Helical tomotherapy: an innovative radiotherapy technique for the treatment of locally advanced oropharynx and inoperable oral cavity carcinoma

Abstract

BackgroundTo report our initial clinical experience of helical tomotherapy (HT) in the treatment of locally advanced oropharynx and inoperable oral cavity cancer.MethodsBetween February 2008 and January 2011, 24 consecutive patients, 15 with oropharyngeal cancer and 9 with oral cavity cancer were treated with exclusive radiotherapy or concomitant chemoradiotherapy. Simultaneous integrated boost (SIB) in 30 fractions scheme was prescribed to all patients, using Helical Tomotherapy. Doses administered to primary tumor, oropharynx/oral cavity and positive lymph-nodes and negative lymph-nodes were 66–67.5 Gy, 60–63 Gy and 54 Gy, respectively.ResultsComplete response rate for the oropharynx and the oral cavity group was 86.7% and 77.8%, respectively. The 1 and 2-year Overall Survival (OS) and Disease Free Survival (DFS) rate for the oropharynx group was 92.9%, 85.1%, 92.9% and 77.4% respectively. For the oral cavity group, 1 and 2-year OS and DFS rates were 55.6%, 55.6%, 75% and 75%, respectively. No patient developed grade ≥3 mucositis, dysphagia or dermatitis. The maximum late-toxicity grade observed was 2, for all the variables examined.ConclusionsHT appears to achieve encouraging clinical outcomes in terms of response, survival and toxicity rates.

Helical intensity‐modulated radiotherapy with concurrent chemotherapy for oropharyngeal squamous cell carcinoma: A prospective investigation of acute swallowing and toxicity patterns

“…Specifically, the low rate of long-term gastrostomy use (>12 months) was comparable to the rates reported by Nguyen et al 37 and Kimura et al 35 Oral mucositis data is the only other acute toxicity available for comparison, however, across the studies that have reported results, the incidence of grade 3 mucositis varies widely from 0%-72%. 46 The incidence of grade 2 dysphagia in that study was more than twice the rate of 29% observed in the current study. Dysphagia outcomes have only been reported in 1 helical IMRT study to date.…”

“…Dysphagia outcomes have only been reported in 1 helical IMRT study to date. 46 The incidence of grade 2 dysphagia in that study Indicates results 20% or lower than the current study.…”

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

“…Rates of grade 2 dysphagia range widely from 11-70%, and grade 3 dysphagia ranged from 0-53% (Donato et al, 2013;Hsieh et al, 2014;Santa Cruz et al, 2018;Van Gestel et al, 2015), with a combined grade 2/3 report at 80% (Kong et al, 2013). One retrospective study found younger patients had higher rates of dysphagia, whilst older patients experienced worse xerostomia and pain (Santa Cruz et al, 2018).…”

“…One retrospective study found younger patients had higher rates of dysphagia, whilst older patients experienced worse xerostomia and pain (Santa Cruz et al, 2018). With regards to oral mucositis, the reported incidence of grade 3 mucositis also ranges widely from 0-76%, with the majority of reports greater than 50% (Chen et al, 2011;Donato et al, 2013;Kreps et al, 2016;Kruser et al, 2013;Santa Cruz et al, 2018;Shueng et al, 2010;Van Gestel et al, 2015). There are a smaller number of studies reporting results for grade 2 mucositis ranging from 30-90% (Donato et al, 2013;Kreps et al, 2016;Kruser et al, 2013;Shueng et al, 2010).…”

“…Furthermore, toxicity rates in many published studies are typically reported as purely a "maximum incidence" figure (e.g., 30% reached grade 3 toxicity) and fail to detail patterns of first presentation, symptom peak and recovery (Donato et al, 2013;Kruser et al, 2013;Shueng et al, 2010). In a 2015 study exploring the views of HNC patients on desired pre-treatment information regarding dysphagia, one of the key themes found was 'expectations about treatment effects', including onset of symptoms, their timing and nature (gradual or sudden), the recovery time, and the severity of swallowing problems (Brockbank et al, 2015).…”