Addition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer—a meta-analysis

Haussmann, Jan; Tamaskovics, Bálint; Bölke, Edwin; Djiepmo-Njanang, Freddy Joel; Kammers, Kai; Corradini, Stefanie; Hautmann, Matthias G.; Ghadjar, Pirus; Maas, Kitti; Schuler, Patrick J.; Hoffmann, Thomas; Lammering, Guido; Budach, Wilfried; Matuschek, Christiane

doi:10.1007/s00066-019-01511-z

Cited by 24 publications

(11 citation statements)

References 38 publications

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“…As IR can induce cell death, radiation therapy (RT) is employed in cancer treatment for more than 50% of all cancer patients [ 27 , 28 ]. By irradiating tumors with fractionated doses of IR (single dose: ~2 Gray (Gy), total dose: 50–70 Gy), IR accumulates in the tumor tissue, leading to the death or senescence of fast dividing, malignant cells.…”

Section: High Dose Radiation—ir In Cancer Therapy and The Influencmentioning

confidence: 99%

The Influence of Radiation on Bone and Bone Cells—Differential Effects on Osteoclasts and Osteoblasts

Donaubauer

Deloch

Becker

et al. 2020

IJMS

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The bone is a complex organ that is dependent on a tight regulation between bone formation by osteoblasts (OBs) and bone resorption by osteoclasts (OCs). These processes can be influenced by environmental factors such as ionizing radiation (IR). In cancer therapy, IR is applied in high doses, leading to detrimental effects on bone, whereas radiation therapy with low doses of IR is applied for chronic degenerative and inflammatory diseases, with a positive impact especially on bone homeostasis. Moreover, the effects of IR are of particular interest in space travel, as astronauts suffer from bone loss due to space radiation and microgravity. This review summarizes the current state of knowledge on the effects of IR on bone with a special focus on the influence on OCs and OBs, as these cells are essential in bone remodeling. In addition, the influence of IR on the bone microenvironment is discussed. In summary, the effects of IR on bone and bone remodeling cells strongly depend on the applied radiation dose, as differential results are provided from in vivo as well as in vitro studies with varying doses of IR. Furthermore, the isolated effects of IR on a single cell type are difficult to determine, as the bone cells and bone microenvironment are building a tightly regulated network, influencing on one another. Therefore, future research is necessary in order to elucidate the influence of different bone cells on the overall radiation-induced effects on bone.

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Section: High Dose Radiation—ir In Cancer Therapy and The Influencmentioning

confidence: 99%

The Influence of Radiation on Bone and Bone Cells—Differential Effects on Osteoclasts and Osteoblasts

Donaubauer

Deloch

Becker

et al. 2020

IJMS

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“…Throughout the past decades, treatment of head and neck squamous cell carcinoma (HNSCC) patients has been improved [1]. However, in advanced staged HNSCC patients recurrences generally occur in approximately 30% [2] and a mean 5-years overall survival of 50% is observed [3]. In order to provide the most optimal individual treatment for these patients, precision medicine targeting patient-specific characteristics of pretreatment clinical examination, histopathology and functional imaging is warranted [4].…”

Section: Introductionmentioning

confidence: 99%

Adherence to pretreatment and intratreatment imaging of head and neck squamous cell carcinoma patients undergoing (chemo) radiotherapy in a research setting

et al. 2021

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The emerge of improved personalized treatment adaptations and outcome prediction is accompanied with increasing non-invasive assessments in early treatment phase, leading to increased patient burden. This study assessed the adherence of patients with head and neck squamous cell carcinoma (HNSCC) to undergo pretreatment and research-related intratreatment imaging, and assessed which factors caused drop-out. Method: Between 2013 and 2019, advanced-staged HNSCC patients were prospectively included, underwent (chemo) radiotherapy with curative intent and planned for both pre-treatment and intratreatment sequential 18F-FDG-PET/CT, 18F-FDG-PET/MRI and thereafter MRI (including DWI/DCE). Drop-out-factors were described as healthcare-related (logistics and imaging-system defects) and patient-related (psychological, physical, not-specified). Common Toxicity Criteria (CTC) were routinely scored by radiation/medical oncologists throughout the first 3 weeks, and compared between patient drop-outs and who complete imaging. Results: Ninety-seven patients (mean age 61 ± 6.8 years) were included; 95 patients (97.9%) underwent pretreatment imaging and 63 (64.9%) intratreatment imaging. For 18F-FDG-PET/CT, 18F-FDG-PET/MRI and MRI pretreatment drop-outs were 2, 10 and 3 patients and for intratreatment drop-outs were 34, 39 and 35 patients, respectively. Patient-related drop-out-factors were physical (n = 16, e.g. dysphagia), psychological (n = 6, e.g. claustrophobia) and non-specified (n = 12). Healthcare-related drop-out-factors were logistics (n = 6) and 18F-FDG-PET/CT-/MRI-system defects (n = 2). The CTC mucosal toxicity was significantly higher (p = 0.023) at week 2 of (chemo)radiotherapy in patient drop-outs than with complete imaging. Conclusions: The drop-out frequency of advanced-staged HNSCC patients for imaging during (chemo)radiotherapy in a research-setting was high and mainly patient-related. Treatment of patient-related inconveniences, communication of rationale and healthcare-related imaging protocol efficiency improvements may contribute to improved adherence.

