Accelerated hyperfractionated irradiation for advanced head and neck cancer: Effect of shortening the median treatment duration by 13 days

Leborgne, Félix; Leborgne, José H.; Fowler, Jack F.; Zubizarreta, Eduardo; Mezzera, Julieta

doi:10.1002/hed.1093

Cited by 16 publications

(17 citation statements)

References 29 publications

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“…This was achieved by gradually reducing the gap to zero, using a slight modification of this BED formula and deciding near the end of each patient's treatment whether to add one or two fractions of 1.6 Gy, or instead to wait a day before adding another one or two fractions or none. The improved results were published in 2001 [30] and showed with 1007 H&N patients an increase at five years of 19% LRC for T3-4 patients treated b.i.d. over 40 days compared with their previous 5F per week schedule which was a median length of 13 days longer.…”

Section: Small Encouraging Stepsmentioning

confidence: 96%

“…This was confirmed by the five published schedules in Table 3. The fifth schedule shows the RTOG ''hyperfractination with a gap'', after the gap had been gradually reduced to zero by Leborgne et al's [30] careful testing of Equation (1). This was a major test of the BED concept at the time, starting in the mid-1990s.…”

Section: Late Complications Gy 3 Beds Were Not the Limiting Constraintmentioning

confidence: 99%

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21 years of Biologically Effective Dose

Fowler¹

2010

BJR

533

448

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ABSTRACT. In 1989 the British Journal of Radiology published a review proposing the term biologically effective dose (BED), based on linear quadratic cell survival in radiobiology. It aimed to indicate quantitatively the biological effect of any radiotherapy treatment, taking account of changes in dose-per-fraction or dose rate, total dose and (the new factor) overall time. How has it done so far? Acceptable clinical results have been generally reported using BED, and it is in increasing use, although sometimes mistaken for ''biologically equivalent dose'', from which it differs by large factors, as explained here. The continuously bending nature of the linear quadratic curve has been questioned but BED has worked well for comparing treatments in many modalities, including some with large fractions. Two important improvements occurred in the BED formula. First, in 1999, high linear energy transfer (LET) radiation was included; second, in 2003, when time parameters for acute mucosal tolerance were proposed, optimum overall times could then be ''triangulated'' to optimise tumour BED and cell kill. This occurs only when both early and late BEDs meet their full constraints simultaneously. New methods of dose delivery (intensity modulated radiation therapy, stereotactic body radiation therapy, protons, tomotherapy, rapid arc and cyberknife) use a few large fractions and obviously oppose well-known fractionation schedules. Careful biological modelling is required to balance the differing trends of fraction size and local dose gradient, as explained in the discussion ''How Fractionation Really Works''. BED is now used for dose escalation studies, radiochemotherapy, brachytherapy, high-LET particle beams, radionuclide-targeted therapy, and for quantifying any treatments using ionising radiation.

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Section: Small Encouraging Stepsmentioning

confidence: 96%

Section: Late Complications Gy 3 Beds Were Not the Limiting Constraintmentioning

confidence: 99%

21 years of Biologically Effective Dose

Fowler¹

2010

BJR

533

448

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“…Clinical results, even for some non-standard scenarios (hyperfractionation [5], high-vs. low dose-rate brachytherapy [6], prostate hypofractionation [7]) were consistent with LQ predictions. In contrast to earlier approaches [8][9][10], there have been no major failures.…”

mentioning

confidence: 96%

High-dose and fractionation effects in stereotactic radiation therapy: Analysis of tumor control data from 2965 patients

Shuryak¹,

Carlson²,

Brown³

et al. 2015

Radiotherapy and Oncology

116

107

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“…Especially in head and neck cancer, good clinical evidence exists for improved tumor control rates and survival by accelerated fractionation schedules [13,17]. These altered fractionation schemes seem to yield higher LCRs also in case of parameningeal rhabdomyosarcoma [16].…”

Section: Altered Fractionation Schemesmentioning

confidence: 99%