scholarly journals Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era

Oral Oncology ◽  
2020 ◽  
Vol 111 ◽  
pp. 105045
Author(s):  
Tejpal Gupta ◽  
Sarbani Ghosh-Laskar ◽  
Jai Prakash Agarwal
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Curative Intent ◽  
Accelerated Radiotherapy

Effect of Epoetin Alfa on Survival and Cancer Treatment–Related Anemia and Fatigue in Patients Receiving Radical Radiotherapy With Curative Intent for Head and Neck Cancer

2009 ◽  
Vol 27 (34) ◽  
pp. 5751-5756 ◽  
Author(s):  
Peter J. Hoskin ◽  
Martin Robinson ◽  
Nicholas Slevin ◽  
David Morgan ◽  
Kevin Harrington ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Adverse Events ◽  
Cancer Treatment ◽  
Head And Neck ◽  
Neck Cancer ◽  
Functional Assessment ◽  
Radical Radiotherapy ◽  
Epoetin Alfa ◽  
Local Tumor ◽  
Curative Intent

Purpose To evaluate the effect of epoetin alfa on local disease-free survival (DFS), overall survival (OS), and cancer treatment–related anemia and fatigue in patients with head and neck cancer receiving radical radiotherapy with curative intent. Patients and Methods Patients (N = 301) with hemoglobin (Hb) less than 15 g/dL were randomly assigned in a ratio of 1:1 to receive radiotherapy plus epoetin alfa (10,000 U subcutaneously [SC] three times weekly if baseline Hb was < 12.5 g/dL; 4,000 U SC three times weekly if baseline Hb ≥ 12.5 g/dL) or radiotherapy alone. Hb levels were monitored weekly. The primary end point was local DFS, defined as the time from random assignment to local disease recurrence or death. Secondary efficacy end points included OS, local tumor response, and local tumor control. Patients were followed at 1, 4, 8, and 12 weeks postradiotherapy and annually for 5 years. Cancer treatment–related anemia and fatigue were evaluated with the Functional Assessment of Cancer Therapy-Anemia and Functional Assessment of Cancer Therapy-Head and Neck. Adverse events were recorded up to 12 weeks postradiotherapy. Results Hb levels increased from baseline with epoetin alfa. The median duration of local DFS was not statistically different between groups (observation, 35.42 months; epoetin alfa, 31.47 months; hazard ratio, 1.04; 95% CI, 0.77 to 1.41). Groups did not significantly differ in DFS, OS, tumor outcomes, or cancer treatment–related anemia or fatigue. No new or unexpected adverse events were observed. Conclusion Addition of epoetin alfa to radical radiotherapy did not affect survival, tumor outcomes, anemia, or fatigue positively or negatively in patients with head and neck cancer.

scholarly journals Hipotiroidismo Secundário à Irradiação Cervical: Avaliação Sistemática da Função Tiroideia no Seguimento

2014 ◽  
Vol 27 (4) ◽  
pp. 467
Author(s):  
Sara Monteiro Gonçalves ◽  
Brigida Da Costa Ferreira ◽  
Maria João Guardado ◽  
Rui Marques ◽  
Tânia Serra ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Thyroid Function ◽  
Neck Cancer ◽  
Rating Scales ◽  
Free Fraction ◽  
Underlying Mechanism ◽  
Systematic Evaluation ◽  
Curative Intent

