Importance of dose in palliative treatment for incurable head and neck cancer with radiotherapy

García-Anaya, María Jesús; Ordóñez, Rafael; Toledo, M. D.; Correa, Raquel; Otero, A.; Roman, A.; García-Ríos, Isabel; Medina, J. A.; Gómez-Millán, Jaime

doi:10.1002/hed.26555

Cited by 8 publications

(8 citation statements)

References 16 publications

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“…Out of these, 40 were excluded, as they did not directly target H&N cancer, elderly patients, or HFRT. The remaining 17 papers were lastly included in this review (20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34)(35).…”

Section: Resultsmentioning

confidence: 99%

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Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Piras¹,

Boldrini

Menna

et al. 2021

Front. Oncol.

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ObjectiveRadiotherapy (RT) in the head and neck (H&N) site are undoubtedly the most challenging treatments for patients. Older and frail patients are not always able to tolerate it, and there are still no clear guidelines on the type of treatments to be preferred for them. The recommendations for Risk-Adapted H&N Cancer Radiation Therapy during the coronavirus disease 2019 (COVID-19) pandemic provided by the ASTRO-ESTRO consensus statement achieved a strong agreement about hypofractionated RT (HFRT). A systematic literature review was conducted in order to evaluate the feasibility and safety of HFRT for older patients affected by H&N malignancies.Materials and MethodsA systematic database search was performed on PubMed and Embase according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Original studies, case series, and case reports describing the use of HFRT (with at least 2.2 Gy fractions) in patients with mean age ≥65 years were included. The analysis was based on the type of study, number of patients, mean age, tumor site, histology, performance status (PS), RT details, concomitant chemotherapy (CT), and described clinical outcomes. All the reported doses have been calculated in equivalent dose in 2 Gy fractions (EQD2) and biologically effective dose (BED) using α/β = 10 Gy or α/β = 12 Gy.ResultsWe selected 17 papers that met the inclusion criteria and divided them in 4 categories: 6 articles analyze HFRT performed twice daily in repeated cycles, 3 once a day in repeated cycles, 4 in alternative days, and the last 4 in consecutive days.ConclusionHFRT seems to be a good treatment with an acceptable prolonged disease control. In older patients fit for radical treatments, a 55 Gy in 20 fractions regimen can be proposed as a valid alternative to the standard fractionated RT, but there are a multitude of hypofractionated regimens, ranging from single fraction, quad shot, and 1-, 2-, 3-, 4-, and 5-week schedules that all may be appropriate. The correct regimen for a patient depends on many factors, and it represents the result of a more specific and complex decision.

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Section: Resultsmentioning

confidence: 99%

“…Like other studies, this paper reported major palliative response for doses higher than 30 Gy and ECOG 0–1 PS. Interestingly, no G3 skin toxicity was reported, and no deaths associated with radiation treatment have been observed ( 23 ).…”

Section: Resultsmentioning

confidence: 99%

Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Piras¹,

Boldrini

Menna

et al. 2021

Front. Oncol.

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“…In addition to the two pre-treatment factors, lower histological grade and absence of distant metastasis, completion of the radiotherapy as planned was significantly associated with better survival on univariate analysis and showed a trend in the multivariate analysis. This importance of the completion of the radiotherapy course for survival aspect was previously reported for palliative irradiation of noncutaneous head-and-neck cancer (26). Thus, close monitoring and optimal supportive care during radiotherapy is important for patients receiving palliative irradiation for advanced cSCC.…”

Section: Discussionmentioning

confidence: 57%

Palliative Radiotherapy for Cutaneous Squamous Cell Carcinoma of the Head-and-Neck Region

Staackmann

Schild

Rades

2021

In Vivo

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Background/Aim: Cutaneous squamous cell carcinoma (cSCC) is a common type of skin cancer. Options for palliative treatment include systemic agents and radiotherapy. Selection of a radiation regimen should consider the patient's survival prognosis. This study aimed to identify prognostic factors of survival after palliative radiotherapy for cSCC of the head-and-neck. Patients and Methods: Ten factors were analyzed for survival in 12 patients including age, gender, tumor site, histological grade, primary tumor stage, lymph node involvement, distant metastases, upfront surgery, radiation dose and completion of radiotherapy. Results: On univariate analysis, improved survival was significantly associated with lower histological grade (better differentiation) (p=0.022), no distant metastases (p=0.040) and completion of radiotherapy (p=0.014). In the multivariate analysis, lower histological grade (risk ratio=6.05, p=0.100) and completion of radiotherapy (risk ratio=4.87, p=0.115) showed trends. Conclusion: Predictors of survival were identified that can help design individual treatments. Patients require optimal supportive care as completion of radiotherapy was associated with better survival.

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“…It was found that the median survival time was 5.2 months. The radiation dose was found to be an independent predictor of both overall survival and treatment response in multivariate analysis14, 15.…”

Section: Discussionmentioning

confidence: 99%

Retrospective Study of Palliative Radiotherapy in Locally Advanced and Metastatic Head and Neck Carcinoma: A Single Institution Study

Shah

Daga

Singh

et al. 2022

BJOHNS

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Introduction The most common cancer of India is head and neck, and about 70% of them present in locally advanced or metastatic disease. Palliative radiotherapy is one of the commonly used treatments in such cases. A retrospective study on the outcomes and toxicity of palliative radiotherapy is studied at a tertiary centre. Materials and Methods In this study, 74 patients who underwent palliative radiotherapy at the tertiary centre between Nov 2017 and Oct 2019 were retrospectively analysed. The frequency of different presenting symptoms, radiotherapy regimens, their outcome in form of symptomatic relief and disease status along with toxicity was studied and analysed through the available records. Results We identified 74 eligible patients. The median age was 48years (range, 26–82). Oropharyngeal primary cancer was the most common primary site. The Eastern Cooperative Oncology Group performance status was 3 or more in 74.4% patients. The radiation regimen used were ranged from 8Gyin single fraction, 20Gy in 4 fractions, 20Gy in 5 fractions, 30Gy in 10 fractions and 60Gy in 30 fractions. 93.2% of them completed their treatment. Pain and swelling were the most common presenting symptoms and 90.6% of them had more than 50% relief, while 46.5% had complete or partial response to the treatment. Conclusion Palliative radiotherapy to the head and neck provides some symptomatic benefit in most patients, there are multiple dose fractionation regimens currently being used for palliative radiation treatment, and consideration should be given to higher dose palliative RT regimens in patients having good performance status to maximize locoregional control and minimize late toxicity, patient with poor performance status will benefit from a hypofractionated palliative radiation treatment.

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Importance of dose in palliative treatment for incurable head and neck cancer with radiotherapy

Cited by 8 publications

References 16 publications

Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Palliative Radiotherapy for Cutaneous Squamous Cell Carcinoma of the Head-and-Neck Region

Retrospective Study of Palliative Radiotherapy in Locally Advanced and Metastatic Head and Neck Carcinoma: A Single Institution Study

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