Switzerland
| | | | - Paul Martin Putora
- Department of Radiation Oncology, Kantonspital St. Gallen, St. Gallen, Switzerland
| | - Daniel Zwahlen
- Department of Radiation Oncology, Kantonspital Winterthur, Winterthur, Switzerland
| | - Felipe Couñago
- Department of Radiation Oncology, University Hospital Quironsalud, Universidad Europea de Madrid, Madrid, Spain
| | - Marta Scorsetti
- Department of Radiation Oncology, Humanitas Clinical and Research Hospital, IRCSS, Radiotherapy and Radiosurgery Department, Rozzano, Italy
| | - Clara Eito
- Department of Radiation Oncology, Instituto Oncólogico Clinica Universitaria IMQ, Bilbao, Spain
| | - Marta Barrado
- Department of Radiation Oncology, Complejo Hospitalario de Navarra, Navarra, Spain
| | - Almudena Zapatero
- Department of Radiation Oncology, University Hospital La Princesa, Madrid, Spain
| | - Paolo Muto
- Department of Radiation Oncology, Napoli Istituto Nazionale Tumori IRCCS Fondazione Pascale, Napoli, Italy
| | | | - Giorgio Lamanna
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | | | - Giovanna Dipasquale
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland
| | - Piet Ost
- Department of Radiation Oncology, Ghent University Hospital, Ghent, Belgium; Department of Human structure and repair, Ghent University, Ghent, Belgium
| | - Thomas Zilli
- Department of Radiation Oncology, Geneva University Hospital, Geneva, Switzerland.
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3
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Khanna NR, Kumar A, Kataki K, Sehra N, Laskar SG, Mummudi N, Gupta T, Tibdewal A, Pathak R, Wadasadawala T, Krishnatry R, Chopra S, Goda JS, Chatterjee A, Budrukkar A, Gurram L, Engineer R, Murthy V, Swain M, Laskar S, Sarin R, Agarwal JP. Compliance of Radiotherapy Treatment at a Tertiary Cancer Center in India—A Clinical Audit. Indian J Med Paediatr Oncol 2022. [DOI: 10.1055/s-0042-1742666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Abstract
Introduction Noncompliance to planned radiotherapy (RT) treatment is associated with inferior outcomes and also serves as an indicator of quality of care offered to the patients. Identification of the rate of noncompliance and its causative factors can help us develop an insight toward implementing mitigation measures thereby improving the quality of treatment.
Objective To ascertain the incidence of noncompliance and the factors affecting the same in patients offered RT appointments.
Materials and Methods We retrospectively reviewed the records of patients from January 1, 2019, to December 31, 2019, who were noncompliant (defaulted RT simulation or defaulted initiation of RT or defaulted planned RT during the course of RT but excluding planned/unplanned treatment breaks or early conclusions prescribed by the treating radiation oncologist) for the planned RT treatment.
Results Of the 8,607 appointments (7,699 external beam RT and 908 brachytherapy) given to the patients attending the radiation oncology outpatient department in the year 2019, a total of 197 (2.28%) patients were found to be noncomplaint. Ninety-seven patients defaulted RT simulation (49.2%), 53 defaulted RT starting (26.9%), and 47 defaulted while on RT (23.9%). Half of these had either head–neck (29.9%) or gynecological (20.8%) malignancies. Patients with breast cancers had the least noncompliance rates (0.02%). The cause for noncompliance was ascertained in 135 patients (68.5%). The common causes of noncompliance were the desire to continue treatment closer to home (21.5%) followed by logistic (17%), lack of confidence in the curative potential of the planned therapy (17%), and financial reasons (11.8%). Patients with head–neck and gynecological malignancies were more often with advanced staged disease and were planned multimodal treatment protocols. The majority of the 23 patients who defaulted palliative RT were planned for fractionated treatments (73.9%).
Conclusion The incidence of noncompliance in patients planned for RT in our institute can be considered optimum. Appropriate counseling of patients at the time of scheduling appointment, upfront identification of patients at high risk of noncompliance, and assisting patients with financial and logistic challenges are imperative to ensure adherence to planned treatment schedule.
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Affiliation(s)
- Nehal R. Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anuj Kumar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Kaushik Kataki
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Nishtha Sehra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Naveen Mummudi
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Anil Tibdewal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rima Pathak
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Tabassum Wadasadawala
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rahul Krishnatry
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Supriya Chopra
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jayant Sastri Goda
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Abhishek Chatterjee
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Ashwini Budrukkar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Lavanya Gurram
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Reena Engineer
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Vedang Murthy
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Monali Swain
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Siddhartha Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Rajiv Sarin
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, Maharashtra, India
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4
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R Khanna N, Ghosh Laskar S, Gupta T, Agarwal JP. Compliance With Radiotherapy Treatment in an Apex Cancer Center of India. JCO Glob Oncol 2022; 8:e2100201. [PMID: 34985910 PMCID: PMC8769151 DOI: 10.1200/go.21.00201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Nehal R Khanna
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Sarbani Ghosh Laskar
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Tejpal Gupta
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
| | - Jai Prakash Agarwal
- Department of Radiation Oncology, Tata Memorial Centre, Homi Bhabha National Institute, Mumbai, India
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5
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He QS, Wang ZP, Li ZJ, Zhou P, Lian CL, Wu SG, Chen SF. Increased risk of cerebrovascular mortality in head and neck cancer survivors aged ≥ 65 years treated with definitive radiotherapy: a population-based cohort study. Radiat Oncol 2021; 16:185. [PMID: 34544466 PMCID: PMC8454064 DOI: 10.1186/s13014-021-01913-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 09/11/2021] [Indexed: 01/23/2023] Open
Abstract
Background To investigate the relationship between radiotherapy (RT) and the risk of cerebrovascular mortality (CVM) in head and neck cancer (HNC) survivors aged ≥ 65 years. Methods Patients with HNC survivors aged ≥ 65 years diagnosed between 2000 and 2012 were included from the Surveillance, Epidemiology, and End Results database. Kaplan–Meier analysis, Log-rank tests, and Cox proportional-hazards regression models were performed for statistical analyses. Results We included 16,923 patients in this study. Of these patients, 7110 (42.0%) patients received surgery alone, 5041 (29.8%) patients underwent RT alone, and 4772 (28.2%) patients were treated with surgery and RT. With a median follow-up time of 87 months, 1005 patients died with cerebrovascular disease. The 10-years CVM were 13.3%, 10.8%, and 11.2% in those treated with RT alone, surgery alone, and surgery plus RT, respectively (P < 0.001). The mean time for CVM was shorter in RT alone compared to surgery alone and surgery plus RT (52 months vs. 56–60 months). After adjusting for covariates, patients receiving RT alone had a significantly higher risk of developing CVM compared to those receiving surgery alone (hazard ratio [HR] 1.703, 95% confidence interval [CI] 1.398–2.075, P < 0.001), while a comparable risk of CVM was found between those treated with surgery alone and surgery plus RT (HR 1.106, 95% CI 0.923–1.325, P = 0.274). Similar trends were found after stratification age at diagnosis, gender, tumor location, and marital status. Conclusions Definitive RT but not postoperative RT can increase the risk of CVM among older HNC survivors. Long-term follow-up and regular screening for CVD are required for HNC patients who received definitive RT to decrease the risk of CVM.
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Affiliation(s)
- Qing-Song He
- Department of Neurology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - Zhen-Ping Wang
- Department of Radiology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, People's Republic of China
| | - Zhao-Jun Li
- Department of Radiation Oncology, Hainan General Hospital (Hainan Affiliated Hospital of Hainan Medical University), Haikou, 570311, People's Republic of China
| | - Ping Zhou
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - Chen-Lu Lian
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China
| | - San-Gang Wu
- Department of Radiation Oncology, The First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
| | - Si-Fang Chen
- Department of Neurosurgery, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, People's Republic of China.
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6
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Xiang M, Gensheimer MF, Pollom EL, Holsinger FC, Colevas AD, Le QT, Beadle BM. Prolongation of definitive head and neck cancer radiotherapy: Survival impact and predisposing factors. Radiother Oncol 2020; 156:201-208. [PMID: 33383061 DOI: 10.1016/j.radonc.2020.12.025] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 12/08/2020] [Accepted: 12/15/2020] [Indexed: 01/18/2023]
Abstract
BACKGROUND AND PURPOSE To quantify the survival impact of prolongation of definitive radiotherapy (RT) for head and neck cancer in a national, modern cohort, and to identify predictive factors for prolongation. MATERIALS AND METHODS The National Cancer Database was queried for adults with non-metastatic cancer of the nasopharynx, oropharynx, larynx, or hypopharynx diagnosed 2004-2015, treated with definitive RT to 66-70 Gy in 30-35 fractions at 2-2.2 Gy per fraction. Multivariable Cox regression and propensity score matching were used to model the survival impact of RT prolongation, adjusting for potential confounders such as age and comorbidity. Predictors of RT prolongation were identified using multivariable multinomial logistic regression. RESULTS In total, 36,367 patients were identified. As a continuous variable, RT prolongation increased the relative hazard of death by 2% per day (P < .0001). In the matched cohorts, patients with short (4-8 days) or long prolongation (>8 days) had lower absolute 4-year overall survival by 4% and 12%, respectively (P < .0001), while prolongation of 1-3 days was not significantly adverse. Major predictors of increased risk of prolongation were administration of systemic therapy, baseline comorbidity, lack of private insurance, and tumor/nodal stage. Conversely, higher facility volume was significantly protective, with a 55% lower risk of long prolongation within the topmost quartile (>11.5 patients/year). CONCLUSION RT prolongation, especially >8 days, is significantly deleterious. Systemic therapy and facility volume were major predictors. Early identification of patients at increased risk of treatment interruptions may facilitate implementation of preventive measures.
