Swallowing sparing intensity modulated radiotherapy versus standard parotid sparing intensity-modulated radiotherapy for treatment of head and neck cancer: a randomized clinical trial

Ashour, May Gamal; Shouman, Tarek Hamed; Hassouna, A.; Mokhtar, Maha H.; Din, Reem Emad El; Youssef, Ayda; Gomaa, Mohammed; Abdalgeleel, Shaimaa Abdalaleem

doi:10.1080/0284186x.2021.2022198

Cited by 10 publications

(6 citation statements)

References 28 publications

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“…These results were confirmed by a retrospective study by Ashour et al. ( 21 ). The findings from these studies collectively suggested that increasing the dose of postoperative adjuvant radiation did not proportionally improve the local control rate.…”

Section: Discussionsupporting

confidence: 74%

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Tao,

Wei,

Shen

et al. 2023

Front. Oncol.

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BackgroundWe conducted a comparative analysis between low and high-dose postoperative radiotherapy in patients with hypopharyngeal squamous cell carcinoma (HPSCC) in stage III or IV without positive surgical margins and extracapsular extension (ECE). Propensity score matching (PSM) was used to eliminate confounding factors and reduce bias.MethodsThe matched-pair analysis included 156 patients divided into two groups: the low-dose radiotherapy group (LD-RT 50 Gy, 78 cases) and the high-dose radiotherapy group (HD-RT 60 Gy, 78 cases). Both cohorts were statistically comparable in terms of age, gender, subsite, and TNM classification.ResultsThe median follow-up time was 49 months (ranging from 5 to 100 months). The overall survival (OS) rate, progression-free survival (PFS) rate, locoregional control rate (87% vs. 85.7%; p = 0.754), distant metastases-free survival (79.2% vs. 76.6%; p = 0.506), and the occurrence of second primary tumors (96.1% vs. 93.5%; p = 0.347) showed no significant differences between the LD-RT group and the HD-RT group. The 3-year OS was 64.9% and 61% in the low-dose and high-dose group, respectively, and 63% in the entire group (p = 0.547). The 3-year PFS was 63.6% and 54.5% (p = 0.250), respectively, and the 3-year PFS of the entire group was 59.1%. Multivariate analyses revealed that pathological T and N classification, and pathological differentiation were associated with 3-year OS, PFS, and LRFS and were independent prognostic factors (p < 0.05). LD-RT was not associated with an increased risk of death and disease progression compared to HD-RT.ConclusionThe results of postoperative low-dose radiotherapy did not show inferiority to those of high-dose radiation for patients with advanced hypopharyngeal cancer without positive surgical margins and ECE in terms of OS, PFS, locoregional control, and metastases-free survival.

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Section: Discussionsupporting

confidence: 74%

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Tao,

Wei,

Shen

et al. 2023

Front. Oncol.

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“…Specifically, irradiation of the pharyngeal constrictor muscles has been demonstrated to be associated with long-term swallowing defects. Moreover, the so-called dysphagia-aspiration-at-risk structures (DARS – constrictor muscles, glottic and SG larynx), as well as muscle-based SFU can also have an impact on reducing radiation-related dysphagia 6 , 15 , 22 , 23 . Accordingly, minimising the absorbed dose to the above-mentioned structures may theoretically reduce long-term dysphagia and aspiration.…”

Section: Discussionmentioning

confidence: 99%

“…advanced nasopharyngeal tumours) along with a lower prevalence of long-term side effects (e.g. xerostomia and dysphagia) [3][4][5][6] . Therefore, IMRT is currently considered the gold standard for several HN subsites 7 .…”

Section: Introductionmentioning

confidence: 99%

Post-operative intensity-modulated vs 3D conformal radiotherapy after conservative surgery for laryngeal tumours of the supraglottic region: a dosimetric analysis on 20 patients

Alterio,

Marani,

Vigorito

et al. 2024

Acta Otorhinolaryngol Ital

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“…Given the prevalence and distressing nature of dysphagia during CCRT, DO-IMRT seeks to spare organs related to swallowing, and thus reduce dysfunction [33]. DO-IMRT is associated with an improvement in patient-reported swallowing function at 12 months and beyond [33,34]. Given the complications associated with enteral feeding in patients with diabetes receiving CCRT, sparing the organs related to swallowing function in this population is a promising approach, though currently DO-IMRT has not demonstrated a significant improvement over standard IMRT in acute dysphagia or feeding tube use [33,34].…”

Section: Discussionmentioning

confidence: 99%

Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer

Mellor,

Girgis,

Rodrigues

et al. 2024

Current Oncology

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Patients with cancer and diabetes face unique challenges. Limited data are available on diabetes management in patients undergoing concurrent chemoradiotherapy (CCRT), a curative intent anticancer therapy commonly associated with glucocorticoid administration, weight fluctuations and enteral feeds. This retrospective case–control study examined the real-world incidence of acute diabetes-related complications in patients with head and neck cancer receiving CCRT, along with the impact of diabetes on CCRT tolerance and outcomes. Methods: Consecutive patients with head and neck squamous cell or nasopharyngeal cancer who underwent definitive or adjuvant CCRT between 2010 and 2019 at two large cancer centers in Australia were included. Clinicopathological characteristics, treatment complications and outcomes were collected from medical records. Results: Of 282 patients who received CCRT, 29 (10.3%) had pre-existing type 2 diabetes. None had type 1 diabetes. The majority (74.5%) required enteral feeding. A higher proportion of patients with diabetes required admission to a high-dependency or intensive care unit (17.2 versus 4.0%, p = 0.003). This difference was driven by the group who required insulin at baseline (n = 5), of which four (80.0%) were admitted to a high-dependency unit with diabetes-related complications, and three (60.0%) required omission of at least one cycle of chemotherapy. Conclusions: Patients with diabetes requiring insulin have a high risk of acute life-threatening diabetes-related complications while receiving CCRT. We recommend multidisciplinary management involving a diabetes specialist, educator, dietitian, and pharmacist, in collaboration with the cancer care team, to better avoid these complications.

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Swallowing sparing intensity modulated radiotherapy versus standard parotid sparing intensity-modulated radiotherapy for treatment of head and neck cancer: a randomized clinical trial

Cited by 10 publications

References 28 publications

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Matched-pair analysis of the impact of low-dose postoperative radiotherapy on prognosis in patients with advanced hypopharyngeal squamous cell carcinoma without positive surgical margins and extracapsular extension

Post-operative intensity-modulated vs 3D conformal radiotherapy after conservative surgery for laryngeal tumours of the supraglottic region: a dosimetric analysis on 20 patients

Acute Diabetes-Related Complications in Patients Receiving Chemoradiotherapy for Head and Neck Cancer

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