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 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.

Prophylactic fluconazole treatment of mucositis in radiotherapy of head and neck cancer patients

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6062-6062
Author(s):  
C. Demiroz ◽  
L. Ozkan ◽  
O. Karadag
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Late Toxicity ◽  
Group A ◽  
Fluconazole Prophylaxis ◽  
Grade 3 ◽  
Group B

6062 Background: The aim of the study is to evaluate the preventive role of antifungal fluconazole prophylaxis on mucositis in head and neck cancer patients treated with radiotherapy. Methods: We evaluated 43 head and neck cancer patients treated with radiotherapy with/without chemotherapy. The patients were randomized to two groups: twenty patients (group A) received fluconazole when micotic infections appeared; 23 patients (group B) received fluconazole 200 mg once a week starting from the sixth irradiation session throughout the treatment.The two groups were similar in terms of patients and radiotherapy characteristics. Oral mucositis was recorded according to EORTC/RTOG criteria. Results: The usage of fluconazole 200 mg once a week was well tolerated and no early and late toxicity was observed. Mucositis was appeared in both groups on the third week of radiotherapy. Grade 3 mucositis developed at eight of the patients in group A (40%), three of the patients in group B (13%) and the result was statistically significant (p = 0.044). While grade 3 mucositis was observed the second/third week in group A, it was also observed in group B on third/fourth week in group B (p = 0.043). Conclusions: Weekly fluconazole prophylaxis showed a significant effect on the grade 3 mucositis and improved radiotherapy results. No significant financial relationships to disclose.

Toxicity induced by radiochemotherapy with weekly paclitaxel versus weekly cisplatin in patients with advanced head and neck cancer

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16534-16534
Author(s):  
D. L. Stanculeanu ◽  
A. Tache ◽  
A. Cringeanu ◽  
D. Mitulescu ◽  
R. Scheusan ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
External Beam Radiation ◽  
Weekly Paclitaxel ◽  
Severe Side Effect ◽  
Advanced Head ◽  
Grade 3

16534 Background: Head and neck cancers represent about 8 % of the total solid cancer cases. For advanced head and neck cancer (HNC) patients, the effects of disease and the side effects of aggressive treatments have the potential to severely affect quality of life. Combined chemoradiotherapy increase rates of locoregional control, but it may cause severe side effects, mainly painful mucositis. In our study we evaluated the chemoradiotherapy induced toxicities in patients treated with concomitant radiochemotherapy using weekly paclitaxel or cisplatin for advanced head and neck cancer. Methods: From April 2003 to December 2005 46 patients with locally advanced head and neck cancer were enrolled onto this study. Patients characteristics: 35 male and 11 female; mean age 62,5; performance status ECOG 0–1, carcinoma histological confirmed. All patients received external beam radiation using DT= 45 Gy, 1,8 Gy/fr, 5 fr/week in combination with chemotherapy: arm A (20 pts) - Paclitaxel 35 mg/mp days 1,8,15,22,29; arm B (26 pts)- Cisplatin 20 mg/mp days 1,8,15,22,29. Results: 40 patients have completed the planed treatment; 4 patients have interrupted treatment because of toxicity; there were 2 toxic death due to neutropenic sepsis and metabolic disorders in arm A. Toxicity grade 3–4 was hematological - neutropenia - 14, 6 % pts in arm A vs. 7, 8 % pts in arm B; gastrointestinal - nausea 6,7 % pts in arm A vs. 5,6% pts in arm B; neurological - neuropathy 5,4 % pts in arm A vs. 0 pts in arm B; dermatological - radic dermitis 4,3% in arm A vs. 4,1% in arm B; oral mucositis 33,6% in arm A vs 27,8% in arm B. All this patients received analgesics and anti-inflammatory drugs, systemic and/or topical. Other toxicities were not significantly related. Conclusions: This study confirmed that radiochemotherapy has shown to provide clinical benefit response and disease stabilization in patients with locally advanced head and neck cancer. Unfortunately, this concomitant therapy was significantly associated with hematological toxicities and oral mycosis. The most severe side effect was oral mycositis grade 3–4, especially in the paclitaxel arm. No significant financial relationships to disclose.

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 IMRT with the Use of Simultaneous Integrated Boost in Treatment of Head and Neck Cancer: Acute Toxicity Evaluation

2006 ◽  
Vol 49 (3) ◽  
pp. 167-173 ◽  
Author(s):  
Milan Vošmik ◽  
Karel Odrážka ◽  
Martin Doležel ◽  
Miloslava Vaculíková ◽  
Petr Kordač ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Neck Cancer ◽  
Concurrent Chemotherapy ◽  
Simultaneous Integrated Boost ◽  
Severe Toxicity ◽  
Subclinical Disease ◽  
Integrated Boost ◽  
Weekly Cisplatin

