Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era

Gupta, Tejpal; Ghosh‐Laskar, Sarbani; Agarwal, Jai Prakash

doi:10.1016/j.oraloncology.2020.105045

Cited by 14 publications

(13 citation statements)

References 37 publications

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“…The 55 Gy at 2.75 Gy per fraction scheme over 4 weeks has also been proposed for other types of H&N cancer in several studies (14,(37)(38)(39)(40)(41)(42). In these studies, the mean age is <60 years, and specific references on elderly patients are not discussed in details However, these studies showed an overall good tolerability and could enhance elderly patients' compliance by reducing the number of needed accesses to the radiotherapy facility.…”

Section: Discussionmentioning

confidence: 99%

“…The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) outbreak has renewed the interest in HFRT, in general, and for locally advanced H&N cancer, in particular, thanks to the reduction in the risk of getting exposed to the virus by reducing the number of visits to the hospital and the interaction with healthcare professionals ( 14 , 15 ).…”

Section: Introductionmentioning

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: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

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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“…This should be considered when designing new multimodal tumor therapies with adapted RT protocols [40]. However, as current studies are carried out with rather small patient cohorts and little is known about long-term effects, especially with regard to normal tissue tolerance [38], additional preclinical research in this area is needed.…”

Section: Icos-l Shows Significantly Enhanced Surface Expression After 5x30gy Only In Hpv-positive Hnscc Cell Linesmentioning

confidence: 99%

“…In recent years, as more and more inhabitants of middle-to low-income countries have been shown to suffer from tumors of the head and neck area, calculations predict that 50% of patients will not be able to gain timely access to therapies while additional resource constraints apply, and thus altered fractionation schemes have been moved even more into the focus of researchers and clinicians. Therefore, an increasing number of studies evaluate hypofractionated-accelerated fractionation schemes also for HNSCC patients [38]. However, as these forms of treatment stretch the tolerance of normal tissue responses, it is important to closely look into these limitations.…”

Section: Introductionmentioning

confidence: 99%

“…In this matter, there are an increasing number of studies, e.g., the multicentric trial of hypo-vs normo-fractionated RT in HNSCC, HYPNO (NCT0765503) study, applying 55Gy in 20 fractions and 4 weeks, addressing these questions. So far, no significant disadvantages in terms of local control, overall survival and quality of life have been found [38,39], and there is evidence that intensifying the treatment by either altering RT fractions or adding concurrent therapies might even improve the outcome in patients [38]. The optimal radiation dose and fractionation for combination of RT with ICM still has to be identified [40].…”

Section: Introductionmentioning

confidence: 99%

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Hypofractionated Radiotherapy Upregulates Several Immune Checkpoint Molecules in Head and Neck Squamous Cell Carcinoma Cells Independently of the HPV Status While ICOS-L Is Upregulated Only on HPV-Positive Cells

Wimmer¹,

Deloch²,

Häder³

et al. 2021

IJMS

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While the treatment of squamous cell carcinoma of the head and neck (HNSCC) with radiotherapy (RT) is complemented more and more by immunotherapy in clinical trials, little is known about the impact of the human papillomavirus (HPV) status or the applied RT scheme on the immune phenotype of the tumor cells. Therefore, we aimed to examine the impact of the HPV status of four human HNSCC cell lines on cell death and the expression of immune checkpoint molecules (ICMs) after RT with either hypofractionation irradiation (5x3.0Gy) or a high single dose (1x19.3Gy) via multicolor flow cytometry and quantitative PCR at an early time point after therapy. In our study, 5x3.0Gy RT induced high numbers of early and late apoptotic cells independent of the HPV status, but necrosis was only increased in the HPV-positive UM-Scc-47 cells. Generally, the immune stimulatory ICMs (CD70, CD137-L, ICOS-L) were less affected by RT compared to the immune suppressive ones (PD-L1, PD-L2, and the herpesvirus entry mediator (HVEM)). A significant higher surface expression of the analyzed ICMs was found after hypofractionated RT compared to a single high dose; however, regardless of the HPV status, with the exception of ICOS-L. Here, HPV-positive HNSCC tumor cells showed a stronger response to 5x3.0Gy than HPV-negative ones. On the RNA level, only minor alterations of ICMs were observed following RT, with the exception of the HPV negative cell line CAL33 treated with 5x3.0Gy, where PD-L2, HVEM and CD70 were significantly increased. We conclude that the HPV status may not distinctly predict immunological responses following RT, and thus cannot be used as a single predictive marker for therapy responses in HNSCC. In contrast, the patient-specific individual expression of ICMs following RT is preferable for the targeted patient selection for immune therapy directed against distinct ICM.

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Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

Piras¹,

Venuti

D’Aviero³

et al. 2022

Clin Transl Imaging

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Introduction Following the Covid-19 pandemic spread, changes in clinical practice were necessary to limit the pandemic diffusion. Also, oncological practice has undergone changes with radiotherapy (RT) treatments playing a key role. Although several experiences have been published, the aim of this review is to summarize the current evidence after 2 years of pandemic to provide useful conclusions for clinicians. Methods A Pubmed/MEDLINE and Embase systematic review was conducted. The search strategy was “Covid AND Radiotherapy” and only original articles in the English language were considered. Results A total of 2.733 papers were obtained using the mentioned search strategy. After the complete selection process, a total of 281 papers were considered eligible for the analysis of the results. Discussion RT has played a key role in Covid-19 pandemic as it has proved more resilient than surgery and chemotherapy. The impact of the accelerated use of hypofractionated RT and telemedicine will make these strategies central also in the post-pandemic period.

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Resource-sparing curative-intent hypofractionated-accelerated radiotherapy in head and neck cancer: More relevant than ever before in the COVID era

Cited by 14 publications

References 37 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

Hypofractionated Radiotherapy Upregulates Several Immune Checkpoint Molecules in Head and Neck Squamous Cell Carcinoma Cells Independently of the HPV Status While ICOS-L Is Upregulated Only on HPV-Positive Cells

Covid-19 and radiotherapy: a systematic review after 2 years of pandemic

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