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Affiliation(s)
- Michael Xiang
- Radiation Oncology, University of California, Los Angeles, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | - Erqi L Pollom
- Radiation Oncology, Stanford University, United States; Palo Alto Veterans Affairs Hospital, United States
| | | | | | - Quynh-Thu Le
- Radiation Oncology, Stanford University, United States
| | - Beth M Beadle
- Radiation Oncology, Stanford University, United States.
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7
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Single-fraction prostate stereotactic body radiotherapy: Dose reconstruction with electromagnetic intrafraction motion tracking. Radiother Oncol 2020; 156:145-152. [PMID: 33310011 DOI: 10.1016/j.radonc.2020.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Revised: 11/30/2020] [Accepted: 12/02/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE To reconstruct the dose delivered during single-fraction urethra-sparing prostate stereotactic body radiotherapy (SBRT) accounting for intrafraction motion monitored by intraprostatic electromagnetic transponders (EMT). METHODS We analyzed data of 15 patients included in the phase I/II "ONE SHOT" trial and treated with a single fraction of 19 Gy to the planning target volume (PTV) and 17 Gy to the urethra planning risk volume. During delivery, prostate motion was tracked with implanted EMT. SBRT was interrupted when a 3-mm threshold was trespassed and corrected unless the offset was transient. Motion-encoded reconstructed (MER) plans were obtained by splitting the original plans into multiple sub-beams with isocenter shifts based on recorded EMT positions, mimicking prostate motion during treatment. We analyzed intrafraction motion and compared MER to planned doses. RESULTS The median EMT motion range (±SD) during delivery was 0.26 ± 0.09, 0.22 ± 0.14 and 0.18 ± 0.10 cm in the antero-posterior, supero-inferior, and left-right axes, respectively. Treatment interruptions were needed for 8 patients because of target motion beyond limits in the antero-posterior (n = 6) and/or supero-inferior directions (n = 4). Comparing MER vs. original plan there was a median relative dose difference of -1.9% (range, -7.9 to -1.0%) and of +0.5% (-0.3-1.7%) for PTV D98% and D2%, respectively. The clinical target volume remained sufficiently covered with a median D98% difference of -0.3% (-1.6-0.5%). Bladder and rectum dosimetric parameters showed significant differences between original and MER plans, but mostly remained within acceptable limits. CONCLUSIONS The dosimetric impact of intrafraction prostate motion was minimal for target coverage for single-fraction prostate SBRT with real-time electromagnetic tracking combined with beam gating.
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8
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Borras JM, Font R, Solà J, Macia M, Tuset V, Arenas M, Eraso A, Verges R, Farré N, Pedro A, Mollà M, Algara M, Solé JM, Mira M, Espinàs JA. Impact of non-adherence to radiotherapy on 1-year survival in cancer patients in Catalonia, Spain. Radiother Oncol 2020; 151:200-205. [PMID: 32771615 DOI: 10.1016/j.radonc.2020.08.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 07/23/2020] [Accepted: 08/01/2020] [Indexed: 01/14/2023]
Abstract
BACKGROUND This study aims to assess the effects of non-adherence to external beam radiation therapy in cancer patients receiving treatment with a curative. METHODS This retrospective cohort study collected health records data for all cancer patients treated with external beam radiotherapy with curative intent in 2016 in Catalonia, Spain. Adherence was defined as having received at least 90% of the total dose prescribed. A logistic regression model was used to assess factors related to non-adherence, and its association with one-year survival was evaluated using Cox regression. RESULTS The final sample included 8721 patients (mean age 63.6 years): breast cancer was the most common tumour site (38.1%), followed by prostate and colon/rectum. Treatment interruptions prolonged the total duration of therapy in 70.7% of the patients, and 1.0% were non-adherent. Non-adherence was associated with advanced age, female gender, and some localization of primary tumour (head and neck, urinary bladder, and haematological cancers). The risk of death in non-adherent patients was higher than in adherent patients (hazard ratio [HR] 1.63, 95% confidence interval 0.97-2.74), after adjusting for the potential confounding effect of age, gender, tumour site and comorbidity. CONCLUSION Non-adherence to radiotherapy, as measured by the received dose, is very low in our setting, and it may have an impact on one-year survival.
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Affiliation(s)
- Josep M Borras
- Department of Clinical Sciences, University of Barcelona and Bellvitge Biomedical Research Institute (IDIBELL), Spain.
| | - Rebeca Font
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Judit Solà
- Cancer Strategy, Department of Health, Barcelona, Spain
| | - Miquel Macia
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Duran i Reynals, L'Hospitalet de Llobregat, Spain
| | - Victòria Tuset
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Germans Trias i Pujol, Badalona, Spain
| | - Meritxell Arenas
- Radiation Oncology Department, Hospital Universitari Sant Joan de Reus, Spain; Faculty of Medicine, University of Rovira i Virgili, Spain
| | - Arantxa Eraso
- Radiation Oncology Department, Institut Català d'Oncologia, Hospital Trueta, Girona, Spain
| | - Ramona Verges
- Radiation Oncology Department, Hospital Universitari de la Vall d'Hebron, Barcelona, Spain
| | - Nuria Farré
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Agustin Pedro
- Radiation Oncology Department, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
| | - Meritxell Mollà
- Department of Radiation Oncology, Hospital Clinic de Barcelona, Spain
| | - Manel Algara
- Radiation Oncology Department, Hospital del Mar, Radiation Oncology Research Group, IMIM and Universitat Autònoma de Barcelona, Spain
| | - Josep M Solé
- Radiation Oncology Department, Consorci Sanitari Terrassa- Hospital General Catalunya- Hospital Manresa, Barcelona, Spain
| | - Moises Mira
- Radiation Oncology Department, H.U. Arnau de Vilanova, Lleida, Spain
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9
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Wakefield DV, Carnell M, Dove APH, Edmonston DY, Garner WB, Hubler A, Makepeace L, Hanson R, Ozdenerol E, Chun SG, Spencer S, Pisu M, Martin M, Jiang B, Punglia RS, Schwartz DL. Location as Destiny: Identifying Geospatial Disparities in Radiation Treatment Interruption by Neighborhood, Race, and Insurance. Int J Radiat Oncol Biol Phys 2020; 107:815-826. [PMID: 32234552 DOI: 10.1016/j.ijrobp.2020.03.016] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 02/11/2020] [Accepted: 03/07/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Radiation therapy interruption (RTI) worsens cancer outcomes. Our purpose was to benchmark and map RTI across a region in the United States with known cancer outcome disparities. METHODS AND MATERIALS All radiation therapy (RT) treatments at our academic center were cataloged. Major RTI was defined as ≥5 unplanned RT appointment cancellations. Univariate and multivariable logistic and linear regression analyses identified associated factors. Major RTI was mapped by patient residence. A 2-sided P value <.0001 was considered statistically significant. RESULTS Between 2015 and 2017, a total of 3754 patients received RT, of whom 3744 were eligible for analysis: 962 patients (25.8%) had ≥2 RT interruptions and 337 patients (9%) had major RTI. Disparities in major RTI were seen across Medicaid versus commercial/Medicare insurance (22.5% vs 7.2%; P < .0001), low versus high predicted income (13.0% vs 5.9%; P < .0001), Black versus White race (12.0% vs 6.6%; P < .0001), and urban versus suburban treatment location (12.0% vs 6.3%; P < .0001). On multivariable analysis, increased odds of major RTI were seen for Medicaid patients (odds ratio [OR], 3.35; 95% confidence interval [CI], 2.25-5.00; P < .0001) versus those with commercial/Medicare insurance and for head and neck (OR, 3.74; 95% CI, 2.56-5.46; P < .0001), gynecologic (OR, 3.28; 95% CI, 2.09-5.15; P < .0001), and lung cancers (OR, 3.12; 95% CI, 1.96-4.97; P < .0001) compared with breast cancer. Major RTI was mapped to urban, majority Black, low-income neighborhoods and to rural, majority White, low-income regions. CONCLUSIONS Radiation treatment interruption disproportionately affects financially and socially vulnerable patient populations and maps to high-poverty neighborhoods. Geospatial mapping affords an opportunity to correlate RT access on a neighborhood level to inform potential intervention strategies.
