A radiation therapy oncology group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003

Fu, Karen K.; Pajak, Thomas F.; Trotti, Andy; Jones, Christopher U.; Spencer, Sharon A.; Phillips, Theodore L.; Garden, Adam S.; Ridge, John A.; Cooper, Jay S.; Ang, K. Kian

doi:10.1016/s0360-3016(00)00663-5

Cited by 1,228 publications

(595 citation statements)

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“…From available clinical data, the local control of 79% in H&N SCC was reported in the grid therapy technique. In contrast, for conventional fractionation regimen, the most recent and largest randomized trial (RTOG 9003) reported local‐regional control rate of 33%‐48% for stage III/IV nonmetastatic SCC of head and neck cancer (32) . The overall results of this data shown in Fig.…”

Section: Discussionmentioning

confidence: 93%

Is grid therapy useful for all tumors and every grid block design?

Gholami

Nedaie

Longo

et al. 2016

J Applied Clin Med Phys

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Grid therapy is a treatment technique that has been introduced for patients with advanced bulky tumors. The purpose of this study is to investigate the effect of the radiation sensitivity of the tumors and the design of the grid blocks on the clinical response of grid therapy. The Monte Carlo simulation technique is used to determine the dose distribution through a grid block that was used for a Varian 2100C linear accelerator. From the simulated dose profiles, the therapeutic ratio (TR) and the equivalent uniform dose (EUD) for different types of tumors with respect to their radiation sensitivities were calculated. These calculations were performed using the linear quadratic (LQ) and the Hug‐Kellerer (H‐K) models. The results of these calculations have been validated by comparison with the clinical responses of 232 patients from different publications, who were treated with grid therapy. These published results for different tumor types were used to examine the correlation between tumor radiosensitivity and the clinical response of grid therapy. Moreover, the influence of grid design on their clinical responses was investigated by using Monte Carlo simulations of grid blocks with different hole diameters and different center‐to‐center spacing. The results of the theoretical models and clinical data indicated higher clinical responses for the grid therapy on the patients with more radioresistant tumors. The differences between TR values for radioresistant cells and radiosensitive cells at 20 Gy and 10 Gy doses were up to 50% and 30%, respectively. Interestingly, the differences between the TR values with LQ model and H‐K model were less than 4%. Moreover, the results from the Monte Carlo studies showed that grid blocks with a hole diameters of 1.0 cm and 1.25 cm may lead to about 19% higher TR relative to the grids with hole diameters smaller than 1.0 cm or larger than 1.25 cm (with 95% confidence interval). In summary, the results of this study indicate that grid therapy is more effective for tumors with radioresistant characteristics than radiosensitive tumors.PACS number(s): 87.55.‐x

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Section: Discussionmentioning

confidence: 93%

Is grid therapy useful for all tumors and every grid block design?

Gholami

Nedaie

Longo

et al. 2016

J Applied Clin Med Phys

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“…22 The 23% 2-year local failure rate for patients with NSNEC is approximately one-half of the rate seen in patients with similarly staged squamous carcinomas. 23 In contrast, DMs represent the major pattern of failure for NSNEC, occurring at a rate nearly double that of local failure. Therefore, we recommend nonsurgical therapy for most patients using combined chemotherapy and RT.…”

Section: Discussionmentioning

confidence: 99%

Management of nonsinonasal neuroendocrine carcinomas of the head and neck

Barker¹,

Glisson²,

Garden³

et al. 2003

Cancer

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BACKGROUNDNonsinonasal neuroendocrine carcinomas (NSNEC) of the head and neck are rare and pose a diagnostic and management challenge. The authors undertook a retrospective study to gain insights into the spectrum of clinicopathologic characteristics, patterns of failure, and optimal management of patients with this disease.METHODSThe authors treated 23 adults with pathologically proven, nonmetastatic, primary NSNEC from 1984 to 2001. The majority (13 patients) had laryngeal origin with the following American Joint Committee on Cancer stage distribution: Stage I disease in 1 patient, Stage II disease in 2 patients, Stage III disease in 6 patients, and Stage IV disease in 14 patients. Nine patients underwent definitive surgery with or without postoperative radiation, and 14 patients received definitive radiotherapy. The median definitive radiation dose was 66 grays (Gy) (range, 44–72 Gy) using conventional fractionation. Fourteen patients received chemotherapy, with two to four cycles of induction platinum plus etoposide used most commonly.RESULTSThe median follow‐up time for surviving patients was 40 months (range, 15–89 months). The actuarial 2‐year and 5‐year overall survival (OS) rates were 53% and 33%, respectively; and the disease‐free survival (DFS) rates were 41% and 25%, respectively. Both the 2‐year OS rate (68% vs. 30%; P = 0.002) and the 2‐year DFS rate (55% vs. 17%; P = 0.004) were improved with chemotherapy compared with local therapy alone. Seventy‐five percent of patients with measurable disease had complete clinical responses to induction chemotherapy. There was 100% complete clinical response of tumor after radiotherapy. The actuarial 2‐year local failure rate was 23%. Chemotherapy did not reduce local failure (P = 0.91). There was no regional failure. The 2‐year and 5‐year distant metastasis rates were 54% and 71%, respectively. The 2‐year rates of metastases without and with chemotherapy were 79% and 39%, respectively (P = 0.006). The 2‐year and 5‐year rates of intracranial metastases were 25% and 44%, respectively, and the 2‐year and 5‐year rates of isolated brain metastases were 21% and 41%, respectively.CONCLUSIONSBased on these results, the authors' treatment strategy for patients with NSNEC is sequential chemotherapy and radiation. They recommend full‐dose radiotherapy alone for patients with NSNEC who achieve a complete clinical response to induction chemotherapy. Newer chemotherapeutic regimens or additional adjuvant chemotherapy should be investigated for patients with NSNEC given the high rate of distant failure. Due to the very high rate of brain metastases among patients in the current study, the authors now consider incorporating prophylactic cranial irradiation into primary radiotherapy for individual patients who have complete clinical responses to induction chemotherapy. Cancer 2003. © 2003 American Cancer Society.

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“…Despite this benefit, AFRT treatment has been associated with increased acute toxicity of greater severity and longer duration (2,3).…”

Section: Introductionmentioning

confidence: 99%