A New Model for Predicting Acute Mucosal Toxicity in Head-and-Neck Cancer Patients Undergoing Radiotherapy With Altered Schedules

Strigari, Lidia; Pedicini, P.; D’Andrea, M.; Pinnarò, Paola; Marucci, Laura; Giordano, Carolina; Benassi, Marcello

doi:10.1016/j.ijrobp.2012.02.004

Cited by 28 publications

(39 citation statements)

References 18 publications

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“…Some comprehensive investigations, which have been done on the hypofractionation effect for the prostate carcinoma predicted α/β values ranges from 1.5 Gy to 8.5 Gy with 1 Gy interval according to the modern radiobiological model (30). Those research findings indicated an α/β value of 5 Gy for late complications for both rectum and bladder as the organs at risk (OARs).…”

Section: Contrast Between Hypofractionation and Standard Fractionationmentioning

confidence: 99%

“…multiple fractions per day), the therapy dose does not allow for rapidly dividing cells such as mucosal cells to repopulate themselves, which have been killed by the radiation (5,28,29). A technique, which could be used for a hypofractionated regimen is to convert the dose received by the mucosal cells that could be equal to the tumor prescribed dose, or to a 2 Gy equivalent dose (EQD2-Gy), applying an α/β = 10 Gy value and afterward see if it is within the 'safe' limit for the total treatment time (30).…”

Section: Radical Alteration Of Hypofractionation Criterionmentioning

confidence: 99%

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Effect of Hypofractionation on Prostate Cancer Radiotherapy

Arabpour

Shahbazi‐Gahrouei

2017

Int J Cancer Manag

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Context: Prior research over the past few decades has shown that the hypofractionated external beam radiation therapy could be a valuable method with an outstanding potential to treat the prostate cancer. The alpha-beta ratio (α/β) is an indication of the fractionation sensitivity of a particular cell type. Values of α/β ≥ 10 Gy are responsible for early-responding normal tissues and most tumors, while values of α/β < 5 Gy are for late-responding normal tissues. The α/β ratio could be raised by either a local tumor control increase or a decrease of normal tissue late effects through the application of an unconventional fractionation schedules. Evidence Acquisition: This review article aimed to investigation the details of radiobiological and clinical trials which are reported to highlight the characteristics of hypofractionation for the prostate cancer treatment based on the investigation of clinical results from hypofractionated treatments. Results:With the sufficient radiobiological and physiological research studies, it may be claimed that if α/β value for prostate cancer is less than the adjacent surrounding organs at risk and by applying fewer and larger fractions; a better therapeutic ratio can be achieved for the patient. Conclusions: Radiobiological modeling can play a major role in the design of new protocols. Also, one should be aware that in modeling the hypofractionated treatment, normal tissue iso-effects are significantly important and some assumptions needed to be made regarding α/β values for the critical normal tissue complication endpoint.

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Section: Contrast Between Hypofractionation and Standard Fractionationmentioning

confidence: 99%

Section: Radical Alteration Of Hypofractionation Criterionmentioning

confidence: 99%

Effect of Hypofractionation on Prostate Cancer Radiotherapy

Arabpour

Shahbazi‐Gahrouei

2017

Int J Cancer Manag

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“…In Eqs. (1) and (2), the incomplete repair has not been included because it modifies BED/EQD 2 by a few percentage points (Strigari et al, 2012).…”

Section: Radiobiological Modelsmentioning

confidence: 99%

Efficacy and mucosal toxicity of concomitant chemo-radiotherapy in patients with locally-advanced squamous cell carcinoma of the head-and-neck in the light of a novel mathematical model