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Affiliation(s)
- Daniel V Wakefield
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; T. H. Chan School of Public Health, Harvard University, Boston, Massachusetts
| | - Matthew Carnell
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Austin P H Dove
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Drucilla Y Edmonston
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Wesley B Garner
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Adam Hubler
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Lydia Makepeace
- University of Tennessee Health Science Center, College of Medicine, Memphis, Tennessee
| | - Ryan Hanson
- Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, Tennessee
| | - Esra Ozdenerol
- Department of Earth Sciences, Spatial Analysis and Geographic Education Laboratory, University of Memphis, Memphis, Tennessee
| | - Stephen G Chun
- Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas
| | - Sharon Spencer
- Department of Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Maria Pisu
- Division of Preventive Medicine, University of Alabama at Birmingham, Birmingham, Alabama
| | - Michelle Martin
- Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Bo Jiang
- Department of Radiation Oncology, Biostatistics, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Rinaa S Punglia
- Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, Massachusetts
| | - David L Schwartz
- Department of Radiation Oncology, University of Tennessee Health Science Center, Memphis, Tennessee; Division of Radiation Oncology, University of Texas, M.D. Anderson Cancer Center, Houston, Texas; Department of Preventive Medicine, University of Tennessee Health Science Center, Memphis, Tennessee.
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Urethra-Sparing Stereotactic Body Radiation Therapy for Prostate Cancer: Quality Assurance of a Randomized Phase 2 Trial. Int J Radiat Oncol Biol Phys 2020; 108:1047-1054. [PMID: 32535161 DOI: 10.1016/j.ijrobp.2020.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 05/12/2020] [Accepted: 06/01/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To present the radiation therapy quality assurance results from a prospective multicenter phase 2 randomized trial of short versus protracted urethra-sparing stereotactic body radiation therapy (SBRT) for localized prostate cancer. METHODS AND MATERIALS Between 2012 and 2015, 165 patients with prostate cancer from 9 centers were randomized and treated with SBRT delivered either every other day (arm A, n = 82) or once a week (arm B, n = 83); 36.25 Gy in 5 fractions were prescribed to the prostate with (n = 92) or without (n = 73) inclusion of the seminal vesicles (SV), and the urethra planning-risk volume received 32.5 Gy. Patients were treated either with volumetric modulated arc therapy (VMAT; n = 112) or with intensity modulated radiation therapy (IMRT; n = 53). Deviations from protocol dose constraints, planning target volume (PTV) homogeneity index, PTV Dice similarity coefficient, and number of monitor units for each treatment plan were retrospectively analyzed. Dosimetric results of VMAT versus IMRT and treatment plans with versus without inclusion of SV were compared. RESULTS At least 1 major protocol deviation occurred in 51 patients (31%), whereas none was observed in 41. Protocol violations were more frequent in the IMRT group (P < .001). Furthermore, the use of VMAT yielded better dosimetric results than IMRT for urethra planning-risk volume D98% (31.1 vs 30.8 Gy, P < .0001), PTV D2% (37.9 vs 38.7 Gy, P < .0001), homogeneity index (0.09 vs 0.10, P < .0001), Dice similarity coefficient (0.83 vs 0.80, P < .0001), and bladder wall V50% (24.5% vs 33.5%, P = .0001). To achieve its goals volumetric modulated arc therapy required fewer monitor units than IMRT (2275 vs 3378, P <.0001). The inclusion of SV in the PTV negatively affected the rectal wall V90% (9.1% vs 10.4%, P = .0003) and V80% (13.2% vs 15.7%, P = .0003). CONCLUSIONS Protocol deviations with potential impact on tumor control or toxicity occurred in 31% of patients in this prospective clinical trial. Protocol deviations were more frequent with IMRT. Prospective radiation therapy quality assurance protocols should be strongly recommended for SBRT trials to minimize potential protocol deviations.
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11
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Van Gestel D, Dragan T, Grégoire V, Evans M, Budach V. Radiotherapy Quality Assurance for Head and Neck Squamous Cell Carcinoma. Front Oncol 2020; 10:282. [PMID: 32226773 PMCID: PMC7081058 DOI: 10.3389/fonc.2020.00282] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2019] [Accepted: 02/18/2020] [Indexed: 12/03/2022] Open
Abstract
The impact of radiotherapy (RT) quality assurance (QA) has been demonstrated by numerous studies and is particularly important for head and neck cancer (HNC) treatment due to the complexity of RT target volumes in this region and the multiple adjacent organs at risk. The RT planning process includes many critical steps including interpretation of diagnostic imaging, image fusion, target volume delineation (tumor, lymph nodes, and organs at risk), and planning. Each step has become highly complex, and precise and rigorous QA throughout the planning process is essential. The ultimate aim is to precisely deliver radiation dose to the target, maximizing the tumor dose and minimizing the dose to surrounding organs at risk, in order to improve the therapeutic index. It is imperative that RT QA programs should systematically control all aspects of the RT planning pathway and include regular end-to-end tests and external audits. However, comprehensive QA should not be limited to RT and should, where possible, also be implemented for surgery, systemic therapy, pathology, as well as other aspects involved in the interdisciplinary treatment of HNC.
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Affiliation(s)
- Dirk Van Gestel
- Department of Radiation Oncology Head and Neck Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Tatiana Dragan
- Department of Radiation Oncology Head and Neck Unit, Institut Jules Bordet, Université Libre de Bruxelles, Brussels, Belgium
| | - Vincent Grégoire
- Radiation Oncology Departement, Léon Bérard Cancer Center, Lyon, France
| | - Mererid Evans
- Department of Clinical Oncology, Velindre University NHS Trust, Cardiff, United Kingdom
| | - Volker Budach
- Departments of Radiation Oncology, Charité University Medicine Berlin, Berlin, Germany
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12
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Antognoni P, Corvò R, Zerini D, Orecchia R. Altered Fractionation Radiotherapy in Head and Neck Cancer: Clinical Issues and Pitfalls of “Evidence-Based Medicine”. TUMORI JOURNAL 2019; 91:30-9. [PMID: 15850002 DOI: 10.1177/030089160509100107] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
The authors present a critical appraisal of the biological bases of altered fractionation and a brief overview of published randomized trials with conventional fractionation as the control arm, reviews and meta-analysis on altered fractionation radiotherapy in head and neck cancer. The major controversial issues emerging from these studies are reviewed and the limiting factors which so far have prevented the widespread use of altered fractionation regimens in current clinical practice are analyzed. Future perspectives regarding predictive biological assays for patient selection and the integration of altered fractionation regimens with radiochemotherapy protocols, biomodulators and novel radiotherapy techniques are also reviewed and summarized.
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Affiliation(s)
- Paolo Antognoni
- Servizio di Radioterapia, CdC Santa Maria-Multimedica Hospitals, Castellanza, VA, Italy.
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Coca‐Pelaz A, Halmos GB, Strojan P, Bree R, Bossi P, Bradford CR, Rinaldo A, Vander Poorten V, Sanabria A, Takes RP, Ferlito A. The role of age in treatment‐related adverse events in patients with head and neck cancer: A systematic review. Head Neck 2019; 41:2410-2429. [DOI: 10.1002/hed.25696] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2018] [Revised: 01/03/2019] [Accepted: 01/24/2019] [Indexed: 12/13/2022] Open
Affiliation(s)
- Andrés Coca‐Pelaz
- Department of OtolaryngologyHospital Universitario Central de Asturias Oviedo Spain
| | - Gyorgy B. Halmos
- Department of Otorhinolaryngology – Head and Neck SurgeryUniversity of Groningen, University Medical Center Groningen Groningen The Netherlands
| | - Primož Strojan
- Department of Radiation OncologyInstitute of Oncology Ljubljana Slovenia
| | - Remco Bree
- Department of Head and Neck Surgical Oncology, UMC Utrecht Cancer CenterUniversity Medical Center Utrecht Utrecht The Netherlands
| | - Paolo Bossi
- Medical Oncology, Department of Medical and Surgical SpecialtiesRadiological Sciencesand Public HealthUniversity of Brescia, ASST‐Spedali Civili Brescia Italy
| | - Carol R. Bradford
- Department of Otolaryngology – Head and Neck SurgeryUniversity of Michigan Ann Arbor Michigan
| | | | - Vincent Vander Poorten
- Otorhinolaryngology – Head and Neck Surgery and Department of Oncology, Section Head and Neck OncologyUniversity Hospitals Leuven, KU Leuven Leuven Belgium
| | - Alvaro Sanabria
- Department of Surgery, School of MedicineUniversidad de Antioquia, Clínica Vida Medellín Colombia
| | - Robert P. Takes
- Department of Otolaryngology – Head and Neck SurgeryRadboud University Medical Center Nijmegen The Netherlands
| | - Alfio Ferlito
- International Head and Neck Scientific Group Padua Italy
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Ohri N, Rapkin BD, Guha C, Kalnicki S, Garg M. Radiation Therapy Noncompliance and Clinical Outcomes in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys 2016; 95:563-70. [DOI: 10.1016/j.ijrobp.2016.01.043] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2015] [Revised: 12/28/2015] [Accepted: 01/22/2016] [Indexed: 12/31/2022]
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15
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Schwartz M, Vuong T, Ballivy O, Parker W, Patrocinio H. Accelerated radiotherapy with simultaneous integrated boost fractionation and intensity-modulated radiotherapy for advanced head and neck cancer. Otolaryngol Head Neck Surg 2016; 136:549-55. [PMID: 17418249 DOI: 10.1016/j.otohns.2006.10.044] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2006] [Accepted: 10/31/2006] [Indexed: 11/30/2022]
Abstract
Objective To determine the feasibility and toxicity profile of accelerated radiotherapy with a simultaneous integrated boost fractionation scheme with intensity-modulated radiotherapy (SIB-IMRT) with or without chemotherapy. Study Design And Setting Forty-nine patients with advanced head and neck cancer underwent SIB-IMRT. Concomitant chemotherapy was administered in 29 patients. Results Grade 3 acute toxicities included 55% mucositis, 20% odynophagia, 12% nausea, 18% hematologic, and 8% skin. There were no grade 4 toxicities or treatment-related deaths. With a median follow-up of 25 months, locoregional control was 83%, and overall survival was 80%. Of patients with grade 3 late toxicities, two patients (4% of the total) required a permanent percutaneous endoscopic gastrostomy tube, and osteonecrosis occurred in one patient (2% of the total). Conclusions SIB-IMRT is a feasible technique that shortens the overall treatment time in the radical treatment of patients with advanced head and neck cancer while maintaining acceptable rates of acute toxicity in this study. Although the results are promising, this approach should be considered only in the setting of a clinical trial.
