scholarly journals Timing of Daily Radiotherapy for Cases of Head and Neck Cancer: Does It Make Difference?

2020 ◽  
pp. 12-16
Author(s):  
Mohamed Saad Eldeen Elzahi ◽  
Shimaa E. Attia ◽  
Skoukri H. Elazab
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Oral Mucositis ◽  
Early Morning ◽  
Quality Score ◽  
Group A ◽  
Group B ◽  
Severe Mucositis

Background: Oral mucositis is a major problem affecting all head and neck cancer (HNC) patients received radiotherapy. Till now, available treatment is just symptomatic with limited effects. Preventive strategies may be better to avoid this complication. Animal models studies have illustrated that anti-cancer treatment toxicity display prominent daily variations; therefore, undesirable side effects could be significantly reduced by administration of radiotherapy at specific times when they are better tolerated. Aim: To compare “soreness quality score” (SQS) between 2 groups of head and neck cancer patients received radiotherapy at different daily time. Methods: 2 groups of head neck cancer patients treated at Mansoura university hospital; each group included 80 cases. Group A received radiotherapy at early morning between 6 and 8 am, while Group B received radiotherapy in the afternoon between 1 and 3 pm. Oral mucositis survey was self-reported weekly during and at the end of treatment by using “soreness quality score” (SQS). Results: For group A, mild mucositis (score 1 and 2) was recorded in 53 cases (66%) and severe mucositis was recorded in 27 cases (34%). For group B, mild mucositis was recorded in 29 cases (36%) and severe mucositis was recorded in 51 cases (64%). There was statistically significant difference (0.003) between both groups as regards development of severe oral mucositis. Conclusion: Better toxicity profile as regards oral mucositis could be obtained by giving radiotherapy for (HNC) patients at early morning compared to late afternoon. Further studies are worthwhile to confirm our findings.

Acute and late effects of radical radiotherapy in elderly head and neck cancer patients

2007 ◽  
Vol 25 (18_suppl) ◽  
pp. 16515-16515
Author(s):  
A. Turaka ◽  
B. K. Mohanti ◽  
S. Chander ◽  
R. Jena ◽  
S. V. Deo
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Phase Ii ◽  
Neck Cancer ◽  
Late Effects ◽  
Radical Radiotherapy ◽  
Group A ◽  
Grade Ii ◽  
Group B

16515 Background: To evaluate the difference between acute and late effects of radical radiotherapy in elderly(above 60 years,Group A) head and neck cancer patients with young patients (below 50 years of age, Group B). Methods: The study was conducted on histologically proven head and neck cancer patients receiving radical radiotherapy (RT),49 patients were in group A and 40 in group B.The acute and late radiation morbidity was assessed using RTOG (phases I,II,&III- Pre RT, During RT & 1 month post RT respectively) and LENT-SOMA scoring systems (phases IV &V-3 & 6 months post RT). Results: In phase II, grade I dermatitis was commonly seen (83.7% in group A,72.5% in group B) and grade II dermatitis was 12.2 % vs 25% of patients.The difference in distribution over age was not significant (p= 0.12 & 0.18 in phase II and III).There was no significant difference in the incidence of late effects between two groups (p=0.91 in phase IV and p=0.99 in phase V).Grade II mucositits was seen in majority of patients in both groups,71.4% vs 72.5% in phase II.The late mucosal changes with worrisome subjective (pain) experiences were observed in 69.4% vs 75% of patients in group A and B, respectively.The difference in distribution over the age was significant (p<0.051) only in phase II.Dryness of mouth was the most common acute and late sequel of RT.The acute salivary gland morbidity was mostly moderate to complete dryness (grade II),seen in phases II and III in 24.5% & 73.5% of patients but the late sequel was seen in 83.37% of patients in group A and 85% in group B and the difference in late effects in both groups was statistically significant except in phase V (p= 0.02). Moderate dysphagia of grade II morbidity was seen in 75.5% vs. 65% in phase II. Grade III dysphagia was seen only 5 patients in group A and one in group B. In phase IV,66.7% patients in group A,72.5% in group B had persistent difficulty in swallowing. Conclusions: Grade I and II mucositis and dermatitis during the course of treatment led to increased morbidity, decreased nutritional intake and pain. Xerostomia is the most common and inevitable acute and late squeal of radical radiotherapy to head and neck cancer region resulting in difficulty in mastication and swallowing. There was no difference in the occurrence of acute and late effects between younger and elderly patients. No significant financial relationships to disclose.

