Simultaneous cisplatinum and 5fu infusion and radiotherapy in patients with advanced head and neck cancer: lack of effect of prolongation of treatment duration on tumor control

Author(s):  
A.K. Murthy ◽  
S.G. Taylor ◽  
K.L. Griem ◽  
D.L. Galinsky ◽  
J.L. Showel ◽  
...  
2010 ◽  
Vol 28 (18) ◽  
pp. 2996-3001 ◽  
Author(s):  
Lester J. Peters ◽  
Brian O'Sullivan ◽  
Jordi Giralt ◽  
Thomas J. Fitzgerald ◽  
Andy Trotti ◽  
...  

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.


Head & Neck ◽  
2001 ◽  
Vol 23 (8) ◽  
pp. 661-668 ◽  
Author(s):  
Felix Leborgne ◽  
Jos� H. Leborgne ◽  
Jack Fowler ◽  
Eduardo Zubizarreta ◽  
Julieta Mezzera

1998 ◽  
Vol 23 (4) ◽  
pp. 376-376
Author(s):  
Quak ◽  
Van Bokhorst ◽  
Klop ◽  
Van Leeuwen ◽  
Snow

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