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Affiliation(s)
- Matthew Schwartz
- Department of Radiation Oncology, McGill University Health Center, Montreal, Quebec, Canada
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16
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Ohri N, Rapkin BD, Guha D, Haynes-Lewis H, Guha C, Kalnicki S, Garg M. Predictors of Radiation Therapy Noncompliance in an Urban Academic Cancer Center. Int J Radiat Oncol Biol Phys 2015; 91:232-8. [DOI: 10.1016/j.ijrobp.2014.09.030] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 09/18/2014] [Accepted: 09/22/2014] [Indexed: 11/26/2022]
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17
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[Quality criteria in radiotherapy for head and neck cancers under the aegis of Head and Neck Intergroup]. Bull Cancer 2014; 101:481-5. [PMID: 24886899 DOI: 10.1684/bdc.2014.1924] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
The aim of radiotherapy is to deliver enough radiation to the tumor in order to achieve maximum tumour control in the irradiated volume with as few serious complications as possible with an irradiation dose as low as possible to normal tissue. The quality of radiotherapy is essential for optimal treatment and quality control is to reduce the bias in clinical trials avoiding possible major deviations. The assurance and quality control programs have been developed in large european (EORTC, GORTEC) and american cooperative groups (RTOG) of radiation oncology since the 1980s. We insist here on the importance of quality assurance in radiotherapy and the current status in this domain and the criteria for quality control especially for current clinical trials within GORTEC are discussed here.
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18
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Ohri N, Shen X, Dicker AP, Doyle LA, Harrison AS, Showalter TN. Radiotherapy protocol deviations and clinical outcomes: a meta-analysis of cooperative group clinical trials. J Natl Cancer Inst 2013; 105:387-93. [PMID: 23468460 DOI: 10.1093/jnci/djt001] [Citation(s) in RCA: 227] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Noncompliance with radiotherapy (RT) protocol guidelines has been linked to inferior clinical outcomes. We performed a meta-analysis of cooperative group trials to examine the association between RT quality assurance (QA) deviations and disease control and overall survival (OS). METHODS We searched MEDLINE and the Cochrane Central Register of Controlled Trials for multi-institutional trials that reported clinical outcomes in relation to RT QA results. Hazard ratios (HRs) describing the association between RT protocol noncompliance and patient outcomes were extracted directly from the original studies or calculated from survival curves. Inverse variance meta-analyses were performed to assess the association between RT QA deviations and OS. A second meta-analysis tested the association between RT QA deviations and secondary outcomes, including local or locoregional control, event-free survival, and relapse. Random-effects models were used in cases of statistically significant (P < .10) effect heterogeneity. The Egger test was used to detect publication bias. All statistical tests were two-sided. RESULTS Eight studies (four pediatric, four adult) met all inclusion criteria and were incorporated into this analysis. The frequency of RT QA deviations ranged from 8% to 71% (median = 32%). In a random-effects model, RT deviations were associated with a statistically significant decrease in OS (HR of death = 1.74, 95% confidence interval [CI] = 1.28 to 2.35; P < .001). A similar effect was seen for secondary outcomes (HR of treatment failure = 1.79, 95% CI = 1.15 to 2.78; P = .009). No evidence of publication bias was detected. CONCLUSION In clinical trials, RT protocol deviations are associated with increased risks of treatment failure and overall mortality.
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Affiliation(s)
- Nitin Ohri
- Department of Radiation Oncology, Montefiore Medical Center, Albert Einstein College of Medicine, 111 E 210th St, Bronx, New York 10467, USA.
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Effect of radiotherapy and chemotherapy on the risk of mucositis during intensity-modulated radiation therapy for oropharyngeal cancer. Int J Radiat Oncol Biol Phys 2011; 83:235-42. [PMID: 22104358 DOI: 10.1016/j.ijrobp.2011.06.2000] [Citation(s) in RCA: 60] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Revised: 05/18/2011] [Accepted: 06/29/2011] [Indexed: 11/23/2022]
Abstract
PURPOSE To define the roles of radiotherapy and chemotherapy on the risk of Grade 3+ mucositis during intensity-modulated radiation therapy (IMRT) for oropharyngeal cancer. METHODS AND MATERIALS 164 consecutive patients treated with IMRT at two institutions in nonoverlapping treatment eras were selected. All patients were treated with a dose painting approach, three dose levels, and comprehensive bilateral neck treatment under the supervision of the same radiation oncologist. Ninety-three patients received concomitant chemotherapy (cCHT) and 14 received induction chemotherapy (iCHT). Individual information of the dose received by the oral mucosa (OM) was extracted as absolute cumulative dose-volume histogram (DVH), corrected for the elapsed treatment days and reported as weekly (w) DVH. Patients were seen weekly during treatment, and peak acute toxicity equal to or greater than confluent mucositis at any point during the course of IMRT was considered the endpoint. RESULTS Overall, 129 patients (78.7%) reached the endpoint. The regions that best discriminated between patients with/without Grade 3+ mucositis were found at 10.1 Gy/w (V10.1) and 21 cc (D21), along the x-axis and y-axis of the OM-wDVH, respectively. On multivariate analysis, D21 (odds ratio [OR] = 1.016, 95% confidence interval [CI], 1.009-1.023, p < 0.001) and cCHT (OR = 4.118, 95% CI, 1.659-10.217, p = 0.002) were the only independent predictors. However, V10.1 and D21 were highly correlated (rho = 0.954, p < 0.001) and mutually interchangeable. cCHT would correspond to 88.4 cGy/w to at least 21 cc of OM. CONCLUSIONS Radiotherapy and chemotherapy act independently in determining acute mucosal toxicity; cCHT increases the risk of mucosal Grade 3 toxicity ≈4 times over radiation therapy alone, and it is equivalent to an extra ≈6.2 Gy to 21 cc of OM over a 7-week course.
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Baujat B, Bourhis J, Blanchard P, Overgaard J, Ang KK, Saunders M, Le Maître A, Bernier J, Horiot JC, Maillard E, Pajak TF, Poulsen MG, Bourredjem A, O'Sullivan B, Dobrowsky W, Andrzej H, Skladowski K, Hay JH, Pinto LHJ, Fu KK, Fallai C, Sylvester R, Pignon JP. Hyperfractionated or accelerated radiotherapy for head and neck cancer. Cochrane Database Syst Rev 2010; 2010:CD002026. [PMID: 21154350 PMCID: PMC8407183 DOI: 10.1002/14651858.cd002026.pub2] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Several trials have studied the role of altered fractionation radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. OBJECTIVES The aim of this individual patient data (IPD) meta-analysis was to assess whether this type of radiotherapy could improve survival. SEARCH STRATEGY We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; CENTRAL (2010, Issue 3); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The date of the most recent search was 8 August 2010. SELECTION CRITERIA We identified randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic head and neck squamous cell carcinomas and grouped trials into three pre-specified treatment categories: hyperfractionated, accelerated and accelerated with total dose reduction. Trials were eligible if they began recruitment after 1969 and ended before 1998. DATA COLLECTION AND ANALYSIS We obtained updated individual patient data. Overall survival was the main outcome measure. The secondary outcome measures were local or regional control rates (or both), distant control rates and cause-specific mortality. MAIN RESULTS We included 15 trials with 6515 patients. The median follow up was six years. Tumour sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (UICC 2002). There was a significant survival benefit with altered fractionation radiotherapy, corresponding to an absolute benefit of 3.4% at five years (hazard ratio (HR) 0.92, 95% CI 0.86 to 0.97; P = 0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at five years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at five years, P = 0.02). There was a benefit in locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at five years; P < 0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (under 50 year old) (HR 0.78, 95% CI 0.65 to 0.94), 0.95 (95% CI 0.83 to 1.09) for 51 to 60 year olds, 0.92 (95% CI 0.81 to 1.06) for 61 to 70 year olds, and 1.08 (95% CI 0.89 to 1.30) for those over 70 years old; test for trends P = 0.007). AUTHORS' CONCLUSIONS Altered fractionation radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation provides the greatest benefit. An update of this IPD meta-analysis (MARCH 2), which will increase the power of this analysis and allow for other comparisons, is currently in progress.
