Quality of Life in Head and Neck Cancer Patients After Treatment With High-Dose Radiotherapy Alone or in Combination With Cetuximab

Curran, Desmond; Giralt, Jordi; Harari, Paul M.; Ang, K. Kian; Cohen, Roger B.; Kies, Merrill S.; Jassem, Jacek; Baselga, J.; Rowinsky, Eric K.; Amellal, Nadia; Comte, Sylvie; Bonner, James A.

doi:10.1200/jco.2006.08.8005

Cited by 227 publications

(139 citation statements)

References 31 publications

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“…[2][3][4][5][6][7][8][9] This may be due to perceptions that radiation, particularly for T4 bony lesions, is an ineffective modality for advanced OCC. In addition, it is generally thought that radiation doses that would be considered therapeutic for advanced OCC would lead to unacceptable toxicities in the form of xerostomia, or radiation-induced soft-tissue or bone necrosis.…”

Section: Discussionmentioning

confidence: 99%

Chemoradiation for patients with advanced oral cavity cancer

Stenson¹,

Kunnavakkam²,

Cohen³

et al. 2009

The Laryngoscope

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Objectives/Hypothesis:Patients with advanced oral cavity cancer (OCC) typically have not been enrolled in clinical trials utilizing contemporary multimodality strategies. There exist dogmatic expectations of inferior outcome in OCC patients secondary to ineffectiveness of treatment and unacceptable toxicity. The purpose of this study was to analyze survival, swallowing function, and incidence of osteoradionecrosis (ORN) of patients with stage III/IV OCC who have undergone primary concomitant chemoradiotherapy (CRT).Methods:All advanced OCC patients who were enrolled in University of Chicago concomitant CRT protocols from 1994 to 2008 were reviewed. One hundred eleven newly diagnosed advanced OCC patients were evaluated. We performed a subset analysis of 27 additional advanced OCC patients who underwent surgery followed by postoperative CRT. Swallowing function was assessed via oropharyngeal motility study, and a Swallowing Performance Status Scale score was assigned. Presence of clinically significant ORN was documented.Results:Median follow‐up was 3.25 years. Five‐year overall and progression‐free survival was 66.9% and 65.9%, respectively. There was no difference in overall or progression‐free survival when the surgery‐first group was compared with the primary CRT group (P = .88 and P = .86 respectively). Function, without gastric tube requirement, was excellent, with 92.2% of patients able to maintain weight via oral route. Incidence of ORN was 18.4%, occurring in nine of 49 patients evaluated.Conclusions:Our data support the use of primary CRT as a viable treatment option for patients with advanced OCC. Survival is high, and overall function for the majority of patients is satisfactory. Patients with T4 oral tongue cancer may be spared total glossectomy. The incidence of ORN may be considered acceptable, in light of the benefits of enduring life and function. Laryngoscope, 2010

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Section: Discussionmentioning

confidence: 99%

Chemoradiation for patients with advanced oral cavity cancer

Stenson¹,

Kunnavakkam²,

Cohen³

et al. 2009

The Laryngoscope

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“…It is hypothesized that the synergistic effect of gemcitabine and anti-EGFR medication results from the fact that the latter is inhibiting EGFR phosphorylation and blocking the initial survival response (EGFR activation) induced by gemcitabine and thereby promoting apoptosis. Cetuximab/ radiotherapy, because of its assumed better tolerance and compliance [72,73], often serves as an alternative for cisplatinbased CCRT in patients who might have difficulties tolerating it, albeit that a recent literature-based meta-analysis suggested inferior efficacy [74]. As the addition of cetuximab to platinumbased CCRT only adds toxicity to platinum-based CCRT without increasing efficacy [75], other cytotoxic agents with less systemic toxicity and with a different mode of action, such as gemcitabine, in combination with cetuximab and radiation, are an interesting field of research.…”

