Avoidance of treatment interruption: an unrecognized benefit of accelerated radiotherapy in oropharyngeal carcinomas?

Allal, Abdelkarim Said; Pree, C. de; Dulguerov, Pavel; Bieri, Sabine; Maire, Daphné; Kurtz, John M.

doi:10.1016/s0360-3016(99)00138-8

Cited by 26 publications

(10 citation statements)

References 15 publications

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“…Before RT 6 patients had neck dissections for bulky neck disease, and because the SUV values used concerned mainly those of the primary tumor uptake (5 on 6 patients), those patients were classified in the RT group. Fifty-seven patients were treated with a modified concomitant-boost accelerated RT schedule that has been previously reported (13). The remainder received other hyperfractionated (n ϭ 14) or monofractionated schedules (n ϭ 2).…”

Section: Treatmentmentioning

confidence: 99%

Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18f]fluoro-2-deoxy-d-glucose

Allal¹,

Slosman²,

Kebdani³

et al. 2004

International Journal of Radiation Oncology*Biology*Physics

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252

153

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Section: Treatmentmentioning

confidence: 99%

Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18f]fluoro-2-deoxy-d-glucose

Allal¹,

Slosman²,

Kebdani³

et al. 2004

International Journal of Radiation Oncology*Biology*Physics

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252

153

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“…The RT schedule was a modified concomitant boost program that has been previously reported. 9 The schedule planned to deliver a total dose of 69.9 Gy in 41 fractions over a period of 38 days, using megavoltage beams. Involved sites and areas of potential microscopic disease (generally both sides of the neck down to the clavicles) received 50.4 Gy in 28 fractions over 5.5 weeks, and the boost to initial involved sites delivered 19.5 Gy in 13 fractions of 1.5 Gy given as a second daily fraction in a progressively accelerated fashion.…”

Section: Treatmentmentioning

confidence: 99%

Quality of life in patients with oropharynx carcinomas: Assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy

et al. 2003

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Abstract:Background. In oropharyngeal carcinomas, it is assumed that the effectiveness of the different treatment approaches is roughly equivalent, whereas the functional outcome after radical radiotherapy (RT) is superior to that associated with primary surgery. The aim of this study is to assess quality of life (QoL) outcomes of patients after two treatment strategies: radical surgery with postoperative RT and accelerated concomitant boost RT with or without chemotherapy.Methods. Sixty patients who were disease free at least 1 year after treatment of oropharynx carcinoma were studied. Forty had been treated with radical RT (median tumor dose, 69.9 Gy in 5.5 weeks), and 20 had been treated with primary surgery and postoperative monofractionated RT (median dose, 60.2 Gy). Seven of the former patients received chemotherapy concomitantly with, and one before, RT. Functional outcome was assessed by the subjective Performance Status Scale for Head and Neck cancer (PSSHN) and the general QoL by the European Organization for Research and Treatment of Cancer Core QoL questionnaire (EORTC QLQ-C30). The unpaired t test was used to assess for significant differences between means.Results. By use of the PSSHN module, scores were generally higher in the RT group, with a significant difference in the speech subscale (p = .005), a trend for a significant difference for the eating in public subscale (p = .08), and an insignificant difference for the normalcy of diet subscale (p = .25). When analyzed by tumor stage, no significant differences were observed for T1-2 tumors, whereas for patients with T3-4 tumors highly significant differences favoring the RT group became evident for all three subscales. Although no significant differences were observed using the EORTC QLQ C-30 functional scales, patients treated with primary surgery reported significantly more dyspnea (28 vs 12, p = .04) and appetite loss (30 vs 13, p = .05). In patients with T3-4 tumors, trends toward better scores favoring the RT group were observed for physical, role, emotional, and social functions, as well as a significantly better score for pain symptoms.Conclusions. Although for early stages no clear advantage in QoL outcome was noted for the RT group compared with the surgery group, for advanced-stage disease an advantage favoring radical RT seemed apparent. For those patients, if an equivalency between the two treatment strategies could be assumed regarding oncologic results, then nonsurgical treatment should

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“…However, acute toxicity appeared to be similar in younger and older patients, suggesting that this schedule is suitable for elderly patients who are physically fit enough to receive curative treatment. The considerable acute toxicity appeared to have little impact on compliance, in that the rate of treatment interruption (7%) was similar, or even inferior, to that observed with standard fractionation or with other 5-week accelerated regimens (1,7,13).…”

Section: Discussionmentioning

confidence: 83%

Can concomitant-boost accelerated radiotherapy be adopted as routine treatment for head-and-neck cancers? a 10-year single-institution experience

Allal

Taussky

Mach

et al. 2004

International Journal of Radiation Oncology*Biology*Physics

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Purpose: Accelerated schedules are effective in overcoming repopulation during radiotherapy (RT) for headand-neck cancers, but their feasibility is compromised by increased toxicity. The therapeutic ratio may be particularly favorable for 5-week regimens. This study reports the 10-year experience of a single institution in the routine use of concomitant boost RT as standard radical treatment in all but the most favorable stage patients. Methods and Materials: Between February 1991 and June 2001, 296 patients (mean age, 59 years) were treated with concomitant boost RT either alone (67%) or combined with cisplatin-based chemotherapy (33%), with a median tumor dose of 69.9 Gy. Tumors were located in the oropharynx in 52%, hypopharynx in 20%, larynx in 15%, nasopharynx in 7%, and oral cavity in 6%. International Union Against Cancer Stage III-IV disease represented 77% of tumors. The median follow-up for surviving patients was 55 months (range, 10 -138 months). Results: The RT schedule was completed to the prescribed dose in all but 1 patient. Twenty patients (7%) had a treatment interruption (median, 5 days; range, 2-35 days). Grade 3-4 Radiation Therapy Oncology Group acute toxicity was observed in 77% of patients, and nutritional support was required in 110 patients (37%). For all patients, the 5-year actuarial locoregional control and disease-free survival rate was 72% and 61%, respectively. In a multivariate analysis, only T and N stage was significantly associated with locoregional control and disease-free survival. Grade 3-4 late toxicity occurred in 14%, mostly bone and cartilage necrosis. Conclusions: The present, moderately accelerated, concomitant boost regimen is logistically feasible, causing minimal inconvenience to the technical staff and yielding a high rate of patient compliance. Concomitant chemotherapy administration is feasible provided that patients are carefully selected and supportive care is introduced in a timely fashion. Considering the manageable toxicity and the satisfactory tumor control obtained, this regimen represents a good choice when considering implementation of an altered RT fractionation schedule as standard treatment for head-and-neck cancers.

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Avoidance of treatment interruption: an unrecognized benefit of accelerated radiotherapy in oropharyngeal carcinomas?

Cited by 26 publications

References 15 publications

Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18f]fluoro-2-deoxy-d-glucose

Prediction of outcome in head-and-neck cancer patients using the standardized uptake value of 2-[18f]fluoro-2-deoxy-d-glucose

Quality of life in patients with oropharynx carcinomas: Assessment after accelerated radiotherapy with or without chemotherapy versus radical surgery and postoperative radiotherapy

Can concomitant-boost accelerated radiotherapy be adopted as routine treatment for head-and-neck cancers? a 10-year single-institution experience

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