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Affiliation(s)
- Bertrand Baujat
- Hôpital TenonService ORL‐CCF4 rue de la ChineParisFrance75020
| | - Jean Bourhis
- Institut Gustave RoussyDépartement de Radiothérapie39 rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Pierre Blanchard
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jens Overgaard
- Aarhus University HospitalDepartment of Experimental Clinical OncologyNorrebrogade 44 Bldg 5AarhusDenmarkC DK‐8000
| | - Kian K Ang
- MD Anderson Cancer CenterRadiation Oncology Department1515 Holcombe Blvd Box 97HoustonTexasUSA77030
| | - Michelle Saunders
- Marie Curie Research Wing for OncologyRadiation Oncology DepartmentMount Vernon Centre for Cancer TreatmentRickmansworth RoadNorthwoodMiddlesexUKHA6 2RN
| | - Aurélie Le Maître
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Jacques Bernier
- Clinique de GenoliaService de Radio‐OncologieGenolierSwitzerlandCH‐1272
| | | | - Emilie Maillard
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Thomas F Pajak
- RTOGStatistical Headquarters1818 Market Street, Suite 1600PhiladelphiaPAUSA19103
| | - Michael G Poulsen
- Mater Queensland Radium InstituteRaymond Terrace, South BrisbaneBrisbaneAustralia4101
| | - Abderrahmane Bourredjem
- Institut Gustave RoussyBiostatistics and Epidemiology Department39, rue Camille DesmoulinsVillejuif CedexFrance94805
| | - Brian O'Sullivan
- Princess Margaret HospitalRadiation Oncology Department610 University AvenueTorontoONCanadaM5G 2M9
| | - Werner Dobrowsky
- Northern Centre for Cancer TreatmentNewcastle General HospitalWestgate roadNewcastle upon TyneUKNE4 6BE
| | | | - Krzystof Skladowski
- Centrum Onkologii‐Inst. M. CurieRadiotherapy ClinicWybrzeze Armii Krajowej 15GliwicePoland44‐101
| | - John H Hay
- Vancouver Cancer CenterDepartment of Radiation Oncology600 W, 10th AvenueVancouverBCCanadaV5Z 4E6
| | - Luiz HJ Pinto
- Instituto Nacional de CancerDepartamento de RadioterapiaRio de JaneiroBrazil20230
| | - Karen K Fu
- University of California San Francisco555 Laurel Ave Apt 508San MateoCAUSA94401‐4153
| | - Carlo Fallai
- Instituto Nazionale dei TumoriDipartimento di RadiotherapiaVia Venezian 1MilanoItaly20133
| | - Richard Sylvester
- European Organisation for Research and Treatment of CancerData CenterAvenue E Mounier 83 ‐ Bte 11BrusselsBelgium1200
| | - Jean Pierre Pignon
- Gustave Roussy Cancer CampusPlateforme LNCC de Méta‐analyse en Oncologie et Service de Biostatistique et d’EpidémiologieVillejuifFrance
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Chan AK, Sanghera P, Choo BA, McConkey C, Mehanna H, Parmar S, Pracy P, Glaholm J, Hartley A. Hypofractionated accelerated radiotherapy with concurrent carboplatin for locally advanced squamous cell carcinoma of the head and neck. Clin Oncol (R Coll Radiol) 2010; 23:34-9. [PMID: 20863676 DOI: 10.1016/j.clon.2010.07.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2010] [Revised: 05/24/2010] [Accepted: 05/27/2010] [Indexed: 11/13/2022]
Abstract
AIMS Hypofractionated accelerated radiotherapy with concurrent carboplatin utilises both advantages of altered fractionation and synchronous chemotherapy to maximise local control in locally advanced head and neck cancer. Such fractionation schedules are increasingly used in the intensity-modulated radiotherapy era and the aim of this study was to determine the outcome of hypofractionated accelerated radiotherapy with carboplatin. MATERIALS AND METHODS One hundred and fifty consecutive patients with squamous cell carcinoma of the larynx, oropharynx, oral cavity and hypopharynx (International Union Against Cancer [IUAC] stage II-IV) treated with 55Gy in 20 fractions over 25 days with concurrent carboplatin were analysed. Outcome measures were 2 year overall survival, local control and disease-free survival. RESULTS The median follow-up in surviving patients was 25 months. IUAC stages: II n=15; III n=42; IV n=93. Two year overall survival for all patients was 74.9% (95% confidence interval 66.0-81.7%). Two year local control was 78.3% (95% confidence interval 69.6-84.8%). Two year disease-free survival was 67.2% (95% confidence interval 58.3-74.7%). There were 135 patients with stage III and IV disease. For these patients, the 2 year overall survival, local control and disease-free survival were 74.3% (95% confidence interval 64.7-81.6%), 79.1% (95% confidence interval 69.8-85.9%) and 67.6% (95% confidence interval 58.0-75.4%), respectively. Prolonged grade 3 and 4 mucositis seen at ≥4 weeks were present in 9 and 0.7%, respectively. Late feeding dysfunction (determined by dependence on a feeding tube at 1 year) was seen in 13% of the surviving patients at 1 year. CONCLUSION Hypofractionated accelerated radiotherapy with concurrent carboplatin achieves a high local control. This regimen should be considered for a radiotherapy dose-escalation study using intensity-modulated radiotherapy.
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Affiliation(s)
- A K Chan
- Hall-Edwards Radiotherapy Research Group, The Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK.
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Fox E, Barrett-McNeil K, Khoo LH, Middleton M. Nurse led electronic toxicity scoring in head and neck radiotherapy. Eur J Oncol Nurs 2010; 15:112-7. [PMID: 20678960 DOI: 10.1016/j.ejon.2010.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2010] [Revised: 06/22/2010] [Accepted: 06/24/2010] [Indexed: 11/15/2022]
Abstract
PURPOSE OF THE STUDY In order to improve 'adherence' to a course of treatment for head and neck radiotherapy, patients need to be managed frequently. In order to achieve this in a busy clinical environment streamlined electronic tools must be utilised. By providing nursing teams with the capacity to conduct electronic toxicity scoring on a bi-weekly basis, adherence can be improved and closer attention paid to head and neck radiotherapy toxicities. METHODS AND MATERIALS A convenience sample of 20 patients undergoing head and neck radiotherapy was analysed. Each of these patients had electronic toxicity data recorded on a bi-weekly basis for dysphagia, mucositis, skin reaction and weight loss. This information was then extracted from the ARIA™ patient information system and analysed. Additionally the time taken for the nursing team to undertake each patient review was also extracted from ARIA™. RESULTS The efficiencies offered by an electronic medical record allow comprehensive toxicity data to be recorded and analysed effortlessly. The average time taken to review these patients on a bi-weekly basis was 6.97 min and contained on average 60 words of toxicity description and action. CONCLUSION Electronic toxicity scoring offers many advantages to the radiation oncology nurse, increased efficiency allows more frequent patient interaction which will in turn aid adherence. In order to better manage the treatment course of head and neck radiotherapy patients, nurses must be provided with streamlined and efficient electronic means of recording data. In this way it is possible to review head and neck radiotherapy patients bi-weekly.
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Affiliation(s)
- Emily Fox
- Radiation Oncology Queensland, Toowoomba 4350, Australia.