Strigari

Pinnarò²,

Carlini³

et al. 2016

Critical Reviews in Oncology/Hematology

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Background: In the last several decades, combined radiotherapy (RT) and chemotherapy (CT) have beenrecognized as feasible in locally-advanced-squamous-cell-carcinoma of the head-and-neck (LA-HNSCC).Several meta-analyses identified concurrent RT + CT (CRT) most likely effective approach respect toRT-alone. However, radiobiological models comparing different chemotherapeutic schedules againstdelivered RT fractionation schedule for overall survival and toxicity are still needed.Methods and materials: Based on 9 randomized trials (2785 patients), radiobiological models andmultivariate logistic regression model were used to derive dose-response curves and estimate the 5-year-overall survival (OS) and ≥G3 acute mucositis rate of CRT or RT-alone.Results: Equivalent dose at 2 Gy/fraction (EQD2) was calculated using the linear quadratic model. Theeffect of CRT schedules, considering the CT type and its administration schedule and the HPV status oftumors were estimated using the univariate/multivariate logistic regression. The multivariate logisticregression model for 5y-OS indicated EQD2 and the type of CT, the chemo-sensitization fraction and theHPV status significant prognostic factors, while for toxicity both EQD2 and the concomitant adminis-tration of 5-fluorouracil (5Fu) resulted as significant prognostic factors. Combined schedules cisplatin(DDP)+/−5Fu + RT produced the higher OS compared with combined carboplatin+/−5Fu + RT or RT-alone

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“…in which the sine function argument is specified in radians, and T is defined as the total radiotherapy duration including both the first and last days of treatment [2], which is 1 day longer than the definition of duration used in the other two tolerance models [3,4] [2]); consequently, the tolerance boundary was defined only up to 50 days duration in Eq. (10) of our article.…”

Section: To the Editormentioning

confidence: 99%

“…

We read with interest a recent article in Tumor Biology [1], in which Meade et al helpfully compared the mucosal tolerability of several concurrent chemo-radiation schedules used to treat head-and-neck squamous cell carcinoma (HNSCC) with the predictions of three tolerance models developed for radiation-only schedules [2][3][4]. Meade et al added estimates of the radiation-equivalent biologically effective doses for cell kill contributed by the chemotherapy components of the various schedules (BED ck-chemo ) to the BEDs contributed by radiation alone (BED ck-RT ), thereby generating total BED values (BED ck-tot ) which were compared with durationspecific tolerance ceilings specified by the three models.

…”

mentioning

confidence: 99%

Letter regarding Meade et al. entitled “Models of acute mucosal tolerance to radiotherapy alone applied to synchronous chemo-radiation schedules in head and neck cancer”

et al. 2014

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We read with interest a recent article in Tumor Biology [1], in which Meade et al. helpfully compared the mucosal tolerability of several concurrent chemo-radiation schedules used to treat head-and-neck squamous cell carcinoma (HNSCC) with the predictions of three tolerance models developed for radiation-only schedules [2][3][4]. Meade et al. added estimates of the radiation-equivalent biologically effective doses for cell kill contributed by the chemotherapy components of the various schedules (BED ck-chemo ) to the BEDs contributed by radiation alone (BED ck-RT ), thereby generating total BED values (BED ck-tot ) which were compared with durationspecific tolerance ceilings specified by the three models. The study concluded that this BED-summation approach was useful but that the tolerance ceilings may need further adjustment in the chemo-radiation setting and noted that an accelerated schedule used in the RTOG 0129 study [5] was predicted to be intolerable by all three models, despite current indications that it may be tolerable.We were a little surprised that our tolerance ceiling model (denoted by Meade et al. as Fen BED ck ) did not correctly predict the tolerance of the accelerated RTOG 0129 schedule, since we had fitted the model to a large radiation-only dataset using discriminant analysis [2], and Meade and colleagues very carefully obtained a BED ck-tot value for the delivered schedule, by adding to its radiation-only BED ck-RT dose a BED ck-chemo value of 2.9 Gy 10 individually estimated for the chemotherapy regimen used in the schedule.

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A New Model for Predicting Acute Mucosal Toxicity in Head-and-Neck Cancer Patients Undergoing Radiotherapy With Altered Schedules

Cited by 28 publications

References 18 publications

Effect of Hypofractionation on Prostate Cancer Radiotherapy

Effect of Hypofractionation on Prostate Cancer Radiotherapy

Efficacy and mucosal toxicity of concomitant chemo-radiotherapy in patients with locally-advanced squamous cell carcinoma of the head-and-neck in the light of a novel mathematical model

Letter regarding Meade et al. entitled “Models of acute mucosal tolerance to radiotherapy alone applied to synchronous chemo-radiation schedules in head and neck cancer”

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