<strong>Introduction:</strong> Sometimes Thyroid dysfunction is an underestimated consequence of radiation exposure. The underlying mechanism is not clearly understood, but it is likely to be multifactorial. As so, the specific risk factors associated with the development of secondary radiotherapy hypothyroidism remain undefined. The direct irradiation of the thyroid gland may result more frequently in hypothyroidism. This is an irreversible condition, requiring lifelong treatment and monitoring.<br /><strong>Objectives:</strong> To evaluate the incidence of hypothyroidism in patients with head and neck cancer who underwent neck irradiation on an intensive or adjuvant basis and determine whether it is justifiable to integrate the monitoring of parameters for evaluation of thyroid function (TSH, free fraction T3 e free fraction T4 ) in this patient group on the Institutional follow up protocol.<br /><strong>Material and Methods:</strong> This is an observational, retrospective descriptive study, which comprises a group of 376 patients with head and neck cancer undergoing radiotherapy, on adjuvant or intensive basis, between the years 2007 and 2012, at Portuguese Institute of Oncology of Coimbra, E.P.E. 145 patients met all the inclusion criteria. Standardized rating scales for the definition of hypothyroidism have been used - LENT-SOMA scales (Late Effects Normal Tissues Subjective Objective Management Analysis). Grade 1 or higher was considered as a complication hypothyroidism.<br /><strong>Results:</strong> The analysis of a cohort of 145 patients was carried out. The most frequent tumor site was the larynx (26.9%). Thirty-two patients received adjuvant radiotherapy and 113 were treated with intensive schemes. The most used radiotherapy technique was intensity modulated (IMRT), performed in 86.2% patients. The overall incidence rate of hypothyroidism at 12 months was 18.6%. The diagnosis for hypothyroidism was done between 9 and 12 months after treatment radiotherapy in 51.9% of the patients with this<br />complication.<br /><strong>Discussion:</strong> An analysis of the published literature, hypothyroidism is the most common thyroid complication after irradiation and affects a large percentage of patients undergoing cervical radiotherapy with curative intent. It has been shown that the risk of hypothyroidism increases with time after exposure, but the highest incidence appears to be in the first two years after treatment. From our analysis we obtained at 12 months, a rate of incidence of hypothyroidism of 18.6% (16.55% grade 1 and grade 2, 2.1%).<br /><strong>Conclusions:</strong> This study found an incidence of hypothyroidism corresponding to the lowest values reported in other published studies. The short duration of follow-up considered in this analysis, may justify these results. With these results and their correlation with the available literature, the authors consider justified and recommend the inclusion of the systematic evaluation of thyroid function in the follow-up protocol of these patients.<br />Keywords: Head and Neck Neoplasms; Radiotherapy; Hypothyroidism; Follow-up Studies.

Hyperfractioned or accelerated radiotherapy in head and neck cancer: a meta-analysis

2007 ◽  
Vol 32 (2) ◽  
pp. 119-119 ◽  
Author(s):  
Jean Bourhis ◽  
Jens Overgaard ◽  
Hélène Audry ◽  
Kian K Ang ◽  
Michele Saunders ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Meta Analysis ◽  
Accelerated Radiotherapy

scholarly journals Disease trajectories, place and mode of death in people with head and neck cancer: Findings from the ‘Head and Neck 5000’ population-based prospective clinical cohort study

2020 ◽  
Vol 34 (5) ◽  
pp. 639-650 ◽  
Author(s):  
Catriona R Mayland ◽  
Kate Ingarfield ◽  
Simon N Rogers ◽  
Paola Dey ◽  
Steven Thomas ◽  
...  
Keyword(s):  
Palliative Care ◽  
Cohort Study ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Population Based ◽  
Hospital Death ◽  
Care Needs ◽  
Curative Intent ◽  
Mode Of Death

Background: Few large studies describe initial disease trajectories and subsequent mortality in people with head and neck cancer. This is a necessary first step to identify the need for palliative care and associated services. Aim: To analyse data from the Head and Neck 5000 study to present mortality, place and mode of death within 12 months of diagnosis. Design: Prospective cohort study. Participants: In total, 5402 people with a new diagnosis of head and neck cancer were recruited from 76 cancer centres in the United Kingdom between April 2011 and December 2014. Results: Initially, 161/5402 (3%) and 5241/5402 (97%) of participants were treated with ‘non-curative’ and ‘curative’ intent, respectively. Within 12 months, 109/161 (68%) in the ‘non-curative’ group died compared with 482/5241 (9%) in the ‘curative’ group. Catastrophic bleed was the terminal event for 10.4% and 9.8% of people in ‘non-curative’ and ‘curative’ groups, respectively; terminal airway obstruction was recorded for 7.5% and 6.3% of people in the same corresponding groups. Similar proportions of people in both groups died in a hospice (22.9% ‘non-curative’; 23.5% ‘curative’) and 45.7% of the ‘curative’ group died in hospital. Conclusion: In addition to those with incurable head and neck cancer, there is a small but significant ‘curative’ subgroup of people who may have palliative needs shortly following diagnosis. Given the high mortality, risk of acute catastrophic event and frequent hospital death, clarifying the level and timing of palliative care services engagement would help provide assurance as to whether palliative care needs are being met.

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