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Peters LJ, O'Sullivan B, Giralt J, Fitzgerald TJ, Trotti A, Bernier J, Bourhis J, Yuen K, Fisher R, Rischin D. Critical Impact of Radiotherapy Protocol Compliance and Quality in the Treatment of Advanced Head and Neck Cancer: Results From TROG 02.02. J Clin Oncol 2010; 28:2996-3001. [DOI: 10.1200/jco.2009.27.4498] [Citation(s) in RCA: 577] [Impact Index Per Article: 41.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose To report the impact of radiotherapy quality on outcome in a large international phase III trial evaluating radiotherapy with concurrent cisplatin plus tirapazamine for advanced head and neck cancer. Patients and Methods The protocol required interventional review of radiotherapy plans by the Quality Assurance Review Center (QARC). All plans and radiotherapy documentation underwent post-treatment review by the Trial Management Committee (TMC) for protocol compliance. Secondary review of noncompliant plans for predicted impact on tumor control was performed. Factors associated with poor protocol compliance were studied, and outcome data were analyzed in relation to protocol compliance and radiotherapy quality. Results At TMC review, 25.4% of the patients had noncompliant plans but none in which QARC-recommended changes had been made. At secondary review, 47% of noncompliant plans (12% overall) had deficiencies with a predicted major adverse impact on tumor control. Major deficiencies were unrelated to tumor subsite or to T or N stage (if N+), but were highly correlated with number of patients enrolled at the treatment center (< five patients, 29.8%; ≥ 20 patients, 5.4%; P < .001). In patients who received at least 60 Gy, those with major deficiencies in their treatment plans (n = 87) had a markedly inferior outcome compared with those whose treatment was initially protocol compliant (n = 502): −2 years overall survival, 50% v 70%; hazard ratio (HR), 1.99; P < .001; and 2 years freedom from locoregional failure, 54% v 78%; HR, 2.37; P < .001, respectively. Conclusion These results demonstrate the critical importance of radiotherapy quality on outcome of chemoradiotherapy in head and neck cancer. Centers treating only a few patients are the major source of quality problems.
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Affiliation(s)
- Lester J. Peters
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Brian O'Sullivan
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jordi Giralt
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Thomas J. Fitzgerald
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Andy Trotti
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jacques Bernier
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Jean Bourhis
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Kally Yuen
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Richard Fisher
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
| | - Danny Rischin
- From the Departments of Radiation Oncology and Medical Oncology, and Centre for Biostatistics and Clinical Trials, Peter MacCallum Cancer Centre; University of Melbourne, Melbourne, Australia; Department of Radiation Oncology, Princess Margaret Hospital, Toronto, Ontario, Canada; Department of Radiation Oncology, Hospital General Vall d'Hebron, Barcelona, Spain; Department of Radiation Oncology, University of Massachusetts Medical Center, North Worcester, MA; Department of Radiation Oncology, H. Lee
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Sethi RA, Stamell EF, Price L, DeLacure M, Sanfilippo N. Head and neck radiotherapy compliance in an underserved patient population. Laryngoscope 2010; 120:1336-41. [DOI: 10.1002/lary.20963] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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Smith GL, Smith BD, Buchholz TA, Giordano SH, Garden AS, Woodward WA, Krumholz HM, Weber RS, Ang KK, Rosenthal DI. Cerebrovascular disease risk in older head and neck cancer patients after radiotherapy. J Clin Oncol 2008; 26:5119-25. [PMID: 18725647 PMCID: PMC4879715 DOI: 10.1200/jco.2008.16.6546] [Citation(s) in RCA: 209] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
PURPOSE Cerebrovascular disease is common in head and neck cancer patients, but it is unknown whether radiotherapy increases the cerebrovascular disease risk in this population. PATIENTS AND METHODS We identified 6,862 patients (age > 65 years) from the Surveillance, Epidemiology, and End Results (SEER) -Medicare cohort diagnosed with nonmetastatic head and neck cancer between 1992 and 2002. Using proportional hazards regression, we compared risk of cerebrovascular events (stroke, carotid revascularization, or stroke death) after treatment with radiotherapy alone, surgery plus radiotherapy, or surgery alone. To further validate whether treatment groups had equivalent baseline risk of vascular disease, we compared the risks of developing a control diagnosis, cardiac events (myocardial infarction, percutaneous coronary intervention, coronary artery bypass graft, or cardiac death). Unlike cerebrovascular risk, no difference in cardiac risk was hypothesized. RESULTS Mean age was 76 +/- 7 years. Ten-year incidence of cerebrovascular events was 34% in patients treated with radiotherapy alone compared with 25% in patients treated with surgery plus radiotherapy and 26% in patients treated with surgery alone (P < .001). After adjusting for covariates, patients treated with radiotherapy alone had increased cerebrovascular risk compared with surgery plus radiotherapy (hazard ratio [HR] = 1.42; 95% CI, 1.14 to 1.77) and surgery alone (HR = 1.50; 95% CI, 1.18 to 1.90). However, no difference was found for surgery plus radiotherapy versus surgery alone (P = .60). As expected, patients treated with radiotherapy alone had no increased cardiac risk compared with the other treatment groups (P = .63 and P = .81). CONCLUSION Definitive radiotherapy for head and neck cancer, but not postoperative radiotherapy, was associated with excess cerebrovascular disease risk in older patients.
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Affiliation(s)
- Grace L. Smith
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Benjamin D. Smith
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Thomas A. Buchholz
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Sharon H. Giordano
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Adam S. Garden
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Wendy A. Woodward
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Harlan M. Krumholz
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - Randal S. Weber
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - K.-Kian Ang
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
| | - David I. Rosenthal
- From the Departments of Radiation Oncology, Breast Medical Oncology, and Head and Neck Surgery, The University of Texas M. D. Anderson Cancer Center, Houston, TX; and the Section of Cardiovascular Medicine, Department of Internal Medicine, Yale University School of Medicine, New Haven, CT
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Johansson KA, Nilsson P, Zackrisson B, Ohlson B, Kjellén E, Mercke C, Alvarez-Fonseca M, Billström A, Björk-Eriksson T, Björ O, Ekberg L, Friesland S, Karlsson M, Lagerlund M, Lundkvist L, Löfroth PO, Löfvander-Thapper K, Nilsson A, Nyman J, Persson E, Reizenstein J, Rosenbrand HO, Wiklund F, Wittgren L. The quality assurance process for the ARTSCAN head and neck study – A practical interactive approach for QA in 3DCRT and IMRT. Radiother Oncol 2008; 87:290-9. [DOI: 10.1016/j.radonc.2007.12.005] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2007] [Revised: 12/08/2007] [Accepted: 12/11/2007] [Indexed: 11/16/2022]
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Gap compensation during accelerated hypofractionated radiotherapy in head and neck cancer. JOURNAL OF RADIOTHERAPY IN PRACTICE 2008. [DOI: 10.1017/s1460396907006231] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
AbstractIntroduction:In squamous-cell carcinoma (SCC) of the head and neck, unplanned gaps risk prolongation of the overall treatment time (OTT) and reduction in tumour control. This audit determines whether further acceleration can safely be employed to compensate for missed treatments during accelerated hypofractionated radiotherapy.Methods:Patients receiving accelerated hypofractionated radiotherapy for SCC of the head and neck were prospectively audited. Outcome measures were OTT, degree of compensation and acute toxicity determined by incidence of grade 3 mucositis, prolonged grade 3 mucositis, grade 3 dysphagia and pain.Results:In the 87 patients identified, the dose administered was 55 Gy in 20 fractions (81 patients), 50 Gy in 20 fractions (1 patient) and 50 Gy in 16 fractions (5 patients). Of those patients receiving 20 fractions, 94% completed within 28 days. Grade 3 mucositis was seen in 56 patients (64%). Compensating for unplanned gaps did not result in any significant increase in toxicity. Administering 6 fractions/week, as compensation, was associated with a lower pain score (p= 0.003) as was receiving 2 fractions on the same day (p= 0.0004).Conclusions:Accelerated hypofractionation is tolerable with most patients completing treatment within the planned OTT. When unplanned gaps occur, then compensation by further acceleration is possible.
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Patient Compliance to Radiation for Advanced Head and Neck Cancer at a Tertiary Care County Hospital. Laryngoscope 2008; 118:428-32. [DOI: 10.1097/mlg.0b013e31815ae3d2] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
Combined chemoradiotherapy is increasingly becoming a standard of care for the nonoperative management of a variety of solid malignancies. A string of randomized controlled phase III trials have shown statistically significant and clinically relevant improvements in outcome, ostensibly without any apparent increase in late toxicity. However, the reliability and the sensitivity of toxicity reporting in most trials are questionable. Audits and phase IV studies suggest that the chemoradiotherapy success comes at a price in terms of late toxicity. This review presents some of the challenges in recording, analyzing, and reporting toxicity data. Methods for summarizing toxicity are reviewed, and a new investigational metric, the TAME reporting system, is discussed. The need for special vigilance in the era of molecular-targeted agents is emphasized because of the possibility that unexpected serious adverse events with a low incidence may occur. Finally, we discuss how progress in molecular pathology and radiation biology may provide novel opportunities for stratifying patients according to risk of adverse effects, interventional targets for reducing or treating adverse effects, and surrogate markers of normal-tissue injury.
