Brachytherapy versus surgery in carcinoma of tonsillar fossa and/or soft palate: late adverse sequelae and performance status: can we be more selective and obtain better tissue sparing?

Levendag, Peter C.; Nijdam, Wideke; Noever, Inge; Schmitz, Paul; Pol, M. van de; Sipkema, Dick; Braat, C.; Boer, Maarten P. de; Jansen, Peter P.

doi:10.1016/j.ijrobp.2003.11.032

Cited by 60 publications

(38 citation statements)

References 18 publications

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“…In addition, there are difficulties in surgical approach and considerable surgical morbidity. Thus, there has been an overall trend toward primary therapy with RT or CRT, especially for patients with advanced disease (1,(3)(4)(5). However, these combined treatments have substantial toxicity and, therefore, are not suitable for all patients.…”

Section: Discussionmentioning

confidence: 99%

“…A single-modality therapy with radiation or surgery can achieve similar locoregional control for early-stage cancers, with RT generally yielding better functional outcomes (2,3). Although patients with more advanced disease (stages III and IV) have been traditionally treated with surgery followed by RT, there has been an increase in the use of chemoradiation organ-preserving protocols.…”

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confidence: 99%

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Use of 18F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

Kim

Roh²,

Kim³

et al. 2007

Journal of Nuclear Medicine

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High tumor uptake of 18 F-FDG is associated with an unfavorable outcome in cancer patients. We evaluated pretreatment 18 F-FDG uptake as guidance for the primary treatment modality in patients with squamous cell carcinoma (SCC) of the oropharynx. Methods: Fifty-two consecutive patients with newly diagnosed resectable SCC of the oropharynx underwent 18 F-FDG PET before treatment. Primary treatment modalities consisted of surgical resection plus radiotherapy (RT) (surgery group, n 5 31) or radical RT plus chemotherapy (RT group, n 5 21). The sex, age, tumor stage, histologic grade, TNM classification, treatment strategy, and maximum standardized uptake value (SUV) categories were analyzed for association with local control (LC) and disease-free survival (DFS). The median follow-up of the surviving patients was 36 mo. Results: The median SUV was significantly higher in the 11 patients who failed treatment than that in the remaining controlled patients (8.0 vs. 5.4; P 5 0.021). Patients having tumors with a high SUV . 6.0 had poorer LC and DFS (P , 0.05). In multivariate analysis, the SUV remained an independent determinant of LC and DFS (P , 0.05). Patients with a SUV . 6.0 in the surgery group had a higher 3-y DFS than that in the RT group (78% vs. 33%; P 5 0.043). Conclusion: Pretreatment tumor 18 F-FDG uptake represents an independent prognostic factor in patients with oropharyngeal SCC. Patients with high 18 F-FDG uptake may be better treated by surgery followed by RT with or without chemotherapy, which needs to be verified by a prospective randomized study.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Use of 18F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

Kim

Roh²,

Kim³

et al. 2007

Journal of Nuclear Medicine

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“…At Rotterdam, 77 patients were treated with IMRT (n = 37), threedimensional conformal RT (n = 22), or computed tomography-based parallel-opposed beam techniques. In 52% of the patients, BT was used according to previously detailed methods (4,5). Additional details regarding the treatment methods used in Rotterdam have been previously published (6).…”

Section: Patients and Therapymentioning

confidence: 99%

“…At Erasmus Medical Center in Rotterdam, brachytherapy (BT) has been used for many years as a tool to facilitate the delivery of a high tumor dose (4,5). BT substantially reduces the doses delivered to neighboring tissues, specifically the neighboring swallowing structures, compared with conventional RT.…”

Section: Introductionmentioning

confidence: 99%

Can IMRT or Brachytherapy Reduce Dysphagia Associated With Chemoradiotherapy of Head and Neck Cancer? The Michigan and Rotterdam Experiences

Eisbruch

Levendag

Feng

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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Purpose-Dysphagia is a major late complication of intensive chemoradiotherapy of head and neck cancer. The initial clinical results of intensity-modulated radiotherapy (IMRT), or brachytherapy, planned specifically to reduce dysphagia are presented.Patients and Methods-Previous research at Michigan University has suggested that the pharyngeal constrictors and glottic and supraglottic larynx are likely structures whose damage by chemo-RT causes dysphagia and aspiration. In a prospective Michigan trial, 36 patients with oropharyngeal (n = 31) or nasopharyngeal (n = 5) cancer underwent chemo-IMRT. IMRT cost functions included sparing noninvolved pharyngeal constrictors and the glottic and supraglottic larynx. After a review of published studies, the retropharyngeal nodes at risk were defined as the lateral, but not the medial, retropharyngeal nodes, which facilitated sparing of the swallowing structures. In Rotterdam, 77 patients with oropharyngeal cancer were treated with IMRT, three dimensional RT, or conventional RT; also one-half received brachytherapy. The dysphagia endpoints included videofluoroscopy and observer-assessed scores at Michigan and patient-reported qualityof-life instruments in both studies.Results-In both studies, the doses to the upper and middle constrictors correlated highly with the dysphagia endpoints. In addition, doses to the glottic and supraglottic larynx were significant in the Michigan series. In the Rotterdam series, brachytherapy (which reduced the doses to the swallowing structures) was the only significant factor on multivariate analysis. Conclusion-The dose-response relationships for the swallowing structures found in these studies suggest that reducing their doses, using either IMRT aimed at their sparing, or brachytherapy, might achieve clinical gains in dysphagia.

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“…It is likely that T stage and anatomic site influence the risk of contralateral disease by determining how much disease approximates the midline mucosa where an increasing risk of contralateral lymphatic drainage occurs. When the tonsil site is considered by itself, the indications for ipsilateral neck radiation have been consistently reported [29,30,[34][35][36][37][38] .…”

Section: Current Treatment Approachmentioning

confidence: 99%

Postoperative Adjuvant Therapy after Transoral Robotic Resection for Oropharyngeal Carcinomas: Rationale and Current Treatment Approach

Quon

O’Malley

Weinstein

2011

ORL

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The advancement of transoral surgical techniques for the management of oropharyngeal carcinomas has raised questions about how adjuvant therapy can best be integrated. Some of these questions have come from the application of established oncologic principles of adjuvant therapy, and some are unique to the evolving experience with transoral surgery and in particular with the recent advancement of robotic surgery. It is important for all members of the multidisciplinary treatment team to have a clear understanding of the foundation for adjuvant therapy and the issues unique to transoral robotic surgery to provide optimal patient care as this new treatment paradigm gains popularity for its safe application.

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Brachytherapy versus surgery in carcinoma of tonsillar fossa and/or soft palate: late adverse sequelae and performance status: can we be more selective and obtain better tissue sparing?

Cited by 60 publications

References 18 publications

Use of 18F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

Use of 18F-FDG PET for Primary Treatment Strategy in Patients with Squamous Cell Carcinoma of the Oropharynx

Can IMRT or Brachytherapy Reduce Dysphagia Associated With Chemoradiotherapy of Head and Neck Cancer? The Michigan and Rotterdam Experiences

Postoperative Adjuvant Therapy after Transoral Robotic Resection for Oropharyngeal Carcinomas: Rationale and Current Treatment Approach

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