scholarly journals Burden of acute toxicities in head-and-neck radiation therapy: A single-institutional experience

2019 ◽  
Vol 08 (02) ◽  
pp. 120-123
Author(s):  
Sandeep Muzumder ◽  
Nirmala Srikantia ◽  
Avinash H. Udayashankar ◽  
Prashanth Bhat Kainthaje ◽  
M. G. John Sebastian
Keyword(s):  
Radiation Therapy ◽  
Supportive Care ◽  
Head And Neck ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Significant Proportion ◽  
Tube Feeding ◽  
Treatment Compliance ◽  
Combined Modality Treatment ◽  
Combined Modality

Abstract Introduction: Combined modality therapy is the standard of care in locally advanced head-and-neck cancer (HNC). The incidence of acute toxicities increases with additional therapy. The present study investigated the incidence and patterns of mucositis, dysphagia, aspiration, feeding tube use, admission for supportive care, and treatment compliance in patients with HNC treated curatively with radiation therapy (RT) with or without chemotherapy. Methods and Material: A retrospective review of 164 consecutive HNC patients treated with RT at St. John's Medical College Hospital, Bengaluru, from January 2013 to June 2017 was done. Results: A total of 148 HNC patients were treated with a curative intent and 122 (82.4%) were locally advanced HNC. Combined Modality treatment was received by 119 (80.4%) patients. Eighty-four (56.7%) patients were treated by concurrent chemo-radiation. IMRT technique was used in 125 (84.5%) patients. The incidence of grade 3-4 mucositis, dysphagia and aspiration was 25%, 46%, and 10%, respectively. Nasogastric tube feeding was necessitated in 18.9% (n=28) and 27% (n = 40) required inpatient admission for supportive care. Twenty-nine (19.6%) patients did not complete planned RT dose and 46 (31%) patients had unscheduled RT break (>2days). Fifty-six (66.7%) patients did not receive planned chemotherapy. Conclusions: Acute toxicity due to RT in HNC remains a challenge despite using modern techniques. A significant proportion of patients require supportive therapy for more than 12 weeks and did not complete the scheduled treatment.

Combined Modality Treatment With Chemotherapy, Radiation Therapy, Bevacizumab, and Erlotinib in Patients With Locally Advanced Squamous Carcinoma of the Head and Neck

2011 ◽  
Vol 17 (5) ◽  
pp. 267-272 ◽  
Author(s):  
John D. Hainsworth ◽  
David R. Spigel ◽  
F. Anthony Greco ◽  
Dianna L. Shipley ◽  
James Peyton ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Combined Modality Treatment ◽  
Combined Modality

Induction chemotherapy + gefitinib followed by concurrent chemotherapy/radiation therapy/gefitinib for patients (pts) with locally advanced squamous carcinoma of the head and neck: A phase I/II trial of the Minnie Pearl Cancer Research Network

2006 ◽  
Vol 24 (18_suppl) ◽  
pp. 5543-5543 ◽  
Author(s):  
H. H. Doss ◽  
F. A. Greco ◽  
A. A. Meluch ◽  
J. R. Gray ◽  
D. R. Spigel ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Concurrent Chemotherapy ◽  
Combined Modality ◽  
Grade 3

5543 Background: Concurrent chemotherapy/radiation therapy (RT) improves treatment outcome in pts with locally advanced unresectable squamous cancers of the head and neck. We previously reported a 51% 3-year disease-free survival with induction paclitaxel/carboplatin/5-FU followed by concurrent paclitaxel/carboplatin/RT. In this phase II trial, we added gefitinib, an EGFR inhibitor, to a similar chemoradiation regimen. Methods: All pts had squamous carcinoma of the head and neck, with at least one of the following: N1-N3 disease, T3 or T4 primary lesion, nasopharynx primary (except T1N0M0). Additional eligibility: no previous therapy, ECOG PS 0 or 1, adequate bone marrow, kidney, liver function; informed consent. All pts received initial docetaxel 60mg/m2 D1, 22; carboplatin AUC 5.0 D1, 22; 5-FU 200mg/m2, 24-hour CI, D1–43; gefitinib 250mg PO qd, D1–43. Beginning week 8, pts received RT, 1.8Gy single daily dose to total 68.4 Gy, and concurrent docetaxel 20mg/m2 weekly × 6 doses + gefitinib 250mg PO daily. At completion of therapy, pts were reevaluated with CT scans and endoscopy. Results: 45 pts entered this trial between 8/04 and 8/05. Pertinent clinical characteristics: clinical T3/T4, 17; N2/N3, 23. 42 pts (93%) completed induction chemotherapy. 34 pts (76%) have completed combined modality therapy and have been restaged. Response to treatment: 11 CR (32%); 18 PR (53%); 5 stable/progression (15%). After median follow-up 7 months, 9 patients (20%) have developed progressive cancer. Actuarial PFS and OS at 1 year are 68% and 86%, respectively. Grade 3/4 myelosuppression was common, and grade 3/4 mucositis occurred in all pts during combined modality therapy. One pt had a treatment-related death during combined modality therapy. The addition of gefitinib did not substantially increase toxicity. Conclusions: This combined modality regimen was feasible and produced high response rates in pts with locally advanced head and neck cancer. Toxicity was consistent with other effective combined modality regimens for these pts. Further follow-up is needed to better assess the benefit of this approach. [Table: see text]

Combined therapy for stage III-IV head and neck cancer: preliminary results.