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Affiliation(s)
- Søren M Bentzen
- University of Wisconsin School of Medicine and Public Health, Department of Human Oncology, Madison, WI, USA
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30
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Treatment Adherence in Head and Neck Cancer Patients Undergoing Radiation Therapy: Challenges for Nursing. ACTA ACUST UNITED AC 2007. [DOI: 10.1016/j.jradnu.2007.04.003] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Sanghera P, McConkey C, Ho KF, Glaholm J, Hartley A. Hypofractionated Accelerated Radiotherapy With Concurrent Chemotherapy For Locally Advanced Squamous Cell Carcinoma of the Head and Neck. Int J Radiat Oncol Biol Phys 2007; 67:1342-51. [PMID: 17241752 DOI: 10.1016/j.ijrobp.2006.11.015] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2006] [Revised: 11/11/2006] [Accepted: 11/16/2006] [Indexed: 11/27/2022]
Abstract
PURPOSE To investigate the tumor control rates in locally advanced head-and-neck cancer using accelerated hypofractionated radiotherapy with chemotherapy. METHODS AND MATERIALS The data from patients with squamous cell cancer of the larynx, oropharynx, oral cavity, and hypopharynx (International Union Against Cancer Stage II-IV), who received accelerated hypofractionated radiotherapy with chemotherapy between January 1, 1998, and April 1, 2005, were retrospectively analyzed. Two different chemotherapy schedules were used, carboplatin and methotrexate, both single agents administered on an outpatient basis. The endpoints were overall survival, local control, and disease-free survival. RESULTS A total of 81 patients were analyzed. The 2-year overall survival rate was 71.6% (95% confidence interval [CI], 61.5-81.8%). The 2-year disease-free survival rate was 68.6% (95% CI, 58.4-78.8%). The 2-year local control rate was 75.4% (95% CI, 65.6-85.1%). When excluding patients with Stage II oral cavity, larynx, and hypopharynx tumors, 68 patients remained. For these patients, the 2-year overall survival, local control, and disease-free survival rate was 67.6% (95% CI, 56.0-79.2%), 72.0% (95% CI, 61.0-83.0%), and 64.1% (95% CI, 52.6-75.7%), respectively. CONCLUSION Accelerated hypofractionated radiotherapy and synchronous chemotherapy can achieve high tumor control rates while being resource sparing and should be the subject of prospective evaluation.
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Affiliation(s)
- Paul Sanghera
- Cancer Centre, Queen Elizabeth Hospital, Birmingham, United Kingdom
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Nuyts S, Dirix P, Hermans R, Poorten VV, Delaere P, Weltens C, Van den Bogaert W. Early experience with a hybrid accelerated radiotherapy schedule for locally advanced head and neck cancer. Head Neck 2007; 29:720-30. [PMID: 17315171 DOI: 10.1002/hed.20565] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND Our aim was to determine feasibility and efficacy of a hybrid radiotherapy schedule in locally advanced head and neck cancer. METHODS Seventy-three patients with locally advanced head and neck cancer were irradiated according to a hybrid accelerated schedule consisting of 20 fractions of 2 Gy (once daily), followed by 20 fractions of 1.6 Gy (twice daily), to a total dose of 72 Gy. RESULTS Locoregional control was 55% after 2 years. Overall survival was 59%, disease-specific survival was 63%, and disease-free survival was 46%. Acute toxicity was prospectively scored in all 73 patients: the most frequent toxicities were mucositis (50.7%, grade 3), dysphagia (47.9%, grade 3), and dermatitis (34.5%, grade 3). All patients were treated to full dose, without treatment interruption. CONCLUSION With this regimen, acceptable locoregional control and survival rates are achieved. Toxicity was well manageable, suggesting that a combination of this schedule with concomitant chemotherapy is possible and could lead to further improvement in the treatment of locally advanced head and neck cancer.
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Affiliation(s)
- Sandra Nuyts
- Department of Radiation Oncology, Leuvens Kanker Instituut (LKI), University Hospital Gasthuisberg, Leuven, Belgium
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Skladowski K, Maciejewski B, Golen M, Tarnawski R, Slosarek K, Suwinski R, Sygula M, Wygoda A. Continuous accelerated 7-days-a-week radiotherapy for head-and-neck cancer: long-term results of phase III clinical trial. Int J Radiat Oncol Biol Phys 2006; 66:706-13. [PMID: 17011446 DOI: 10.1016/j.ijrobp.2006.05.026] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2006] [Revised: 05/24/2006] [Accepted: 05/24/2006] [Indexed: 11/19/2022]
Abstract
PURPOSE To update 5-year results of a previously published study on special 7-days-a-week fractionation continuous accelerated irradiation (CAIR) for head-and-neck cancer patients. METHODS AND MATERIALS One hundred patients with squamous cell carcinoma of head and neck in Stage T(2-4)N(0-1)M(0) were randomized between two definitive radiation treatments: accelerated fractionation 7 days a week including weekends (CAIR) and conventional 5 days a week (control). Hence the overall treatment time was 2 weeks shorter in CAIR. RESULTS Five-year local tumor control was 75% in the CAIR group and 33% in the control arm (p < 0.00004). Tumor-cure benefit corresponded with significant improvement in disease-free survival and overall survival rates. Confluent mucositis was the main acute toxicity, with the incidence significantly higher in CAIR patients than in control (respectively, 94% vs. 53%). When 2.0-Gy fractions were used, radiation necrosis developed in 5 patients (22%) in the CAIR group as a consequential late effect (CLE), but when fraction size was reduced to 1.8 Gy no more CLE occurred. Actuarial 5-year morbidity-free survival rate was similar for both treatments. CONCLUSIONS Selected head-and-neck cancer patients could be treated very effectively with 7-days-a-week radiation schedule with no compromise of total dose and with slight 10% reduction of fraction dose (2 Gy-1.8 Gy), which article gives 1 week reduction of overall treatment time compared with standard 70 Gy in 35 fractions over 47-49 days. Although this report is based on the relatively small group of patients, its results have encouraged us to use CAIR fractionation in a standard radiation treatment for moderately advanced head-and-neck cancer patients.
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Affiliation(s)
- Krzysztof Skladowski
- Department of Radiation Oncology, Center of Oncology-Maria Sklodowska-Curie Memorial Institute, Gliwice, Poland.
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Bourhis J, Overgaard J, Audry H, Ang KK, Saunders M, Bernier J, Horiot JC, Le Maître A, Pajak TF, Poulsen MG, O'Sullivan B, Dobrowsky W, Hliniak A, Skladowski K, Hay JH, Pinto LHJ, Fallai C, Fu KK, Sylvester R, Pignon JP. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet 2006; 368:843-54. [PMID: 16950362 DOI: 10.1016/s0140-6736(06)69121-6] [Citation(s) in RCA: 735] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND Several trials have studied the role of unconventional fractionated radiotherapy in head and neck squamous cell carcinoma, but the effect of such treatment on survival is not clear. The aim of this meta-analysis was to assess whether this type of radiotherapy could improve survival. METHODS Randomised trials comparing conventional radiotherapy with hyperfractionated or accelerated radiotherapy, or both, in patients with non-metastatic HNSCC were identified and updated individual patient data were obtained. Overall survival was the main endpoint. Trials were grouped in three pre-specified categories: hyperfractionated, accelerated, and accelerated with total dose reduction. FINDINGS 15 trials with 6515 patients were included. The median follow-up was 6 years. Tumours sites were mostly oropharynx and larynx; 5221 (74%) patients had stage III-IV disease (International Union Against Cancer, 1987). There was a significant survival benefit with altered fractionated radiotherapy, corresponding to an absolute benefit of 3.4% at 5 years (hazard ratio 0.92, 95% CI 0.86-0.97; p=0.003). The benefit was significantly higher with hyperfractionated radiotherapy (8% at 5 years) than with accelerated radiotherapy (2% with accelerated fractionation without total dose reduction and 1.7% with total dose reduction at 5 years, p=0.02). There was a benefit on locoregional control in favour of altered fractionation versus conventional radiotherapy (6.4% at 5 years; p<0.0001), which was particularly efficient in reducing local failure, whereas the benefit on nodal control was less pronounced. The benefit was significantly higher in the youngest patients (hazard ratio 0.78 [0.65-0.94] for under 50 year olds, 0.95 [0.83-1.09] for 51-60 year olds, 0.92 [0.81-1.06] for 61-70 year olds, and 1.08 [0.89-1.30] for over 70 year olds; test for trends p=0.007). INTERPRETATION Altered fractionated radiotherapy improves survival in patients with head and neck squamous cell carcinoma. Comparison of the different types of altered radiotherapy suggests that hyperfractionation has the greatest benefit.
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Affiliation(s)
- Jean Bourhis
- Radiation Oncology Department, Institut Gustave Roussy, Villejuif, France
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Wirth L, Allen AM, Machtay M. Altered fractionation: a fractional benefit? Lancet 2006; 368:819-21. [PMID: 16950339 DOI: 10.1016/s0140-6736(06)69300-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Affiliation(s)
- Lori Wirth
- Dana-Farber Cancer Institute, Boston, MA 02115, USA.