Acute toxicity has been evaluated in head and neck cancer patients treated with intensity-modulated radiotherapy using simultaneous integrated boost (SIB-IMRT). The basis of the treatment protocol is an irradiation in 30 fractions with a total dose: 66 Gy to the region of macroscopic tumor, 60 Gy to the region of high-risk subclinical disease and 54 Gy to the region of low-risk subclinical disease. Between December 2003 and September 2005, 38 patients with carcinoma of different locations in the head and neck region were irradiated. Five patients underwent concurrent chemotherapy (weekly cisplatin). Acute toxicity was evaluated according to Radiation Therapy Oncology Group toxicity scale for skin, mucous membrane, salivary glands, pharynx and esophagus and larynx. All 38 patients completed the therapy without urgency of interruption due to acute toxicity of radiotherapy. No patient experienced grade 4 toxicity. More severe toxicity was observed in patients with concurrent chemotherapy. The results confirm that the irradiation according to our SIB-IMRT protocol is a therapy with acceptable toxicity and there is a space for radiobiological enhancement of this regimen by concurrent chemotherapy, e.g. weekly cisplatin.

scholarly journals Acute Toxicity and Preliminary Clinical Outcomes of Concurrent Radiation Therapy and Weekly Docetaxel and Daily Cisplatin for Head and Neck Cancer

2005 ◽  
Vol 35 (11) ◽  
pp. 639-644 ◽  
Author(s):  
Yoshizumi Kitamoto ◽  
Tetsuo Akimoto ◽  
Hitoshi Ishikawa ◽  
Tetsuo Nonaka ◽  
Hiroyuki Katoh ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Acute Toxicity ◽  
Head And Neck ◽  
Clinical Outcomes ◽  
Neck Cancer ◽  
Weekly Docetaxel

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

2003 ◽  
Vol 89 (1) ◽  
pp. 20-25 ◽  
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.

scholarly journals Carbon ion reirradiation compared to intensity-modulated re-radiotherapy for recurrent head and neck cancer (CARE): a randomized controlled trial

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Thomas Held ◽  
Kristin Lang ◽  
Sebastian Regnery ◽  
Katharina Weusthof ◽  
Adriane Hommertgen ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Clinical Outcome ◽  
Head And Neck ◽  
Neck Cancer ◽  
Severe Toxicity ◽  
Carbon Ion ◽  
Intensity Modulated ◽  
Link Type ◽  
Recurrent Head ◽  
Grade Iii

Abstract Background Intensity-modulated re-radiotherapy (reIMRT) has been established as a standard local treatment option in patients with non-resectable, recurrent head and neck cancer (rHNC). However, the clinical outcome is unfavorable and severe toxicities (≥grade III) occurred in 30–40% of patients. The primary aim of the current trial is to investigate carbon ion reirradiation (reCIRT) compared to reIMRT in patients with rHNC regarding safety/toxicity as well as local control, overall survival (OS), and quality of life (QoL). Methods The present trial will be performed as a single center, two-armed, prospective phase II study. A maximum of 72 patients will be treated with either reIMRT or reCIRT to evaluate severe (≥grade III) treatment-related toxicities (randomization ratio 1:1). The primary target value is to generate less than 35% acute/subacute severe toxicity (≥grade III), according to the Common Terminology Criteria for Adverse Events v5.0, within 6 months after study treatment. The total dose of reirradiation will range between 51 and 60 Gy or Gy (RBE), depending primarily on the radiotherapy interval and the cumulative dose to organs at risk. Individual dose prescription will be at the discretion of the treating radiation oncologist. The local and distant progression-free survival 12 months after reirradiation, the OS, and the QoL are the secondary endpoints of the trial. Explorative trial objectives are the longitudinal investigation of clinical patient-related parameters, tumor parameters on radiological imaging, and blood-based tumor analytics. Discussion Recent retrospective studies suggested that reCIRT could represent a feasible and effective treatment modality for rHNC. This current randomized prospective trial is the first to investigate the toxicity and clinical outcome of reCIRT compared to reIMRT in patients with rHNC. Trial registration ClinicalTrials.gov; NCT04185974; December 4th 2019.

The EORTC randomized trial on three fractions per day and misonidazole (trial no. 22811) in advanced head and neck cancer: long-term results and side effects

1995 ◽  
Vol 35 (2) ◽  
pp. 91-99 ◽  
Author(s):  
Walter Van den Bogaert ◽  
Emmanuel van der Schueren ◽  
Jean-Claude Horiot ◽  
Mario De Vilhena ◽  
Simon Schraub ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Side Effects ◽  
Randomized Trial ◽  
Head And Neck ◽  
Neck Cancer ◽  
Long Term Results ◽  
Advanced Head

Nonstandard Fractionation Schedules in Radiation Therapy of Head and Neck Cancer: A Review

1997 ◽  
Vol 83 (3) ◽  
pp. 633-642 ◽  
Author(s):  
Patrizia Olmi ◽  
Carlo Fallai
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Late Toxicity ◽  
Research Field ◽  
Current Status ◽  
Introductory Overview ◽  
Accelerated Fractionation ◽  
Fractionation Schedules ◽  
Standard Fractionation

The authors present an updated review of the clinical trials on hyperfractionated and accelerated fractionation schedules in radiotherapy of head and neck cancer. The available results in terms of survival and local control, and acute and late toxicity data are summarized in order to show the current status of this research field. The new breed of fractionation schedules that are on study, designed on the ground of new rationales, are presented as well. Finally, an introductory overview of combination therapy including non standard fractionation radiotherapy associated with chemotherapy is reported70.

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