1984 ◽  
Vol 2 (7) ◽  
pp. 804-810 ◽  
Author(s):  
S H Krasnow ◽  
M H Cohen ◽  
A Johnston-Early ◽  
M L Citron ◽  
B E Fossieck ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Response Rate ◽  
Combined Modality Therapy ◽  
Combined Therapy ◽  
Stage Iii ◽  
Combined Modality Treatment ◽  
Combined Modality ◽  
Rbc Deformability

As part of a combined modality treatment program using chemotherapy, surgery, and/or radiotherapy, 25 patients with previously untreated stage III or IV head and neck cancer received initial combination chemotherapy. Pathologically confirmed complete remission was noted in nine patients (36%). The overall objective major response rate (with all patients included in analysis) was 68%. The chemotherapy regimen included bleomycin, cisplatin, vinblastine, methotrexate, and 5-fluorouracil. A novel concept of drug scheduling was used, based on chemotherapy-induced improvement in RBC deformability. The underlying concept is that improved RBC deformability results in improved capillary blood flow and thereby, increased drug delivery to tumor cells. Treatment resulted in moderate hematologic and renal toxicity with no treatment-related deaths. This exceptionally high, pathologically confirmed complete response rate will hopefully provide a mechanism by which combined modality therapy can adequately be tested for its ability to prolong survival of patients with advanced head and neck cancer.

Patterns of relapse in locally advanced head and neck cancer patients who achieved complete remission after combined modality therapy

Cancer ◽  
1985 ◽  
Vol 56 (6) ◽  
pp. 1242-1245 ◽  
Author(s):  
Waun Ki Hong ◽  
Richard H. Bromer ◽  
David A. Amato ◽  
Stanley Shapshay ◽  
Miriam Vincent ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Complete Remission ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Combined Modality Therapy ◽  
Locally Advanced ◽  
Advanced Head ◽  
Combined Modality

Rapid-fractionation preoperative chemoradiation, pancreaticoduodenectomy, and intraoperative radiation therapy for resectable pancreatic adenocarcinoma.

1998 ◽  
Vol 16 (12) ◽  
pp. 3843-3850 ◽  
Author(s):  
P W Pisters ◽  
J L Abbruzzese ◽  
N A Janjan ◽  
K R Cleary ◽  
C Charnsangavej ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Pancreatic Adenocarcinoma ◽  
Combined Modality Therapy ◽  
Pancreatic Head ◽  
Preoperative Chemoradiation ◽  
Intraoperative Radiation Therapy ◽  
Combined Modality Treatment ◽  
Intraoperative Radiation ◽  
Combined Modality ◽  
Grade 3

PURPOSE To evaluate the toxicities, radiographic and pathologic responses, and event-free outcomes with combined modality treatment that involves preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and electron-beam intraoperative radiation therapy (EB-IORT) for patients with resectable pancreatic adenocarcinoma. PATIENTS AND METHODS Patients with radiographically resectable localized adenocarcinoma of the pancreatic head were entered onto a preoperative protocol that consisted of a 2-week course of fluorouracil (5-FU) 300 mg/m2 daily 5 days per week and concomitant rapid-fractionation radiation 30 Gy, 3 Gy daily 5 days per week. Radiographic restaging was performed 4 weeks after chemoradiation, and patients with localized disease underwent pancreaticoduodenectomy with EB-IORT 10 to 15 Gy. RESULTS Thirty-five patients were entered onto the study and completed chemoradiation, 34 (97%) as outpatients. Three patients (9%) experienced grade 3 nausea and vomiting; no other grade 3 or 4 toxicities were observed. Of the 27 patients taken to surgery, 20 patients (74%) underwent pancreaticoduodenectomy with EB-IORT. All patients had a less than grade III pathologic response to preoperative chemoradiation. At a median follow-up of 37 months, the 3-year survival rate in patients who underwent combined modality therapy was 23%. CONCLUSION Combined modality treatment with preoperative rapid-fractionation chemoradiation, pancreaticoduodenectomy, and EB-IORT is associated with minimal toxicity and excellent locoregional control. This represents one approach to maximize the proportion of patients who receive all components of combined modality therapy and avoids the toxicity of pancreaticoduodenectomy in patients found to have metastatic disease at the time of restaging.

