Concomitant boost radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx

Ang, K. Kian; Peters, Lester J.; Weber, Randal S.; Maor, Moshe; Morrison, William H.; Wendt, Charles D.; Brown, Barry W.

doi:10.1016/0360-3016(90)90341-g

Cited by 221 publications

(62 citation statements)

References 10 publications

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“…The boost appears to be more efficacious when administered late in treatment rather than early [56], which is consistent with our results. This regimen is currently being tested against conventional fractionation, hyperfractionation and splitcourse accelerated fractionation in the RTOG Trial 90-03.…”

Section: Wein 16supporting

confidence: 92%

Dynamic optimization of a linear–quadratic model with incomplete repair and volume-dependent sensitivity and repopulation

Wein

Cohen

2000

International Journal of Radiation Oncology*Biology*Physics

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Purpose: The linear-quadratic model typically assumes that tumor sensitivity and repopulation are constant over the time course of radiotherapy. However, evidence suggests that the growth fraction increases and the cell loss factor decreases as the tumor shrinks. We investigate whether this evolution in tumor geometry, as well as the irregular time intervals between fractions in conventional hyperfractionation schemes, can be exploited by fractionation schedules that employ time-varying fraction sizes. Methods:We construct a mathematical model of a spherical tumor with a hypoxic core and a viable rim, and embed this model into the traditional linear-quadratic model by assuming instantaneous reoxygenation. Dynamic programming is used to numerically compute the fractionation regimen that maximizes the tumor control probability (TCP) subject to constraints on the biologically effective dose of the early and late tissues. Results:In a numerical example that employs 10 fractions per week, optimally varying the fraction sizes increases the TCP from 0.7 to 0.966, and the optimal regimen incorporates large Friday afternoon doses that are escalated throughout the course of treatment, and larger afternoon doses than morning doses.Conclusions: Numerical results suggest that a significant increase in tumor cure can be achieved by allowing the fraction sizes to vary throughout the course of treatment. Several strategies deserve further investigation: using larger fractions before overnight and weekend breaks, and escalating the dose (particularly on Friday afternoons) throughout the course of treatment.

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Section: Wein 16supporting

confidence: 92%

Dynamic optimization of a linear–quadratic model with incomplete repair and volume-dependent sensitivity and repopulation

Wein

Cohen

2000

International Journal of Radiation Oncology*Biology*Physics

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“…Instead, this group of patients was typically treated with 70 Gy in 33 fractions, similar to the fractionation scheme described for nasopharyngeal carcinoma. 14 Only 4 patients were treated with concomitant boost fractionation schedule 9 . The original treatment planning systems were unable to create a dose distribution combining the large field and boost field treatments, causing uncertainty in the plans that often had considerable heterogeneity.…”

Section: Discussionmentioning

confidence: 99%

“…The concomitant boost fractionation schedule 9 was used in the treatment of 4 patients. This boost fractionation involved 2 separate treatments.…”

Section: Imrt: Volume Definition Dose Prescription Fractionation Amentioning

confidence: 99%

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma

Garden

Morrison

Wong

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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130

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“…AFRT with concomitant boost (AFRT-CB) delivers radiotherapy in an accelerated format without total dose reduction, resulting in heightened toxicity which may persist longer and result in a higher incidence of severe functional injury, including possible deleterious effects on swallowing and nutrition [4][5][6][7][8][9] .…”

Section: Introductionmentioning

confidence: 99%

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

et al. 2011

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Altered fractionation radiotherapy for head and neck cancer has been associated with improved locoregional control, overall survival, and heightened toxicity compared with conventional treatment. Swallowing, nutrition and patient-perceived function for altered fractionation radiotherapy with concomitant boost (AFRT-CB) for T1-T3 oropharyngeal SCC has not been previously reported. Fourteen consecutive patients treated with AFRT-CB for oropharyngeal SCC were recruited from November 2006 to August 2009 in a tertiary hospital in Brisbane, Australia. Swallowing, nutrition and patient-perceived functional impact assessments were conducted pre-treatment, at 4-6 weeks post-treatment and at 6 months posttreatment. Deterioration from pre-treatment to 4-6 weeks post-treatment in swallowing, nutrition and functional impact was evident, likely due to the heightened toxicity associated with AFRT-CB. There was significant improvement at 6 months post-treatment in functional swallowing, nutritional status, patient-perceived swallowing and overall function, consistent with recovery from acute toxicity. However, weight and patient-perception of their physical function and side effects remained significantly worse than pre-treatment scores. The ongoing deficits related to weight and patient-perceived outcomes at 6 months revealed this treatment has a long-term impact on function possibly related to the chronic effects of AFRT-CB.

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Concomitant boost radiotherapy schedules in the treatment of carcinoma of the oropharynx and nasopharynx

Cited by 221 publications

References 10 publications

Dynamic optimization of a linear–quadratic model with incomplete repair and volume-dependent sensitivity and repopulation

Dynamic optimization of a linear–quadratic model with incomplete repair and volume-dependent sensitivity and repopulation

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma

A Prospective Investigation of Swallowing, Nutrition, and Patient-rated Functional Impact Following Altered Fractionation Radiotherapy with Concomitant Boost for Oropharyngeal Cancer

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