Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

Clavel, S.; Nguyen, David; Fortin, B.; Després, Philippe; Khaouam, Nader; Donath, David; Soulières, Denis; Guertin, Louis; Nguyen-Tân, Phuc Félix

doi:10.1016/j.ijrobp.2010.10.061

Cited by 49 publications

(61 citation statements)

References 23 publications

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“…This may also imply the occurrence of salivary tissue regeneration. These improved XeQOLS scores may, however, also be explained by the possible natural recovery of salivary function after parotid sparing radiation techniques as suggested in a previous study 41 . The randomized phase III component of this study will help to define the full efficacy of ALTENS treatment in alleviating radiation-induced xerostomia.…”

Section: Discussionmentioning

confidence: 69%

Phase 2 results from Radiation Therapy Oncology Group Study 0537

Wong

James

Sagar

et al. 2012

Cancer

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Purpose This phase II component of a multi-institutional phase II/III randomized trial assessed the feasibility and preliminary efficacy of acupuncture-like transcutaneous electrical nerve stimulation (ALTENS) in reducing radiation-induced xerostomia. Methods Head and neck cancer patients who were 3–24 months from completing radiotherapy ± chemotherapy (RT±C) and experiencing xerostomia symptoms with basal whole saliva production ≥0.1 ml/min and without recurrence were eligible. Patients received twice weekly ALTENS sessions (24 over 12 weeks) using a Codetron™ unit. The primary objective assessed the feasibility of ALTENS treatment. A patient was considered compliant if 19/24 ALTENS were delivered, with a targeted 85% compliance rate. Secondary objectives measured treatment-related toxicities and ALTENS effect on overall radiation-induced xerostomia burden using the University of Michigan Xerostomia-Related Quality of Life Scale (XeQOLS). Results Of 48 accrued patients, 47 were evaluable. Median age was 60 years; 84% were male, 70% completed RT±C for > 12 months and 21% had received prior pilocarpine. All ALTENS sessions were completed in 34 patients, but 9 and 1 completed 20–23 and 19 sessions respectively, representing a 94% total compliance rate. 6-month XeQOLS scores were available for 35 patients; 30 (86%) achieved a positive treatment response with a mean reduction of 35.9% (SD 36.1). Five patients developed grade 1–2 gastrointestinal toxicity and one had grade 1 pain event. Conclusions ALTENS treatment for radiation-induced xerostomia can be uniformly delivered in a cooperative multicenter setting and has possible beneficial treatment response. Given these results, the phase III component of this study was initiated.

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Section: Discussionmentioning

confidence: 69%

Phase 2 results from Radiation Therapy Oncology Group Study 0537

Wong

James

Sagar

et al. 2012

Cancer

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“…Several studies in the literature have reported favourable treatment outcomes for patients treated with IMRT technique [8, 9, 24, 25, 28–30, 32, 34, 37, 41, 45]. Comparable rates of LRC are observed in Table 1 among the published studies for different radiotherapy techniques as also comparable survival rates.…”

Section: Discussionmentioning

confidence: 85%

“…The published clinical results demonstrate equivalence or noninferiority of IMRT in terms of tumor control or survival in any head and neck site [8–10, 20, 21, 23] while IMRT plays a significant role on the reduction of radiation-induced toxicity [8, 9, 12, 18, 20–23]. According to the published data as shown in Table 3, it seems that IMRT reduces late xerostomia down to 2.3%.…”

Section: Discussionmentioning

confidence: 99%

“…In the case of late toxicity, the most common characteristic is xerostomia where the considerable reduction of saliva leads to persistent dryness of mouth, oral discomfort, sore throat, dental decay, difficulty in speech, taste alteration, and impairment of chewing and swallowing functions which can lead to nutritional depletion and weight loss [13–16]. According to the published results, IMRT technique improves the toxicity profiles without compromising the efficacy [9, 12, 17–19]. The reduction of acute and late toxicities [8, 9, 12, 18, 20–22] in conjunction with comparable or superior treatment outcomes [8–10, 20, 21, 23] increases the necessity of IMRT technique for the treatment of head and neck carcinomas.…”

Section: Introductionmentioning

confidence: 99%

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The Treatment Outcome and Radiation-Induced Toxicity for Patients with Head and Neck Carcinoma in the IMRT Era: A Systematic Review with Dosimetric and Clinical Parameters

Kouloulias

Thalassinou

Platoni

et al. 2013

BioMed Research International

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A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70–97%) and 74.4 (range: 61–82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.

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“…On the other hand, few studies reported significant differences in survival rates between the two RT techniques. Clavel et al [21] compared the treatment outcomes of 249 oropharyngeal cancer patients treated by conventional RT (149 patients) and IMRT (100 patients), and reported significantly improved 3-year overall survival (p < 0.001) and disease-free survival (p = 0.001) in patients treated by IMRT. In addition, Chao et al [26] reported significantly improved 2-year disease-free (p = 0.002) and overall survival (p = 0.001) in oropharyngeal cancer patients treated by IMRT (12 patients) compared with patients treated by conventional RT (153 patients).…”

Section: Discussionmentioning

confidence: 99%

Comparison of survival rates between patients treated with conventional radiotherapy and helical tomotherapy for head and neck cancer

et al. 2013

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PurposeCompared to conventional radiotherapy (RT), intensity-modulated radiotherapy (IMRT) significantly reduces the rate of treatment-induced late toxicities in head and neck cancer. However, a clear survival benefit of IMRT over conventional RT has not yet been shown. This study is among the first comparative study to compare the survival rates between conventional RT and helical tomotherapy in head and neck cancer.Materials and MethodsFrom January 2008 to November 2011, 37 patients received conventional RT and 30 patients received helical tomotherapy for management of head and neck cancer. We retrospectively compared the survival rates between patients treated with conventional RT and helical tomotherapy, and analyzed the prognostic factors for survival.ResultsThe 1- and 2-year locoregional recurrence-free survival rates were 61.2% and 58.1% for the conventional RT group, 89.3% and 80.3% for the helical tomotherapy group, respectively. The locoregional recurrence-free survival rates of the helical tomotherapy group were significantly higher than conventional RT group (p = 0.029). There were no significant differences in the overall and distant metastasis-free survival between the two groups. RT technique, tumor stage, and RT duration were significant prognostic factors for locoregional recurrence-free survival.ConclusionThis study showed the locoregional recurrence-free survival benefits of helical tomotherapy in the treatment of head and neck cancers.

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Simultaneous Integrated Boost Using Intensity-Modulated Radiotherapy Compared With Conventional Radiotherapy in Patients Treated With Concurrent Carboplatin and 5-Fluorouracil for Locally Advanced Oropharyngeal Carcinoma

Cited by 49 publications

References 23 publications

Phase 2 results from Radiation Therapy Oncology Group Study 0537

Phase 2 results from Radiation Therapy Oncology Group Study 0537

The Treatment Outcome and Radiation-Induced Toxicity for Patients with Head and Neck Carcinoma in the IMRT Era: A Systematic Review with Dosimetric and Clinical Parameters

Comparison of survival rates between patients treated with conventional radiotherapy and helical tomotherapy for head and neck cancer

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