Combined modality therapy with radiation therapy (RT), chemotherapy, bevacizumab, and erlotinib in the treatment of patients (pts) with locally advanced squamous carcinoma of the head and neck

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. 6012-6012 ◽  
Author(s):  
A. A. Meluch ◽  
D. Spigel ◽  
H. A. Burris ◽  
C. Lane ◽  
J. D. Peyton ◽  
...  
Keyword(s):  
Head And Neck ◽  
Induction Therapy ◽  
Combined Modality Therapy ◽  
Objective Response ◽  
Locally Advanced ◽  
Squamous Carcinoma ◽  
Concurrent Chemotherapy ◽  
Advanced Head ◽  
Combined Modality ◽  
Grade 3

6012 Background: Concurrent chemotherapy/RT is the standard of treatment for locally advanced head and neck cancer. Agents targeting EGFR and the angiogenesis pathway have also demonstrated activity. In this phase II trial, we added bevacizumab and erlotinib to an active combined modality regimen in the first-line treatment of pts with locally advanced head and neck cancer. Methods: Eligible pts had previously untreated squamous carcinoma of any head and neck site, with T3/T4 primary lesions and/or N1-N3 nodal involvement. Additional eligibility: ECOG PS 0 or 1; adequate organ function; indwelling central venous catheter; standard bevacizumab exclusions. All pts received induction therapy with 2 courses of paclitaxel (200mg/m2), carboplatin (AUC 6.0), 5-FU (200mg/m2 per day, 24 hour CI days 1–21), and bevacizumab (15 mg/kg); cycles were repeated at 21-day intervals. Pts then received concurrent RT (68.4 Gy, 1.8 Gy/day), paclitaxel (50 mg/m2 weekly x 6), bevacizumab (15 mg/kg weeks 1 and 4), and erlotinib (150 mg daily x 7 weeks). PFS was the primary endpoint. Results: Between December 2006 and July 2008, 60 pts were enrolled; the first 48 pts are included in this preliminary report. The median age was 56 years; T3/T4 = 9/8; N1/N2/N3 = 13/27/4. 45 pts (94%) completed the 6-week induction therapy, and 41 pts (85%) completed all therapy. After induction therapy, 56% of pts had objective response; 77% had objective response after completion of therapy. After a median follow-up of 16 months, the 18-month progression-free and overall survivals are 85% and 87%, respectively. Grade 3/4 toxicity during induction therapy included neutropenia (46%), neutropenic fever (6%), mucositis (14%), diarrhea (14%), and hand/foot syndrome (11%). Severe local toxicity (mucositis/esophagitis) occurred in 31 patients (76%) during combined modality therapy (56% grade 3/20% grade 4). Conclusions: The addition of bevacizumab and erlotinib to concurrent chemotherapy/RT was feasible, with no unexpected toxicity. After short followup, the regimen appears highly active. Updated results will be presented. [Table: see text]

Combined therapies for squamous-cell carcinoma of the esophagus, a Southwest Oncology Group Study (SWOG-8037).

1987 ◽  
Vol 5 (4) ◽  
pp. 622-628 ◽  
Author(s):  
E Poplin ◽  
T Fleming ◽  
L Leichman ◽  
H G Seydel ◽  
Z Steiger ◽  
...  
Keyword(s):  
Radiation Therapy ◽  
Progressive Disease ◽  
Residual Disease ◽  
Combined Modality Therapy ◽  
Initial Therapy ◽  
Combined Modality Treatment ◽  
Aggressive Approach ◽  
Carcinoma Of The Esophagus ◽  
Combined Modality ◽  
Gi Symptoms

Conservative treatment of esophageal cancer with radiation therapy has afforded few long-term survivors. In order to improve outcome, patients with locoregional disease were treated using a combined modality approach. Patients were treated with chemotherapy consisting of a 96-hour continuous infusion of 5-fluorouracil (5-FU), 1,000 mg/m2/d, days 1 to 4 and days 29 to 32; cisplatin 75 mg/m2, day 1 and 29; and radiation 3,000 rad, days 1 to 19. In the absence of progressive disease, patients underwent esophagectomy. One hundred twenty-eight patients were registered of whom 113 were eligible and 106 were evaluable. Toxicity included gastrointestinal (GI) symptoms, mucositis, and myelosuppression. One hundred two patients completed chemoradiotherapy. Following its completion, 11 patients refused surgery, six were considered poor surgical risks, and 14 had progressive disease. Of the remaining 71 patients, 16 had unresectable disease, 13 had residual disease which was incompletely resected, 24 had disease which could be completely resected, and 18 were without disease on pathologic examination. The overall operability rate was 63% and the overall resectability rate, 49%. Surgical mortality was 11%. Eighty-nine of 113 eligible patients have died, with a median survival of 12 months and a 2-year survival of 28%. The median postsurgical survival for all 71 patients was 14 months and was 32 months for those patients attaining complete remission (CR). Combined modality therapy remains an investigational approach. Attempts should be directed at increasing response rate to initial therapy. A randomized comparison between combined modality treatment and radiation therapy is necessary to definitively determine the usefulness of this more aggressive approach.

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