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.

scholarly journals Impact of early dysphagia intervention on swallowing function and quality of life in head and neck cancer patients treated with intensity-modulated radiation therapy or image guided radiation therapy with or without surgery/chemotherapy

2015 ◽  
Vol 01 (01) ◽  
pp. 037-043 ◽  
Author(s):  
Rajender Kumar ◽  
Hitesh Gupta ◽  
Keshavanand Konwar ◽  
Ritesh Sharma ◽  
Anil Anand ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Radiation Therapy ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Swallowing Function ◽  
Group A ◽  
Group B

Abstract Introduction: Dysphagia is a very common problem associated with head and neck cancer patients. Inspite of best of technologies like Intensity Modulated Radiotherapy (IMRT) or Image Guided Radiotherapy (IGRT), Dysphagia remains a major problem in locally advanced head and neck cancer patients. Materials and Methods: We randomized 50 head and neck cancer patients, including all sites and stages into two groups, 25 patients in each group. In Group-A dysphagia prevention exercises were done from the day of the onset of radiation therapy and continued till 6 months, while in Group-B no dysphagia interventions were given. We analyzed rate of dysphagia, aspiration rate and its impact on quality of life. We used M.D. Anderson Dysphagia Inventory (MDADI) which is a validated and reliable questionnaire designed specifically for evaluating impact of dysphagia on quality of life (QOL) in head and neck cancer patients. American Speech language Hearing Association (ASHA) scale was used for assessing swallowing function. Penetration Aspiration Scale (PAS) was used to assess aspiration during swallowing with the help of Fiberoptic Endoscopic Evaluation of Swallowing (FEES). Results: Quality of life was significantly better in dysphagia preventive exercise arm (group - A). There was significant improvement in the MDADI score, from the baseline to 6 months in exercise arm (14 versus 7.76, p= 0.017). Swallowing function score was also in favour of exercise arm (6.44 versus 5.8, p=0.002). Patients in exercise arm were able to swallow much better by the end of 6 months post radiotherapy. Risk of silent aspiration as evaluated by PAS score at the end of three months was 36% (Group A = 16%, Group B = 20%). At the end of six months, it improved to 24% (Group A = 8%, Group B = 16%). There was a trend towards lesser incidence of aspiration in exercise arm, although it was not statistically significant (p=0.21). Conclusion: Results from this study demonstrated that swallowing exercises, if administered from first week of chemo-radiation and continued till 6 months, results in significant improvement in swallowing function and quality of life. Use of FEES helps in detection of silent aspiration at an early stage and reduces aspiration related morbidities.

scholarly journals Randomized double-blind, placebo-controlled trial evaluating oral glutamine on radiation-induced oral mucositis and dermatitis in head and neck cancer patients

2019 ◽  
Vol 109 (3) ◽  
pp. 606-614 ◽  
Author(s):  
Chih-Jen Huang ◽  
Ming-Yii Huang ◽  
Pen-Tzu Fang ◽  
Frank Chen ◽  
Yu-Tsang Wang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Oral Mucositis ◽  
University Hospital ◽  
Phase Iii ◽  
Care Providers ◽  
Double Blind ◽  
Radiation Induced

ABSTRACT Background Glutamine is the primary fuel for the gastrointestinal epithelium and maintains the mucosal structure. Oncologists frequently encounter oral mucositis, which can cause unplanned breaks in radiotherapy (RT). Objectives The aim of this study was to explore the association between oral glutamine and acute toxicities in patients with head and neck cancer undergoing RT. Methods This was a parallel, double-blind, randomized, placebo-controlled Phase III trial conducted in a university hospital. A central randomization center used computer-generated tables to allocate interventions to 71 patients with stages I–IV head and neck cancers. The patients, care providers, and investigators were blinded to the group assignment. Eligible patients received either oral glutamine (5 g glutamine and 10 g maltodextrin) or placebo (15 g maltodextrin) 3 times daily from 7 d before RT to 14 d after RT. The primary and secondary endpoints were radiation-induced oral mucositis and neck dermatitis, respectively. These were documented in agreement with the National Cancer Institute Common Terminology Criteria for Adverse Events version 3. Results The study included 64 patients (placebo n = 33; glutamine n = 31) who completed RT for the completers’ analysis. Based on multivariate analysis, glutamine had no significant effect on the severity of oral mucositis (OR: 0.3; 95% CI: 0.05, 1.67; P = 0.169). Only the change in body mass index (BMI) was significant in both multivariate completers (OR: 0.41; 95% CI: 0.20, 0.84; P = 0.015) and per-protocol analysis (OR: 0.40; 95% CI: 0.20, 0.83; P = 0.014). No difference was found in the incidence and severity of neck dermatitis between the two arms. Conclusions The decrease in BMI was strongly related to the severity of oral mucositis in the head and neck cancer patients under RT, but not to the use of glutamine. This trial was registered at clinicaltrials.gov as NCT03015077.

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