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“…Addition of concurrent chemotherapy to hyperfractionated radiotherapy (HFCRT) whether feasible with acceptable toxicity or have any benefit over hyperfractionated radiation (HFRT) alone, have been investigated in numerous studies [5][6][7]. A recent metaanalysis comparing hyperfractionated radiotherapy (HFRT) alone to hyperfractionated radiotherapy with concurrent chemotherapy (HFCRT) have shown significant improvement in overall survival and locoregional recurrence without significant increase in highgrade toxicities [8]. However, variable chemotherapy scheduling and dosing with different radiation dose in the meta-analysis was used, so the most effective combination of chemotherapy and radiotherapy has yet to be defined.…”

Section: Introductionmentioning

confidence: 99%

Comparison of Hyperfractionated Radiotherapy with Concomitant Chemotherapy and Conventional Chemoradiotherapy in Locally Advanced Head and Neck Cancer Treated with Volumetric Modulated Arc Technique (VMAT)

Snehit¹,

Vishwanathan²,

Narayanan³

et al. 2021

Act Scie Canbio

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Background: Concomitant Chemoradiotherapy (CRT) is standard approach for treating locally advanced head and neck squamous cell carcinoma (HNSCC). Altered fractionation such as hyperfractionated radiotherapy (HF) has also shown similar survival benefits as compared to conventional CRT. To determine whether addition of concomitant chemotherapy to hyperfractionated radiotherapy further improves outcome in HNSCC patients treated with modern volumetric arc modulated radiotherapy (VMAT).Methods: From January 2018 to March 2019, thirty four patients with stage III-IV HNSCC (excluding oral cavity, nasopharynx and paranasal sinus) were randomly assigned to hyperfractionated HFCRT (VMAT) with concomitant chemotherapy arm with radiation dose 81.6Gy/68 fractions,1.2Gy/fraction, twice daily, 5days/week or Conventional CRT (VMAT) arm with radiation dose 70GY/35 fractions, 2Gy/fraction, once daily, 5days/week, seventeen patients in each arm. Concurrent cisplatin 40mg/m 2 /week was given in both arm from first week. Overall survival (OS), Disease free survival (DFS) and toxicities were assessed. Results:The cisplatin full dose was received by 94.1% and 82.4% patients in HFCRT (VMAT) and CRT (VMAT) arm respectively. High grade (3-4) acute skin and mucosal were higher in HFCRT (VMAT) arm (47.1%) in comparison to CRT (VMAT) arm (17.6%) with no statistical significance (p = 0.067). Late toxicity was similar in both arms. The OS was better in HFCRT (VMAT) arm with median overall survival-17 months as compared to CRT (VMAT) arm with median overall survival -12 months, however, difference did not reach significance (log-rank test, p = 0.341), with similar trend in DFS. Conclusion:Hyperfractionated HFCRT (VMAT) with concomitant chemotherapy showed an encouraging trend for OS and DFS with acceptable toxicity profile. A larger study with longer follow up needed to elucidate possible superiority of HFCRT over CRT.

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Addition of chemotherapy to hyperfractionated radiotherapy in advanced head and neck cancer—a meta-analysis

Cited by 24 publications

References 38 publications

The Influence of Radiation on Bone and Bone Cells—Differential Effects on Osteoclasts and Osteoblasts

The Influence of Radiation on Bone and Bone Cells—Differential Effects on Osteoclasts and Osteoblasts

Adherence to pretreatment and intratreatment imaging of head and neck squamous cell carcinoma patients undergoing (chemo) radiotherapy in a research setting

Comparison of Hyperfractionated Radiotherapy with Concomitant Chemotherapy and Conventional Chemoradiotherapy in Locally Advanced Head and Neck Cancer Treated with Volumetric Modulated Arc Technique (VMAT)

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