Adaptive radiotherapy for head and neck cancer: Are we ready to put it into routine clinical practice?

Abstract In the Netherlands, the model-based approach is used to identify patients with head and neck cancer who may benefit most from proton therapy in terms of prevention of late radiation-induced side effects in comparison with photon therapy. To this purpose, a National Indication Protocol Proton therapy for Head and Neck Cancer patients (NIPP-HNC) was developed, which has been approved by the health care authorities. When patients qualify according to the guidelines of the NIPP-HNC, proton therapy is fully reimbursed. This article describes the procedures that were followed to develop this NIPP-HNC and provides all necessary information to introduce model-based selection for patients with head and neck cancer into routine clinical practice.

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Selective Nodal Irradiation for Head and Neck Cancer Using Intensity-Modulated Radiotherapy: Application of RTOG Consensus Guidelines in Routine Clinical Practice

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2009.01.060 ◽

2010 ◽

Vol 76 (1) ◽

pp. 146-153 ◽

Cited By ~ 11

Author(s):

Sapna Nangia ◽

Kundan S. Chufal ◽

Atul Tyagi ◽

Anshul Bhatnagar ◽

Manindra Mishra ◽

...

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Head And Neck ◽

Neck Cancer ◽

Intensity Modulated Radiotherapy ◽

Routine Clinical Practice ◽

Consensus Guidelines ◽

Intensity Modulated

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MRI - Guided Adaptive RadioTHerapy for Reducing XerostomiA in Head and Neck Cancer (MARTHA-trial)

Case Medical Research ◽

10.31525/ct1-nct03972072 ◽

2019 ◽

Author(s):

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Adaptive Radiotherapy ◽

Mri Guided

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Dental Restrictions to Clinical Practice during the COVID-19 Pandemic: An Australian Perspective

JDR Clinical & Translational Research ◽

10.1177/23800844211000341 ◽

2021 ◽

pp. 238008442110003

Author(s):

T.M. Nguyen ◽

U. Tonmukayakul ◽

H. Calache

Keyword(s):

Head And Neck Cancer ◽

Clinical Practice ◽

Dental Caries ◽

Knowledge Transfer ◽

Head And Neck ◽

Neck Cancer ◽

Dental Care ◽

Oral Diseases ◽

Increased Risk ◽

Dental Profession

The coronavirus disease 2019 (COVID-19) has disrupted essential oral healthcare in Australia. Sources for COVID-19 transmission via dental settings is considered to have high potential due to the production of aerosols and because transmission can occur through the airborne route. However, COVID-19 cases in dentistry is reportedly low. Delayed timely dental care, where severe oral diseases remain undetected, untreated, or asymptomatic such as advanced dental caries, periodontitis, and head and neck cancer, can have detrimental consequences for individuals at increased risk for oral diseases. The dental profession should remain vigilant and advocate for the continuation of essential oral healthcare even in times of uncertainty. Knowledge Transfer Statement: The reportedly low COVID-19 transmission occurring in dental settings highlight achievements made by the dental profession. There are valid reasons to reconsider risk-based essential oral healthcare during the COVID-19 pandemic.

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Adaptive radiotherapy for head and neck cancer

Radiološke tehnologije ◽

10.48026/isnn.26373297.2020.11.1.2 ◽

2020 ◽

Vol 11 (1) ◽

Author(s):

Enis Tinjak ◽

Velda Smajlbegović ◽

Adnan Beganović ◽

Mirjana Ristanić ◽

Halil Ćorović ◽

...

