Effect of daily fraction size on laryngoesophageal dysfunction after chemoradiation for squamous cell carcinomas of the larynx and hypopharynx

Chen, Allen M.; Hsu, Sophia; Meshman, Jessica; Chin, Robert; Beron, P.J.; Abemayor, Elliot; John, Maie St.

doi:10.1002/hed.24757

Cited by 8 publications

(9 citation statements)

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“…the superior pharyngeal constrictor muscle) and radiation induced acute and late dysphagia. (25)(26)(27)(28)(29)(30)(31). Subsequently, several studies are currently focusing on reducing the elective radiation dose and the irradiated volume in order to decrease acute and late swallowing dysfunction (32)(33)(34)(35).…”

Section: Discussionmentioning

confidence: 99%

Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of A National Survey Among Radiation Oncologists

Dragan

Duprez

Gossum

et al. 2020

Preprint

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Background: Nutritional complications in patients with locally advanced head and neck cancer (LA-HNC) treated by concurrent chemoradiotherapy (CCRT) often lead to placement of a prophylactic gastrostomy (PG) tube, while indication lacks harmonization. Our aim was to explore the current PG tube utilization among Belgian radiation oncology centers.Methods: A survey was distributed to all 24 Belgian Radiation oncology departments, with questions about the number of patient treated per year, whether the PG indication is discussed at the multidisciplinary board, placement technique, time of starting nutrition and removal, its impact on swallowing function and importance of clinical factors. For the latter Relative Importance and Discordance Indexes were calculated to describe the ranking and agreement.Results: All 24 center submitted the questionnaire. Twenty three treat more than 20 head and neck (HNC) patients per year, while four (1 in 21-50; 3 in 51-100) are not discussing the gastrostomy tube indication at the multidisciplinary board. For the latter, endoscopic placement (68%) is the dominant technique, followed by the radiologic (16%) and laparoscopic (16%) methods. Seventy-five percent start the enteral nutrition when clinically indicated, 17% immediately and 8% from the start of radiotherapy. Majority of specialists (19/24) keep the gastrostomy tube until the patient assume an adequate oral feeding. Fifteen centres are considering PG decrease swallowing function. Regarding factors and their importance in the decision for the PG, foreseen irradiated volume reached highest importance, followed by ‘anatomical site’, ‘patients’ choice’ and ‘postoperative versus definitive’ and ‘local expertise’, with decreasing importance respectively. Disagreement indexes showed moderate variation.Conclusions: The use of a PG tube for LAHNC patients treated by CCRT shows disparity at national level. Prospective studies are needed to ensure proper indication of this supportive measure.

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Section: Discussionmentioning

confidence: 99%

Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of A National Survey Among Radiation Oncologists

Dragan

Duprez

Gossum

et al. 2020

Preprint

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“…However, despite recent technological RT advances and successes in other tumor sites [ 10 – 12 ], the use of hypofractionation regimens with radical intent in LAHNC is modest and restricted to a few countries, particularly the United Kingdom [ 14 , 16 , 22 – 24 ]. The main reason for this restriction is the toxicity concern regarding the high dose per fraction, notably with concomitant chemotherapy [ 25 ]. Moreover, whether concomitant CDDP improve outcomes in the context of hypofractionation for LAHNC is unknown.…”

Section: Discussionmentioning

confidence: 99%

Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma

et al. 2018

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BackgroundThe evolution of radiotherapy over recent decades has reintroduced the hypofractionation for many tumor sites with similar outcomes to those of conventional fractionated radiotherapy. The use of hypofractionation in locally advanced head and neck cancer (LAHNC) has been already used, however, its use has been restricted to only a few countries. The aim of this trial was to evaluate the safety and feasibility of moderate hypofractionated radiotherapy (HYP-RT) with concomitant cisplatin (CDDP).MethodsThis single-arm trial was designed to evaluate the safety and feasibility of HYP-RT with concomitant CDDP in LAHNC. Stage III and IV patients withnonmetastatic disease were enrolled. Patients were submitted to intensity modulatedradiation therapy, which comprised 55 Gy/20 fractions to the gross tumor and44–48 Gy/20 fractions to the areas of subclinical disease. Concomitant CDDPconsisted of 4 weekly cycles of 35 mg/m2. The primary endpoints were the treatment completion rate and acute toxicity.ResultsTwenty patients were enrolled from January 2015 to September 2016, and 12 (60%) were classified as unresectable. All patients completed the total dose of radiotherapy, and 19 patients (95%) received at least 3 of 4 cycles of chemotherapy. The median overall treatment time was 29 days (27–34). Grade 4 toxicity was reported twice (1 fatigue and 1 lymphopenia). The rates of grade 3 dermatitis and mucositis were 30% and 40%, respectively, with spontaneous resolution. Nasogastric tubes were offered to 15 patients (75%) during treatment; 4 patients (20%) needed feeding tubes after 2 months, and only 1 patient needed a feeding tube after 12 months.ConclusionHYP-RT with concomitant CDDP was considered feasible for LAHNC, and the rate of acute toxicity was comparable to that of standard concomitant chemoradiation. A feeding tube was necessary for most patients during treatment. Further investigation of this strategy is warranted.Trial registrationClinicalTrials, NCT03194061. Registered 21 Jun 2017 – Retrospectively registered.