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Bernier J, Bentzen SM. Radiotherapy for head and neck cancer: latest developments and future perspectives. Curr Opin Oncol 2006; 18:240-6. [PMID: 16552235 DOI: 10.1097/01.cco.0000219252.45467.88] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
PURPOSE OF REVIEW Despite recent advances in multimodality management the prognosis of patients with stage III-IV squamous cell head and neck cancer remains disappointing. The objective of this review is to identify how, within the main axes of the current translational and clinical research and in an attempt to improve treatment outcome, a number of institutions and cooperative groups have embarked on systematic investigations of novel strategies for radiotherapy delivery and for combining radiation with systemic treatments. RECENT FINDINGS Four domains of translational and clinical researches can be identified in head and neck radio-oncology: altered fractionation, concurrent delivery of chemotherapy and radiotherapy, combination of targeted therapies with radiation, and high-conformality radiotherapy. SUMMARY Here we provide a critical appraisal of recent strategies allowing an increase in dose intensity for treatments based on radiotherapy and drug-radiation interactions, and revisit the potential opportunities they offer as well as the possible caveats they may present in patients with locally advanced head and neck cancers.
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Affiliation(s)
- Jacques Bernier
- Department of Radio-Oncology, Oncology Institute of Southern Switzerland, Bellinzona, Switzerland.
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Abstract
Efforts to improve the efficacy of treatment for SCCHN have led to the use of multimodality approaches with combinations of surgery, radiotherapy and chemotherapy. Conventional head and neck radiotherapy, a standard approach for locoregionally advanced disease, is associated with a variety of well-known acute and long-term toxicities. These chronic toxicities (i.e. xerostomia, dysphagia, fibrosis) can impact negatively on patient quality of life. Altered radiation fractionation regimens that incorporate acceleration and/or hyperfractionation can improve locoregional control but also increase acute toxicities for head and neck cancer patients. Intensity modulated radiation therapy (IMRT) has emerged as a promising method for delivering effective radiation dose to head and neck tumour targets while reducing exposure of surrounding healthy tissue. Another method for improving head and neck cancer outcome with conventional radiotherapy is with the concurrent addition of chemotherapy. Indeed, chemoradiotherapy is now a standard treatment approach for locoregionally advanced disease. Molecular targeted agents, such as the epidermal growth factor receptor (EGFR) antagonist, cetuximab (Erbitux), have recently been shown to enhance the effects of radiotherapy, and reports to date suggest that this potentiation occurs without an increase in the characteristic toxicities associated with head and neck radiation.
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Affiliation(s)
- P M Harari
- Department of Human Oncology, University of Wisconsin, Madison, WI 53792, USA.
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Collins R, Flynn A, Melville A, Richardson R, Eastwood A. Effective health care: management of head and neck cancers. Qual Saf Health Care 2005; 14:144-8. [PMID: 15805462 PMCID: PMC1743991 DOI: 10.1136/qshc.2005.013961] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
The management of head and neck cancer, published in a recent issue of Effective Health Care, is reviewed.
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Affiliation(s)
- R Collins
- Centre for Reviews and Dissemination, University of York, York YO10 5DD, UK.
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Kumar S, Pandey M, Lal P, Rastogi N, Maria Das KJ, Dimri K. Concomitant boost radiotherapy with concurrent weekly cisplatin in advanced head and neck cancers: a phase II trial. Radiother Oncol 2005; 75:186-92. [PMID: 16086908 DOI: 10.1016/j.radonc.2004.12.004] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2004] [Revised: 11/24/2004] [Accepted: 12/10/2004] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE To determine the safety and efficacy of concomitant boost radiotherapy (CBRT) with concurrent cisplatin chemotherapy (CT) in advanced head and neck cancers. PATIENTS AND METHODS Between February 2000 and June 2001, 95 previously untreated patients of advanced head and neck cancers were treated with CBRT and concurrent cisplatin CT. CBRT consisted of: phase I--44 Gy/22fx/4.5 weeks, phase IIa--16 Gy/8fx/1.5 weeks and phase IIb--10 Gy/8fx (delivered as a second daily fraction after a gap of 6h along with phase IIa). CT (cisplatin 35 mg/m(2)) was administered weekly usually preceding CBRT by an hour. RESULTS The median follow-up was 39 months (range 8-50 months). CBRT compliance (70 Gy in 40-44 days) was seen in 66% (63/95). Six cycles of CT was delivered in 73% (69/95). Acute grade III/IV mucosal toxicity was seen in 79% and resulted, on average, in a total weight loss of 7.9 kg from a mean pretreatment weight of 51 kg. Nasogastric tube placements were required in 26% (25/95) for an average duration of 19.3 days. Grade III leucopenia was seen in 2%. Mortality during and within 30 days of treatment was seen in 14% (13/95). Crude incidence of late subcutaneous fibrosis (grade III) was 21% (12/57) and a case of mandibular necrosis and thyroid cartilage necrosis each were seen. Initial loco regional disease clearance was seen in 59% (56/95) and the Kaplan-Meier estimates of 3-year loco-regional control rate and overall survival were 25% (median 7 months, 95% C.I. 3-11) and 27% (median 12 months, 95% C.I. 8-16), respectively. CONCLUSIONS On present evidence, in the settings of a developing country, CBRT with concurrent cisplatin cannot be recommended as primary therapy in advanced head and neck cancers without formal comparison with other treatment modalities.
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Affiliation(s)
- Shaleen Kumar
- Department of Radiotherapy, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, India.
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González San Segundo C, Calvo Manuel FA, Santos Miranda JA. [Delays and treatment interruptions: difficulties in administering radiotherapy in an ideal time-period]. Clin Transl Oncol 2005; 7:47-54. [PMID: 15899208 DOI: 10.1007/bf02710009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Prescribed total radiation dose should be administered within in a specific time-frame and delays in commencing treatment and/or unplanned interruptions in radiation delivery are unacceptable because, in certain cancer sites, treatment-time prolongation can have a deleterious effect on local tumour control, and on patient outcomes. The present review evaluated the causes of initial treatment delays as well as interruptions in the scheduled radiotherapy. The literature search highlighted a significant concern in avoiding treatment-time prolongation in head and neck, cervix, breast and lung cancer. Among the causes involved in delay in radiotherapy commencement factors such as waiting lists, lack of material and human resources, and an increase complexity in planning, simulation and verification are highlighted. Most authors recommend radiotherapy commencement as soon as possible in radical (exclusive irradiation with active tumour present) and palliative situations with a maximum delay of no more than 6 to 8 weeks in the case of adjuvant radiotherapy (post-resection) programs. Interruptions during the course of treatment include: planned unit maintenance and servicing, acute patient toxicity or unexpected malfunction of linear accelerators; this last feature has the most deleterious effect on patients as well as radiotherapy practitioners. Interruptions that impact on the programmed time-course for radiotherapy needs to be compensated-for so as assure the biological equivalence in treatment efficacy with respect to cancer site and stage.
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Gibson MK, Forastiere AA. Multidisciplinary approaches in the management of advanced head and neck tumors: state of the art. Curr Opin Oncol 2004; 16:220-4. [PMID: 15069316 DOI: 10.1097/00001622-200405000-00005] [Citation(s) in RCA: 50] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
PURPOSE OF REVIEW Head and neck cancer remains a significant cause of morbidity worldwide, with approximately 400,000 new cases per year. Ongoing advances in multidisciplinary management of this complex and multivaried disease process are resulting in improved function, quality of life, and survival. This review presents selected advances in primary research in head and neck cancer during the year 2003. RECENT FINDINGS Successful management of head and neck cancer now requires a cooperative approach among a broad group of medical disciplines that includes head and neck surgery, radiation oncology, medical oncology, medical imaging, clinical pathology and lab medicine, social work, nutrition, and others. Translation of continued advances in these fields by cooperative work will continue to yield incremental advances in diagnosis, staging, treatment, follow-up, supportive care, and quality of life. Accordingly, this review aims to include facets of each individual field. Diagnosis and staging continue to evolve with the inclusion of nuclear medicine and in vivo molecular imaging based on the technology of positron emission tomography and single photon emission computed tomographic scanning. Multimodality approaches remain the forefront of intervention for patients with advanced disease. Facets that continue to be defined and studied include the best treatment order of the three disciplines of surgery, radiation, and chemotherapy; the refinement of radiation by altering fraction dose, sequence, and time course; radiosensitization by chemo- and biologic therapy; and the addition of novel, biologically targeted agents to these disciplines. Following from the side effects of these intensive treatments to a functionally critical part of the body are ongoing advances in supportive care and quality of life. SUMMARY Head and neck cancer represents a collection of diseases that, although seemingly united by location and histology, on closer inspection represent a diverse collection of subcategories that often differ in pathogenesis, tumor biology, sublocation within the head and neck region, diagnosis, prognosis, treatment, and effect on quality of life. Given this complexity, it is not surprising that clinical management is also complicated and requires a cooperative effort among multiple subspecialties. This review of the current standard of care for patients with head and neck cancer aims to assist this diverse group of practitioners in caring for this complex group of patients.
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Affiliation(s)
- Michael K Gibson
- The Sidney Kimmel Comprehensive Cancer Center, Johns Hopkins, Baltimore, Maryland 21231, USA.
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Baumann M, Verfaillie C, Heeren G, Leer JW. Shaping the future: training of professionals for radiotherapy in Europe. Radiother Oncol 2004; 70:103-5. [PMID: 15028396 DOI: 10.1016/j.radonc.2004.01.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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