Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70–75 Gy in 5 weeks for advanced head and neck cancer

Cvek, Jakub; Kubes, J.; Skácelíková, Eva; Otahal, B.; Komínek, Pavel; Halamka, Magdalena; Feltl, David

doi:10.1007/s00066-012-0128-x

Cited by 25 publications

(11 citation statements)

References 21 publications

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“…Similar results are described by Cvek et al; 17 after hyperfractionated accelerated RT with integrated boosts, no 3 or 4 grade toxicity was observed (RTOG/EORTC). Saunders et al 19 described a small, but significant reduction in epidermal and mucosal late adverse effects in the arm treated with accelerated hyperfractionation in comparison with Conv.…”

Section: Discussionsupporting

confidence: 89%

“…arm. Other authors reported larger percentages of 2-year OS: 55%, 60%, 71% and 74% for hyperfractionated accelerated RT with concomitant integrated boost, 17 hyperfractionated accelerated RT combined with chemotherapy, 15 neoadjuvant chemotherapy followed by concurrent hyperfractionated radiation therapy and sensitizing chemotherapy 9 and hyperfractionated accelerated RT plus cisplatin, 12 respectively. Some authors described an even better 3-year OS: 57% and 60% for split-course hyperfractionated accelerated radiochemotherapy 14 and accelerated hyperfractionated RT concurrent with carboplatin and paclitaxel, 8 respectively (OS 17% in the CHA-CHA arm).…”

Section: Discussionmentioning

confidence: 96%

“…[7][8][9][10][11][12][13][14][15] Less frequent were attempts of RT as an alone utility. [16][17][18][19][20] Some individual publications describe a combination of RT and surgery. 21,22 There is very limited data concerning QOL after such therapies.…”

Section: Discussionmentioning

confidence: 99%

“…18,23,24 Again, different scales were used in the literature. Among publications regarding RT alone, Cvek et al 17 described 51% and Yoney et al 20 24% of Grade 3 acute mucositis (RTOG/EORTC).…”

Section: Discussionmentioning

confidence: 99%

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Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

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Objective: Evaluation of the efficacy and toxicity of splitcourse accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck (H&N) cancer patients. Methods: We enrolled 101 patients (39 in CHA-CHA and 37 in conventional (Conv.) arm completed the treatment). The CHA-CHA arm patients were irradiated twice a day, 7 days a week, using a fraction dose (fd) of 1.6 Gy up to 64 Gy with an 8-day gap in midterm. Patients in the control (Conv.) arm group were irradiated with a fd of 2 Gy, five times a week to a total dose of 72-74 Gy in the overall treatment time of 50-53 days. Quality of life (QOL) and acute mucosal reaction were evaluated during radiotherapy (RT). After RT, we followed the effect of treatment, QOL, performance status and adverse effects of radiation. For statistical analysis mainly a hierarchical multilevel modelling was used.Results: QOL was most deteriorated in the CHA-CHA arm; the CHA-CHA scheme also caused a relatively stronger acute injury. There were no significant differences in late adverse effects. In the CHA-CHA arm in 35% and in Conv. arm in 30% of patients, disease was controlled during follow-up. Tumour regression 1 year after the treatment was significantly better in the CHA-CHA arm. However, the overall survival rate analysis did not show significant difference between both arms. Conclusion: Despite differences in treatment results, we cannot conclude that split-course accelerated hyperfractionated irradiation is superior to conventionally fractionated RT as a sole treatment for advanced H&N cancer patients. Advances in knowledge: Obtained results in the context of published data support the statement that altered fractionations alone do not give an advantage for advanced H&N cancer patients.There are, and have been, many attempts to create a clear and effective treatment modality for advanced inoperable head and neck (H&N) cancers. The most common are different combinations of chemoradiotherapy, or different schedules of altered and usually intensive radiation treatment. It is clear that intense dose delivery combined with a high total dose (TD) and short treatment time gives a higher probability of tumour destruction; unfortunately, it is also connected with a higher, usually unacceptable, risk of normal tissue damage. One of the causes of radiation toxicity in such cases is the inability of sufficient repair of healthy tissue damage.The reason for this is the intensity of dose delivery and the lack of time for repopulation of normal cells and proper repair. On the other hand, the accelerated repopulation of squamous cancer cells starts 4 weeks after radiotherapy (RT); therefore, radiation treatment should be completed in that time. Considering the aforementioned facts, we tried to construct a very intense and short RT schedule allowing for normal tissue (mainly mucosa) repair. We went back to the old concept of split-course RT and combined it with accelerated, continuous, intense hyperfractionation.Finally, we proposed twice-a-day irradiation, usi...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 96%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Miszczyk