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“…Data regarding IMRT for the head and neck cancer showed a superior dose conformity and improved preservation of organs at risk with decreased toxicity rates compared with 3D-radiotherapy [ 35 , 36 , 37 , 38 , 39 , 40 ]. Nevertheless, in the hypopharynx and larynx region, IMRT can lead to severe acute and chronic side effects due to the proximity of several organs at risk [ 11 , 12 , 41 , 42 , 43 ]. In a meta-analysis of three prospective randomized Radiation Therapy Oncology Group (RTOG) studies, Machtay et al identified the larynx and hypopharynx as independent negative prognostic factors for severe late side effects after concurrent chemoradiotherapy with IMRT [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

“…Thus, Ward et al reported on a 5-year occurrence of severe dysphagia in 27% of the patients who were treated by chemoradiotherapy with IMRT for locally advanced stage laryngeal tumors [ 41 ]. Caudell et al and Chen et al described a high rate of severe laryngoesophageal dysfunction after chemoradiotherapy for locally advanced stage hypopharyngeal and laryngeal tumors [ 42 , 43 ]. It is known that concurrent chemotherapy in combination with radiotherapy led to an increased toxicity compared with radiotherapy alone [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

“…In comparison, in the current analysis, no laryngoesophageal dysfunction or stricture could be identified for CIRT. Although altered fractionation regimes like hypofractionated IMRT results in significantly higher toxicity rates, accelerated hypofractionated CIRT seems to be a safe therapy alternative without any severe late effects [ 43 , 44 , 45 ]. For further evaluation, long-term follow-ups are necessary.…”

Section: Discussionmentioning

confidence: 99%

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Accelerated Hypofractionated Active Raster-Scanned Carbon Ion Radiotherapy (CIRT) for Laryngeal Malignancies: Feasibility and Safety

Akbaba

Lang

Held

et al. 2018

Cancers

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(1) Background: The authors present the first results of active raster-scanned carbon ion radiotherapy (CIRT) for radioresistant laryngeal malignancies regarding efficacy and toxicity. (2) Methods: 15 patients with laryngeal adenoid cystic carcinoma (ACC; n = 8; 53.3%) or chondrosarcoma (CS; n = 7; 46.7%) who underwent radiotherapy with carbon ions (C12) at the Heidelberg Ion Beam Therapy Center (HIT) between 2013 and 2018 were identified retrospectively and analyzed for local control (LC), overall survival (OS), and distant progression-free survival using the Kaplan–Meier method. CIRT was applied either alone (n = 7, 46.7%) or in combination with intensity modulated radiotherapy (IMRT) (n = 8, 53.3%). The toxicity was assessed according to the Common Toxicity Terminology Criteria for Adverse Events (CTCAE) v4.03. (3). Results: the median follow-up was 24 months (range 5–61 months). Overall, the therapy was tolerated very well. No grade >3 acute and chronic toxicity could be identified. The most reported acute grade 3 side effects were acute dysphagia (n = 2; 13%) and acute odynophagia (n = 3; 20%), making supportive nutrition via gastric tube (n = 2; 13.3%) and via high caloric drinks (n = 1; 6.7%) necessary due to swallowing problems (n = 4; 27%). Overall, chronic grade 3 toxicity in the form of chronic hoarseness occurred in 7% of the patients (n = 1; 7%). At the last follow-up, all the patients were alive. No local or locoregional recurrence could be identified. Only one patient with laryngeal ACC developed lung metastases three years after the first diagnosis. (4) Conclusions: the accelerated hypofractionated active raster-scanned carbon ion radiotherapy for radioresistant laryngeal malignancies is feasible in practice with excellent local control rates and moderate acute and late toxicity. Further follow-ups are necessary to evaluate the long-term clinical outcome.

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Effect of daily fraction size on laryngoesophageal dysfunction after chemoradiation for squamous cell carcinomas of the larynx and hypopharynx

Abstract: As the importance of a functional larynx becomes recognized as an endpoint for patients treated by voice preservation, the results of our study help refine treatment guidelines. © 2017 Wiley Periodicals, Inc. Head Neck 39: 1322-1326, 2017.

Cited by 8 publications

References 24 publications

Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of A National Survey Among Radiation Oncologists

Prophylactic Gastrostomy in Locally Advanced Head and Neck Cancer: Results of A National Survey Among Radiation Oncologists

Feasibility of concomitant cisplatin with hypofractionated radiotherapy for locally advanced head and neck squamous cell carcinoma

Accelerated Hypofractionated Active Raster-Scanned Carbon Ion Radiotherapy (CIRT) for Laryngeal Malignancies: Feasibility and Safety

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