Randomized Trial of Antioxidant Vitamins to Prevent Acute Adverse Effects of Radiation Therapy in Head and Neck Cancer Patients

Bairati, Isabelle; Meyer, François; Gélinas, Malorie; Fortin, A.; Nabid, Abdenour; Brochet, François; Mercier, Jean-Philippe; Têtu, Bernard; Harel, François; Abdous, Belkacem; Vigneault, Éric; Vass, Sylvie; Vecchio, P. Del; Roy, Jean

doi:10.1200/jco.2005.05.514

Cited by 226 publications

(184 citation statements)

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“…The detailed description of the trial methods and the results concerning the main effects of the supplementation on SPC and cancer-free survival, on acute adverse effects of radiation therapy and recurrence of the initial cancer and on mortality have been presented. [5][6][7] The institutional review board of each participating center approved the study protocol. All patients gave written informed consent prior to randomization.…”

Section: Study Population and Interventionmentioning

confidence: 99%

“…Contrary to expectation, the supplementation had adverse effects on the recurrence of the initial cancer, on the incidence of second primary cancers and on mortality. [5][6][7] There is strong evidence from chemoprevention trials that beta carotene supplementation increases lung cancer incidence only among smokers. [8][9][10][11] In head and neck cancer patients treated by radiation therapy, smoking during treatment was associated with a lower rate of complete response and a poorer 2-year survival.…”

mentioning

confidence: 99%

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Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long‐term effects on recurrence and mortality: A randomized trial among head and neck cancer patients

Meyer

Bairati

Fortin

et al. 2008

Intl Journal of Cancer

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There has been concern that the efficacy of radiation therapy may be reduced when patients smoke or take antioxidant vitamins during treatment. Cancer prevention trials with beta carotene supplements documented adverse effects only among smokers. We conducted a randomized trial with alpha tocopherol (400 IU/day) and beta carotene (30 mg/day) supplements among 540 head and neck cancer (HNC) patients treated by radiation therapy. We examined whether smoking during radiation therapy modified the effects of the supplementation on HNC recurrence and on mortality. During the follow-up, 119 patients had a HNC recurrence and 179 died. Cox models were used to test the interaction between smoking and supplementation and to estimate the hazard ratios (HR) for HNC recurrence and death associated with the supplementation. Cigarette smoking either before or after radiation therapy did not modify the effects of the supplementation. In contrast, the interactions between supplementation and cigarette smoking during radiation therapy were statistically significant for HNC recurrence (p 5 0.03), all-cause mortality (p 5 0.02) and mortality from the initial HNC (p 5 0.04). Among cigarette smokers, the HR were 2.41 (95% CI: 1.25-4.64) for recurrence, 2.26 (95% CI: 1.29-3.97) for all-cause mortality and 3.38 (95% CI: 1.11-10.34) for HNC mortality. All corresponding HR among nonsmokers were close to 1. These results could best be explained by the hypothesis that the combined exposures reduced the efficacy of radiation therapy. Particular attention should be devoted to prevent patients from both smoking and taking antioxidant supplements during radiation therapy. ' 2007 Wiley-Liss, Inc.

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Section: Study Population and Interventionmentioning

confidence: 99%

mentioning

confidence: 99%

Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long‐term effects on recurrence and mortality: A randomized trial among head and neck cancer patients

Meyer

Bairati

Fortin

et al. 2008

Intl Journal of Cancer

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111

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“…Some evidence exists for this concern. During a large randomized, double blind, placebo controlled trial of 540 patients with head and neck cancer undergoing radiation [68], subjects were given either placebo or a combination of antioxidants (400-IU alpha-tocopherol, 30-mg beta-carotene) daily throughout radiation therapy and for 3 years afterwards. Although acute side effects of radiation were significantly less in the antioxidant group, quality of life was not improved significantly, and the rate of local recurrence was higher in the supplemented group (odds ratio or OR 1.37; confidence interval or CI 0.93-2.02).…”

Section: Antioxidantsmentioning

confidence: 99%

Dietary Supplement Use in Cancer Care: Help or Harm

Hardy

2008

Hematology/Oncology Clinics of North America

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“…22 Recent results of large multicenter, double blind, randomized placebo-controlled chemoprevention trial by Bairati et al for patients treated with radiation therapy for stage 1 or 2 squamous cell carcinoma of the head and neck have shown no benefit from vitamin E. The proportion of patients free of second primary cancers after 8 years was similar in treated and placebo group. 23 Most of the studies have used vitamin E in combination therapy with other agents. Further studies of vitamin E alone would be necessary to better define its effectiveness as a sole chemopreventive agent.…”

Section: Vitamin Ementioning

confidence: 99%

Chemoprevention of Oral Cancer

Chhaparwal¹,

Pai²,

Vineetha³

2012

JIAOMR

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Oral cancer is one among the ten most common cancers in the world and shows a marked geographic variation in occurrence. It causes considerable morbidity and is associated with a 5-year survival rate of less than 50%. Current treatment primarily consists of surgery and radiotherapy and improvement in longterm cure rates with these modalities has reached a plateau. As, curative therapy available for oral cancer often results in debilitating changes in appearance, speech, swallowing and breathing, preventive strategies are desirable. Cancer chemoprevention is the use of natural, synthetic or biologic chemical agents to reverse, suppress, or prevent carcinogenic progression. Chemoprevention has been an extensively-studied strategy and continues to hold promise in the management of oral cancer. Many agents have been evaluated as possible chemopreventive agents including vitamin A and retinoids, betacarotene, vitamin E and dietary agents. Recently, molecularly targeted approach has generated interest among researchers worldwide which includes cyclooxygenase-2 (COX-2) inhibitors, EGFR inhibitors and adenovirus vectors. This article reviews the various aspects of chemoprevention and describes important chemopreventive agents and design of chemopreventive trials.

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Randomized Trial of Antioxidant Vitamins to Prevent Acute Adverse Effects of Radiation Therapy in Head and Neck Cancer Patients

Abstract: Supplementation with high doses of alpha-tocopherol and beta-carotene during radiation therapy could reduce the severity of treatment adverse effects. However, this trial suggests that use of high doses of antioxidants as adjuvant therapy might compromise radiation treatment efficacy.

Cited by 226 publications

References 27 publications

Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long‐term effects on recurrence and mortality: A randomized trial among head and neck cancer patients

Interaction between antioxidant vitamin supplementation and cigarette smoking during radiation therapy in relation to long‐term effects on recurrence and mortality: A randomized trial among head and neck cancer patients

Dietary Supplement Use in Cancer Care: Help or Harm

Chemoprevention of Oral Cancer

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