Acute toxicity to the skin and mucosa of radiotherapy alone versus radiotherapy in combination with cetuximab or chemotherapy in patients with head and neck cancer

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17007-e17007
Author(s):  
H. I. Garcia-Huttenlocher ◽  
C. Timke ◽  
A. D. Jensen ◽  
P. E. Huber ◽  
J. Debus ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Early Intervention ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Skin Toxicity ◽  
Platinum Based Chemotherapy ◽  
Radiotherapy Alone ◽  
Grade 3

e17007 Background: To evaluate acute toxicity of the skin and mucosa in patients with head and neck cancer who received Radiotherapy alone (RT) or in combination with cetuximab (IRT) or chemotherapy (CRT). Methods: We retrospectively analyzed 204 patients with head and neck cancer, treated between 2006 and 2008. RT was combined with cetuximab (n = 57), or with platinum-based chemotherapy (n = 99), 48 patients received RT alone. We included 149 male and 55 female patients with a median age of 62 years (range 22–92). Median radiation dose was 66 Gy (range 26.4–71.6Gy). 126 patients received intensity modulated radiotherapy (IMRT), 78 patients had conventional RT. Toxicity was assessed according to CTCAE Version 3.0. Results: Median follow-up was 9 months (range 1–34). Acute grade 3 toxicity of the skin was observed in 26% of IRT, 0% of RT, and 7% of CRT patients. Typical appearance of grade 3 skin toxicity in IRT was a massive confluent epitheliolysis of the RT field. Grade 3 mucositis appeared in 21% of IRT-, 12.5% of RT-, and 16% of CRT-patients. Rates of skin toxicity grade 3 were 8% in patients with IMRT and 15% in patients with conventional RT. Grade 3 mucositis was seen in 22% of the IMRT-patients and 8% of the patients with conventional RT. Cetuximab did not lead to a higher rate of RT interruptions as compared to RT and CRT. Early intervention and supportive care in case of high grade toxicity was performed for all patients. 8 weeks after RT all patients showed recovery from toxicity. Conclusions: Higher toxicity to the skin and to the mucosa occurred in the IRT group, and seems to be a specific side effect in the treatment of head and neck cancer patients with concomitant cetuximab and RT. But severity of toxicity may also be influenced by other factors such as RT technique. IRT patients need close observation and early intervention in case of therapy induced toxicity in order to prevent RT interruption, which might limit the advantage of cetuximab. Longer follow-up is needed to evaluate outcome and late toxicity of the different treatment groups. [Table: see text]

scholarly journals Overlapping volumes in re-irradiation for head and neck cancer - an important factor for patient selection

2020 ◽  
Author(s):  
Anna Embring ◽  
Eva Onjukka ◽  
Claes Mercke ◽  
Ingmar Lax ◽  
Anders Berglund ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Late Toxicity ◽  
Severe Toxicity ◽  
Grade 3 ◽  
Definition Of ◽  
Strict Definition

Abstract Background: There is a lack of consensus concerning the definition of re-irradiation and re-irradiation volumes in head and neck cancer (HNC). The aim of the present study is to introduce a more strict definition of the re-irradiated volume that might better predict the risk of serious side-effects from treatment. Methods: Fifty-four consecutive patients re-irradiated for HNC cancer were retrospectively analysed. CT images were deformably registered and the dose distributions accumulated after conversion to EQD2. Patients with a cumulative dose of ≥100 Gy in the overlapping volume (V100) were included in the study. Survival data and radiation-related acute and late toxicities were recorded. Results: The overall survival of all included patients at 2 and 5 years was 42.6% and 27.3% respectively and the progression free survival at 2 and 5 years was 32.5% and 28.5% respectively. The overall rate of any event of severe (grade ≥3) acute and late toxicity was 26% and 51%, respectively. We found that severe acute toxicity was more common in patients who had a larger overlapping volume (V100 >mean) where 43% of the patients experienced grade ≥3 acute toxicity, compared to the patients with smaller overlapping volumes (V100 <mean) where only 11% had severe toxicity (p = 0.02). The seemingly high rates of late toxicity in the present study could be due to the use of a more strict definition of re-irradiation. In previous studies also patients with low dose overlap are included and our results imply that there is a risk that previous studies might have overestimated the risk-benefit ratio in re-irradiation of HNC.Conclusions: Our study describes the outcome of a patient material where a more strict definition of the re-irradiated volume is used. With this definition, which could better describe the volume of highest risk for serious complications, we found that larger such overlapping volumes result in an increase in severe acute side-effects. A clear definition of re-irradiation and re-irradiation volumes is of utmost importance for future studies of HNC to make results from different studies comparable.

scholarly journals Temporal Lobe Necrosis in Head and Neck Cancer Patients after Proton Therapy to the Skull Base

2020 ◽  
Vol 6 (4) ◽  
pp. 17-28 ◽  
Author(s):  
Sarin Kitpanit ◽  
Anna Lee ◽  
Ken L. Pitter ◽  
Dan Fan ◽  
James C.H. Chow ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Skull Base ◽  
Temporal Lobe ◽  
Neck Cancer ◽  
Proton Therapy ◽  
Dose Volume ◽  
Temporal Lobe Necrosis ◽  
Grade 3

