Assessing feasibility, compliance and toxicity of concomitant chemo-radiotherapy in head and neck cancers in the Northern Territory: initial experience and challenges

Abstract

IntroductionComprehensive oncology services have recently been introduced in the Northern Territory (NT) enabling delivery of concurrent chemo‐radiotherapy (CCRT) in locally advanced head and neck squamous cell carcinoma (LAHNSC). The purpose of this study is to assess feasibility, compliance and toxicity of CCRT in remote Australia.MethodsChart review was conducted for all patients >18 years, with biopsy‐proven LAHNSC, receiving curative intent CCRT between January 2010 and September 2012.ResultsThe study population comprised of 26 patients, 20 Caucasian and 6 Indigenous, having a median age of 58 years, with most common sites of involvement being the oropharynx (n = 16) and the oral cavity (n = 6). Major risk factors were smoking and alcoholism. Cardiovascular disease, viral hepatitis, latent tuberculosis and strongyloidosis were the major comorbidities. Fifty‐eight per cent (n = 15) required assisted feeding. All patients received intensity modulated radiotherapy. Systemic therapy comprised of cisplatin or carboplatin/cetuximab. Most common acute (grade 3/4) toxicities were mucositis, dysphagia and dermatological in 54%, 31% and 23% respectively. Complications were infection and gastrostomy insertion related.Hospitalisation occurred in 23%, treatment break >2 days in 38%, with no difference in toxicities between indigenous and nonindigenous patients. Platinum use was associated with greater nausea (P = 0.003), renal dysfunction (P = 0.03) and ototoxicity (P = 0.04) and cetuximab with dermatological reactions (P = 0.05). At median follow‐up of 16 months, overall survival was 58% with progression‐free survival of 50%.ConclusionsWe have demonstrated good compliance rates, tolerance and feasibility outcomes. The seeming preponderance of LAHNSC in the NT is cause for concern.

Radioluminescent nanoparticles for radiation-controlled release of drugs

“…A significant improvement in disease-free and locoregional recurrence-free survival rate has been observed; the survival rate has been reported to be around 50 -60% at 5 years [11,12]. However, symptoms of grade 2, 3 and even grade 4 toxicity (such as rash, fatigue, neuropathy, anemia, alopecia, myelosuppression, neutropenia, mucositis, immunosuppression, xerostomia, hypothyroidism, diarrhea, and constipation) have been observed in different clinical studies with systemic chemotherapy [13][14][15][16]. A recent study has reported certain changes in gut microbiota leading to clostridium difficile infection (CDI) in head and neck cancer patients who received systemic paclitaxel chemotherapy followed by radiation [17].…”

Effect of Paclitaxel Stereochemistry on X-ray-Triggered Release of Paclitaxel from CaWO4/Paclitaxel-Coloaded PEG-PLA Nanoparticles

“…IV-infused Taxol (which also contains ethanol) has been shown to cause Grade I–Grade IV toxicity in the majority of patients who received it. , Currently, chemoradiation (concurrent/sequential chemotherapy–radiotherapy combination (CT–RT)) is the standard treatment for patients with inoperable/locally advanced cancer because this combination produces benefits in terms of tumor response and overall survival relative to either alone . Unfortunately, however, using chemotherapeutic drugs on top of radiation significantly increases side effects, resulting in a progressive worsening of the quality of life for patients. − The seriousness of side effects of conventional chemoradiation (CT–RT) raises a need for tumor-specific radiosensitization.…”

Radiation Therapy Reduced Blood Levels of LDH, HIF-1α, and miR-210 in OSCC

“…Oral squamous cell carcinoma (OSCC) is a significant public health problem in many countries [1] and is the most common malignant neoplasia of the oral cavity [1]. Alcohol and tobacco consumption are the most critical risk factors currently described for OSCC [2]. However, individual intrinsic factors also play a significant role in the development and prognosis of cancer [3][4][5].…”