Section: Discussionmentioning

confidence: 99%

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

et al. 2015

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Background. Platinum-based concurrent chemoradiation (CCRT) improves locoregional control and overall survival of locoregionally advanced (LA) squamous cell carcinoma of the head and neck (SCCHN) when compared to radiotherapy alone, but this approach is hampered by significant toxicity. Therefore, alternative ways to enhance the radiation effects are worth investigating. Gemcitabine (29,29-difluorodeoxycytidine), in addition to its activity against a variety of solid tumors, including SCCHN, is one of the most potent radiosensitizers, and it has an overall favorable safety profile. In this paper, the clinical experience with gemcitabine-based chemoradiation in the treatment of patients with LA-SCCHN is reviewed. Methods. We conducted a review of the literature on the clinical experience with radiotherapy combined with either single-agent gemcitabine or gemcitabine/cisplatin-based polychemotherapy for the treatment of patients with LA-SCCHN. We also searched abstracts in databases of major international oncology meetings from the last 20 years. A meta-analysis was performed to calculate pooled proportions with 95% confidence intervals (CIs) for complete response rate and grade 3-4 acute mucositis rate.

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“…Bonner et al,19, 20 in their prospective randomized trial, compared RT‐alone with RT plus cetuximab and reported improvement in locoregional control and survival with no significant increase in toxicity. Short‐term QOL between the two arms was also similar 21. In a retrospective study comparing concurrent cisplatin and RT with cetuximab and RT for LAHNC, concurrent cisplatin achieved better local control and survival but there was no significant difference in late Gr3 or Gr4 effects or feeding tube dependence 22, 23.…”

Section: Discussionmentioning

confidence: 69%

Feasibility of optimizing intensity‐modulated radiation therapy plans based on measured mucosal dose adjacent to dental fillings and toxicity outcomes

Seol

Aggarwal

Eyben

et al. 2018

J Applied Clin Med Phys

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We prospectively investigated the feasibility of IMRT treatment plan optimization based on dosimeter measurements of lateral tongue mucosal dose adjacent to the dental fillings and evaluated dose‐toxicity relationship and factors affecting oral mucositis (OM) in head and neck cancer patients. Twenty‐nine head and neck cancer patients with metallic dental fillings who were scheduled to undergo fractionated external beam radiation therapy (RT) ± chemotherapy were enrolled. The lateral tongue dose was measured and if the calculated dose for the entire treatment was ≥35 Gy, a re‐plan was generated to reduce the lateral tongue mucosal dose. OM was graded weekly according to Common Terminology Criteria for Adverse Events version 4.0 and the patients completed the Oral Mucositis Weekly Questionnaire‐Head and Neck Cancer. The result showed that it was not feasible to optimize the IMRT plan based on measured tongue dose in most of the patients who needed re‐plan as re‐planning compromised the target coverage in 60% of these patients. The duration of grade (Gr) 2 OM was correlated with measured lateral tongue dose (P = 0.050). Concurrent cetuximab was significantly associated with faster onset of Gr2 OM than concurrent cisplatin (P = 0.006) and with longer duration of OM (P = 0.041) compared to concurrent cisplatin or IMRT‐alone. The pattern of reported pain over time was significantly different for each treatment type (RT and cetuximab, RT and cisplatin and RT‐alone) and depending on the dose level (P = 0.006). In conclusion, optimizing the IMRT plan based on measured lateral tongue dose was not feasible. Measured lateral tongue dose was significantly correlated with longer duration of OM ≥Gr2, and concurrent cetuximab was associated with earlier onset and longer duration of OM ≥Gr2.

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Quality of Life in Head and Neck Cancer Patients After Treatment With High-Dose Radiotherapy Alone or in Combination With Cetuximab

Abstract: The addition of cetuximab to radiotherapy significantly improved locoregional control and increased overall survival without adversely affecting QoL.

Cited by 227 publications

References 31 publications

Chemoradiation for patients with advanced oral cavity cancer

Chemoradiation for patients with advanced oral cavity cancer

Gemcitabine-Based Chemoradiation in the Treatment of Locally Advanced Head and Neck Cancer: Systematic Review of Literature and Meta-Analysis

Feasibility of optimizing intensity‐modulated radiation therapy plans based on measured mucosal dose adjacent to dental fillings and toxicity outcomes

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