Abstract Purpose To demonstrate temporal lobe necrosis (TLN) rate and clinical/dose-volume factors associated with TLN in radiation-naïve patients with head and neck cancer treated with proton therapy where the field of radiation involved the skull base. Materials and Methods Medical records and dosimetric data for radiation-naïve patients with head and neck cancer receiving proton therapy to the skull base were retrospectively reviewed. Patients with &lt;3 months of follow-up, receiving &lt;45 GyRBE or nonconventional fractionation, and/or no follow-up magnetic resonance imaging (MRI) were excluded. TLN was determined using MRI and graded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Clinical (gender, age, comorbidities, concurrent chemotherapy, smoking, radiation techniques) and dose-volume parameters were analyzed for TLN correlation. The receiver operating characteristic curve and area under the curve (AUC) were performed to determine the cutoff points of significant dose-volume parameters. Results Between 2013 and 2019, 234 patients were included. The median follow-up time was 22.5 months (range = 3.2–69.3). Overall TLN rates of any grade, ≥ grade 2, and ≥ grade 3 were 5.6% (N = 13), 2.1%, and 0.9%, respectively. The estimated 2-year TLN rate was 4.6%, and the 2-year rate of any brain necrosis was 6.8%. The median time to TLN was 20.9 months from proton completion. Absolute volume receiving 40, 50, 60, and 70 GyRBE (absolute volume [aV]); mean and maximum dose received by the temporal lobe; and dose to the 0.5, 1, and 2 cm3 volume receiving the maximum dose (D0.5cm3, D1cm3, and D2cm3, respectively) of the temporal lobe were associated with greater TLN risk while clinical parameters showed no correlation. Among volume parameters, aV50 gave maximum AUC (0.921), and D2cm3 gave the highest AUC (0.935) among dose parameters. The 11-cm3 cutoff value for aV50 and 62 GyRBE for D2cm3 showed maximum specificity and sensitivity. Conclusion The estimated 2-year TLN rate was 4.6% with a low rate of toxicities ≥grade 3; aV50 ≤11 cm3, D2cm3 ≤62 GyRBE and other cutoff values are suggested as constraints in proton therapy planning to minimize the risk of any grade TLN. Patients whose temporal lobe(s) unavoidably receive higher doses than these thresholds should be carefully followed with MRI after proton therapy.

scholarly journals Overlapping volumes in re-irradiation for head and neck cancer—an important factor for patient selection

2020 ◽  
Author(s):  
Anna Embring ◽  
Eva Onjukka ◽  
Claes Mercke ◽  
Ingmar Lax ◽  
Anders Berglund ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Late Toxicity ◽  
Severe Toxicity ◽  
Grade 3 ◽  
Definition Of ◽  
Strict Definition

Abstract Background: There is a lack of consensus concerning the definition of re-irradiation and re-irradiation volumes in head and neck cancer (HNC). The aim of the present study is to introduce a more strict definition of the re-irradiated volume that might better predict the risk of serious side-effects from treatment.Methods: Fifty-four consecutive patients re-irradiated for HNC cancer were retrospectively analysed. CT images were deformably registered and the dose distributions accumulated after conversion to EQD2. Patients with a cumulative dose of ≥100 Gy in the overlapping volume (V100) were included in the study. Survival data and radiation-related acute and late toxicities were recorded.Results: The overall survival of all included patients at 2 and 5 years was 42.6% and 27.3% respectively and the progression free survival at 2 and 5 years was 32.5% and 28.5% respectively. The overall rate of any event of severe (grade ≥3) acute and late toxicity was 26% and 51%, respectively. We found that severe acute toxicity was more common in patients who had a larger overlapping volume (V100 >mean) where 43% of the patients experienced grade ≥3 acute toxicity, compared to the patients with smaller overlapping volumes (V100 <mean) where only 11% had severe toxicity (p = 0.02). The seemingly high rates of late toxicity in the present study could be due to the use of a more strict definition of re-irradiation. In previous studies also patients with low dose overlap are included and our results imply that there is a risk that previous studies might have overestimated the risk-benefit ratio in re-irradiation of HNC.Conclusions: Our study describes the outcome of a patient material where a more strict definition of the re-irradiated volume is used. With this definition, which could better describe the volume of highest risk for serious complications, we found that larger such overlapping volumes result in an increase in severe acute side-effects. A clear definition of re-irradiation and re-irradiation volumes is of utmost importance for future studies of HNC to make results from different studies comparable.

Neutrophilic Dermatosis of Hands as Oncological Finding: Importance of Follow-Up

ORL ◽  
2021 ◽  
pp. 1-3
Author(s):  
Jérôme R. Lechien ◽  
Daphné Delplace ◽  
Mohamad Khalife ◽  
Sven Saussez
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Paraneoplastic Syndrome ◽  
Tobacco Consumption ◽  
Neutrophilic Dermatosis ◽  
Pharyngeal Cancer ◽  
Head And Neck Malignancy ◽  
Neck Malignancy

Neutrophilic febrile dermatosis (NFD) is a rare paraneoplastic syndrome that may be found in patients with head and neck cancer. NFD may appear before the neoplasia and may only concern the dorsal faces of the hands. This article reports the NFD findings of a patient with pharyngeal cancer, which was developed 2 years after the occurrence of NFD. The development of NFD in patient with alcohol and tobacco consumption should lead otolaryngologists and dermatologists to suspect head and neck malignancy. In cases of normal otolaryngological examination, patients have to be followed.

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