Helical Tomotherapy in Head and Neck Cancer: A European Single-Center Experience

Abstract

Background. We report on a retrospective analysis of 147 patients with early and locoregionally advanced squamous cell head and neck cancer (SCCHN) treated with helical tomotherapy (HT). Patients and Methods. Included were patients with SCCHN of the oral cavity (OC), oropharynx (OP), hypopharynx (HP), or larynx (L) consecutively treated in one radiotherapy center in 2008 and 2009.The prescribed HT dose was 60-66 Gy in the postoperative setting (group A) and 66-70 Gy when given as primary treatment (group B). HT was given alone, concurrent with systemic therapy (ST), that is, chemotherapy, biotherapy, or both, and with or without induction therapy (IT). Acute and late toxicities are reportedusing standard criteria; locoregional failure/progression (LRF), distant metastases (DM), and second primary tumors (SPT) were documented, and event-free survival (EFS) and overall survival (OS) were calculated from the start of HT.

Dysphagia and related toxicity in patients with head and neck cancer receiving helical intensity modulated radiotherapy +/- chemotherapy: Implications for speech pathology management

“…Currently, the incidence of grade 2 xerostomia in the available H-IMRT literature ranges from 54-67% (Kong et al, 2013;Van Gestel et al, 2015), which is comparable to our rate of 72% for both groups. Dysphagia rates were also comparable to rates of grade 3 dysphagia reported as 45% (Van Gestel et al, 2015), and combined grade 2/3 at 80%.…”

“…Direct comparison of our results with previously reported H-IMRT data is problematic and limited due to the heterogeneous patient populations, the variability in the assessment and scoring of acute toxicities, limited numbers of toxicities studied, cohorts combining patients with and without concurrent chemotherapy and the manner in which results are presented (Goepfert, Yom, Ryan, & Cheung, 2015). Currently, the incidence of grade 2 xerostomia in the available H-IMRT literature ranges from 54-67% (Kong et al, 2013;Van Gestel et al, 2015), which is comparable to our rate of 72% for both groups. Dysphagia rates were also comparable to rates of grade 3 dysphagia reported as 45% (Van Gestel et al, 2015), and combined grade 2/3 at 80%.…”

“…A small number of retrospective studies and an even smaller number of prospective studies have reported outcomes for xerostomia, dysphagia, and mucositis only, generally as a maximum incidence. The incidence of acute grade 2 xerostomia in the available H-IMRT literature ranges from 10-67% (Hsieh et al, 2011;Kong, Hong, Choi, & Kim, 2013;Kreps et al, 2016;Van Gestel et al, 2015). A study by Kreps et al (2016) found H-IMRT reduced the incidence and severity of xerostomia due to reduced parotid gland doses and volumes, at 6 months, followed by an increase in values at 12 months for all salivary glands and a return to close to baseline values at 18 months for the parotid gland.…”

“…Rates of grade 2 dysphagia range widely from 11-70%, and grade 3 dysphagia ranged from 0-53% (Donato et al, 2013;Hsieh et al, 2014;Santa Cruz et al, 2018;Van Gestel et al, 2015), with a combined grade 2/3 report at 80% (Kong et al, 2013). One retrospective study found younger patients had higher rates of dysphagia, whilst older patients experienced worse xerostomia and pain (Santa Cruz et al, 2018).…”

“…One retrospective study found younger patients had higher rates of dysphagia, whilst older patients experienced worse xerostomia and pain (Santa Cruz et al, 2018). With regards to oral mucositis, the reported incidence of grade 3 mucositis also ranges widely from 0-76%, with the majority of reports greater than 50% (Chen et al, 2011;Donato et al, 2013;Kreps et al, 2016;Kruser et al, 2013;Santa Cruz et al, 2018;Shueng et al, 2010;Van Gestel et al, 2015). There are a smaller number of studies reporting results for grade 2 mucositis ranging from 30-90% (Donato et al, 2013;Kreps et al, 2016;Kruser et al, 2013;Shueng et al, 2010).…”