Maciejewski²,

Tukiendorf³

et al. 2014

BJR

View full text Add to dashboard Cite

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“…Radiotherapy plays a significant role in the management of head and neck squamous cell carcinoma (HNSCC), either for the definitive radiotherapy or for the post-surgical adjuvant radiation[1], [2]. The mucositis, acute or late xerostomia caused by radiation are the most common toxic effects, which usually interrupt the planned course of treatment[3].…”

Section: Introductionmentioning

confidence: 99%

Effect of Amifostine in Head and Neck Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

Zhu

et al. 2014

PLoS ONE

121

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BackgroundAmifostine is the most clinical used chemical radioprotector, but its effect in patients treated with radiation is not consistent.MethodsBy searching Medline, CENTRAL, EMBASE, ASCO, ESMO, and CNKI databases, the published randomized controlled trials (RCTs) about the efficacy of amifostine in HNSCC patients treated with radiotherapy were collected. The pooled efficacy and side effects of this drug were calculated by RevMan software.ResultsSeventeen trials including a total of 1167 patients (604 and 563 each arm) were analyzed in the meta-analysis. The pooled data showed that the use of amifostine significantly reduce the risk of developing Grade3–4 mucositis (relative risk [RR],0.72; 95% confidence interval [CI],0.54–0.95; p<0.00001), Grade 2–4 acute xerostomia (RR,0.70; 95%CI,0.52–0.96; p = 0.02), or late xerostomia (RR,0.60; 95%CI,0.49–0.74; p<0.00001) and Grade 3–4 dysphagia (RR,0.39; 95%CI,0.17–0.92; p = 0.03). However, subgroup analysis demonstrated that no statistically significant reduction of Grade3–4 mucositis (RR,0.97; 95% CI,0.74–1.26; p = 0.80), Grade 2–4 acute xerostomia (RR,0.35; 95%CI,0.02–5.44; p = 0.45), or late xerostomia (RR,0.40; 95%CI,0.13–1.24; p = 0.11) and Grade 3–4 dysphagia (RR,0.23; 95%CI,0.01–4.78; p = 0.35) was observed in patients treated with concomitant chemoradiotherapy. Compared with placebo or observation, amifostine does not show tumor protective effect in complete response (RR,1.02; 95%CI,0.89–1.17; p = 0.76) and partial response (RR,0.90; 95%CI, 0.56–1.44; p = 0.66). For the hematologic side effect, no statistical difference of Grade 3–4 leucopenia (RR,0.60; 95%CI,0.35–1.05; p = 0.07), anemia (RR,0.80; 95%CI, 0.42–1.53; p = 0.50) and thrombocytopenia (RR,0.43; 95%CI,0.16–1.15; p = 0.09) were found between amifostine and control groups. The most common amifostine related side effects were nausea, emesis, hypotension and allergic with an average incidence rate (Grade 3–4) of 5%, 6%, 4% and 4% respectively.ConclusionThis systematic review showed that amifostine significantly reduce the serious mucositis, acute/late xerastomia and dysphagia without protection of the tumor in HNSCC patients treated with radiotherapy. And the toxicities of amifostine were generally acceptable.

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Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

et al. 2019

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Background Technological advances in radiotherapy have allowed investigations into new methods to spare healthy tissue in those treated for head and neck cancer. This systematic review with meta‐analysis demonstrates the effect that radiation has on swallowing. Methods Selection and analysis of studies examining the effect of radiation to swallowing structures. A fixed effects meta‐analysis calculated the pooled proportions for select outcomes of dysphagia, common across many studies. Results The majority of the papers found a correlation between radiation dose to the swallowing structures and dysphagia, however a meta‐analysis found the studies carried a significant degree of heterogeneity. The appraisal demonstrates the need for large‐scale studies using a randomized design and instrumental dysphagia assessments. Conclusions Radiation dose to dysphagia and aspiration structures is correlated with incidence of dysphagia and aspiration. The variables in this population contribute to the heterogeneity within and cross studies and future studies should consider controlling for this.

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Hyperfractionated accelerated radiotherapy with concomitant integrated boost of 70–75 Gy in 5 weeks for advanced head and neck cancer

Cited by 25 publications

References 21 publications

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Split-course accelerated hyperfractionated irradiation (CHA-CHA) as a sole treatment for advanced head and neck cancer patients—final results of a randomized clinical trial

Effect of Amifostine in Head and Neck Cancer Patients Treated with Radiotherapy: A Systematic Review and Meta-Analysis Based on Randomized Controlled Trials

Systematic review and meta‐analysis of the impact of dosimetry to dysphagia and aspiration related structures

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