Keyword(s):

Radiation Therapy ◽

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Locally Advanced ◽

Adaptive Radiotherapy ◽

Tumor Control ◽

Parotid Glands ◽

Image Guided Radiotherapy ◽

The Impact

Introduction: Radiation therapy has long played an integral role in the manage¬ment of locally advanced head and neck cancer (HNC), both for organ preservation and to improve tumor control in the postoperative setting. The aim of this research is to investigate the effects of adaptive radiotherapy on dosimetric, clinical, and toxicity outcomes for patients with head and neck cancer undergoing radiation therapy treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an interesting treatment paradigm that has been developed to directly adjust to these changes.Material and methods: This research contains the results of 15 studies, including clinical trials, randomized prospective and retrospective studies. The researches analyze the impact of radiation therapy on changes in tumor volume and the relationship with planned radiation dose delivery, as well as the possibility of using adaptive radiotherapy in response to identified changes. Also, medical articles and abstracts that are closely related to the title of adaptive radiotherapy were researched.Results: The application of ART significantly improved the quality of life of patients with head and neck cancer, as well as two-year locoregional control of the disease. The average time to apply ART is the middle of the treatment course approximately 17 to 20 fractions of the treatment.Conclusion: Based on systematic review of the literature, evidence based changes in target volumes and dose reduction at OAR, adaptive radiotherapy is recommended treatment for most of the patients with head and neck cancer with the support of image-guided radiotherapy.

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Compliance and Outcomes in Locally Advanced Head and Neck Cancer Patients Treated with Alternating Chemoradiotherapy in Clinical Practice

Tumori Journal ◽

10.1177/030089160308900105 ◽

2003 ◽

Vol 89 (1) ◽

pp. 20-25 ◽

Cited By ~ 4

Author(s):

Vittorio Franciosi ◽

Marco Fumagalli ◽

Luciana Biscari ◽

Roberto Martinelli ◽

Teore Ferri ◽

...

Keyword(s):

Overall Survival ◽

Head And Neck Cancer ◽

Clinical Practice ◽

Head And Neck ◽

Cancer Patients ◽

Neck Cancer ◽

Locally Advanced ◽

Hematologic Toxicity ◽

Advanced Head ◽

Grade 3

Background and Aims To evaluate the feasibility in clinical practice of alternating chemo-radiotherapy in locally advanced head and neck cancer patients. Patients and Methods From August 1993 to April 1998 at the Division of Medical Oncology of Parma, 48 consecutive patients were observed, and 38 (79%) started the Merlano chemo-radiotherapy. The characteristics of the patients were: males (32, 84%); median age, 57 years; PS <2 (32, 84%). The primary sites were the oropharynx (18, 47%), oral cavity (8, 21%), hypopharynx (7, 19%), larynx (5, 13%); stage IV disease was present in 29 (76%) patients. Twenty-five (66%) patients were married, and 24 (63%) resided outside of the city. Results The compliance was very low: 21 patients (55%) performed all the programmed cycles of chemotherapy, whereas only 5 patients (13%) performed the chemo-radiotherapy at full doses without any delay. The objective responses were 3 (8%) complete and 21 (55%) complete plus partial responses. Failures were 2 (5%) stable disease and 2 (5%) progressive disease, and the response was not assessable in 10 (26%). The median duration of the response was 8 months. The median overall survival and the time to progression were 18 and 13 months, respectively; the 5-year overall and relapse-free survival were 36% and 26%, respectively. Nine (24%) patients were still alive as of August 30, 2001, 8 (21%) of them without progression. Twenty-six patients (68%) died with a local-regional relapse. One patient (3%) died for a second cancer. Grade 3–4 hematologic toxicity was leukopenia (n = 25, 66%) and thrombocytopenia (n = 9, 24%); grade 3–4 non-hematologic toxicity was diarrhea (n = 3, 8%) and mucositis (n = 2, 5%). Two patients (5%) died for intestinal infarction and perforation possibly related to treatment. Conclusions Compliance to the chemo-radiotherapy was very poor. The response rate was lower than that reported in clinical trials, whereas overall survival was comparable. The alternating chemo-radiotherapy is a very complex treatment that cannot be easily applied in clinical practice; a careful selection of patients is mandatory not only considering oncologic and medical criteria, but also the level of awareness of the patient and his family.

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