Total Mucosal Irradiation with Intensity-modulated Radiotherapy in Patients with Head and Neck Carcinoma of Unknown Primary: A Pooled Analysis of Two Prospective Studies

Richards, Thomas M.; Bhide, Shreerang A.; Miah, Aisha; Rosario, Lyra Del; Bodla, Shankar; Thway, Khin; Gujral, Dorothy M.; Rooney, Keith; Schick, Ulrike; McGovern, T.; Grove, Lorna; Newbold, Kate; Harrington, Kevin; Nutting, Christopher M.

doi:10.1016/j.clon.2016.04.035

Cited by 31 publications

(26 citation statements)

References 28 publications

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“…IMRT techniques could spare patients from extensive toxicity . A moderate dose, such as 54 Gy, may also be sufficient for mucosal control, but 54Gy dose were delivered to the total mucosal regions for consideration of acute toxicities. This study showed the mucosal control rate of 100% with acceptable toxicities, indicating such approach is feasible.…”

Section: Discussionmentioning

confidence: 99%

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

Dou

Zhang

et al. 2020

Cancer Medicine

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Objective Controversy still exists regarding the volume of radiation for head and neck cancer of unknown primary (HNCUP). Theoretically, elective mucosal irradiation (EMI) should achieve a balance between survival and toxicity. This prospective study was conducted to evaluate the long‐term benefit of EMI in Chinese HNCUP patients. Methods A phase II, single‐arm trial was performed at two centers in China. HNCUP patients with pathologically confirmed metastatic squamous cell carcinoma or poorly differentiated carcinoma were enrolled. Patients with metastatic lymph nodes limited to level IV and/or the supraclavicular fossa were excluded. The EMI approach was specifically customized to Chinese patients by differentiating HNCUP as putative nasopharyngeal carcinoma (NPC) or non‐putative NPC. The primary endpoint was 3‐year mucosal recurrence‐free survival (MRFS). Results A total of 48 patients were enrolled between 02/02/2010 and 08/01/2018; 46 patients were analyzed, including 24 putative NPC and 22 non‐putative NPC patients. No primary recurrence was observed during a median follow‐up period of 70 months, and only 1 patient experienced out of field recurrence in the contralateral neck. The 3‐year MRFS was 90.6% (95%CI: 76.4%‐96.4%). The 5‐year MRFS, regional‐recurrence free survival (RRFS) and overall survival (OS) were 90.6% (95%CI: 76.4%‐96.4%), 86.0% (95%CI: 71.1%‐93.7%), and 90.6% (95%CI: 76.4%‐96.4%), respectively. No grade 4 acute or late toxicities occurred, and the most frequent grade 3 acute toxicity was oral mucositis (45.7%). Conclusion To the best of our knowledge, this is the first prospective study to evaluate the long‐term outcomes of EMI in Chinese HNCUP patients. Excellent MRFS and OS rates were observed. Further randomized studies are warranted.

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Section: Discussionmentioning

confidence: 99%

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

Dou

Zhang

et al. 2020

Cancer Medicine

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“…Considering the low median mucosal recurrence rate following comprehensive radiotherapy of 9.5%, Cuaron et al proposed ongoing consideration of mucosal structure sparing and dose lowering. Moreover, in Richards et al head and neck CUP cohort, all 36 patients were treated with IMRT and received 54 Gy to the mucosa at 1.8 Gy per fraction . They not only reported OS and locoregional control rates similar to other studies that included lower mucosal doses, but also demonstrated rates comparable to studies with higher doses, suggesting that dose reduction does not compromise outcome.…”

Section: Discussionmentioning

confidence: 86%

“…This rate was found to be three times higher (15%) in patients treated with IMRT without laryngeal sparing in Chen et al's study of 51 head and neck CUP patients (53% IMRT, 59% chemotherapy) . Richards et al report a median PEG tube duration of 35 days (range 22‐804 days) for the 28.7% of patients who ultimately required tube placement . Lu et al and Mourad et al found significantly lower rates of stricture in their head and neck CUP cohorts, for which a larynx‐sparing approach was used.…”

Section: Discussionmentioning

confidence: 97%

“…Sixty‐two percent of patients required a PEG tube, the median duration of which was 5.6 months (range 2.3‐14.5 months) . In a study of 36 head and neck CUP patients treated with IMRT and 53% with chemotherapy, Richards et al also report a 5% stricture rate in the context of no laryngeal sparing . This rate was found to be three times higher (15%) in patients treated with IMRT without laryngeal sparing in Chen et al's study of 51 head and neck CUP patients (53% IMRT, 59% chemotherapy) .…”

Section: Discussionmentioning

confidence: 98%

“…More recently, Cuaron et al from the Memorial Sloan‐Kettering Cancer Center showed a 2‐year OS rate of 81.3%, and locoregional control rate of 86.4% . Richards et al of Royal Marsden Hospital in the United Kingdom further reported 2‐year OS and locoregional control rates of 81.3% and 89.8%, respectively …”

Section: Discussionmentioning

confidence: 99%

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IMRT‐based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

et al. 2019

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Background Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods Retrospective analysis of 58 patients with head and neck CUP treated with intensity‐modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx‐sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion In this single institution study, a 56 Gy IMRT‐based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx‐sparing IMRT.

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Outcomes of patients diagnosed with carcinoma metastatic to the neck from an unknown primary source and treated with intensity‐modulated radiation therapy

Kamal

Mohamed

Fuller

et al. 2018

Cancer

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Total Mucosal Irradiation with Intensity-modulated Radiotherapy in Patients with Head and Neck Carcinoma of Unknown Primary: A Pooled Analysis of Two Prospective Studies

Abstract: At a median follow-up of 36.1 months, the use of TM-IMRT was associated with good local control. Toxicity was comparable with previously reported TM-IMRT regimens encompassing similar mucosal volumes.

Cited by 31 publications

References 28 publications

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

Long‐term results of elective mucosal irradiation for head and neck cancer of unknown primary in Chinese population: The EMICUP study

IMRT‐based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

Outcomes of patients diagnosed with carcinoma metastatic to the neck from an unknown primary source and treated with intensity‐modulated radiation therapy

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