Accelerated versus conventional fractionation in the postoperative irradiation of locally advanced head and neck cancer: influence of tumour proliferation

Awwad, Hassan K.; Khafagy, Yassir; Barsoum, Mohsen Samy; Ezzat, Shahira Mohammed; Elattar, Inas; Farag, Hamid; Akoush, H.; Meabid, Hassan; Zaghloul, Mohamed S.

doi:10.1016/0167-8140(92)90245-p

Cited by 68 publications

(25 citation statements)

References 8 publications

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“…Furthermore, DFS and OS were negatively affected by ECE confirmed by histological examination. Similar observations have been reported by other authors [19,32,35,40,41,42]. Peters et al [17] support the significant effects of ECE on combined treatment outcomes.…”

Section: Discussionsupporting

confidence: 79%

“…Thus, many years of clinical experience clearly demonstrate that postoperative radiotherapy in patients with advanced laryngeal cancer is an effective treatment. Numerous literature reports confirm that the main predictive factors are related to intraoperative and histopathological evaluation of the surgical specimen [13,16,17,18,19,21,29,31,32,33,34,35,36,37,38,39,40].…”

Section: Discussionmentioning

confidence: 99%

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Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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The aim of the study was to assess the prognostic value of postoperative histopathological factors as well as the clinical usefulness of the modified risk score for recurrence. In a group of 197 patients with laryngeal cancer who underwent surgery followed by radiation therapy, partial resection was performed in 21.5% of patients and total resection in 78.5%. The majority of patients had T3 or T4 (74%) and N0 (63%) cancer. Macroscopically positive margins were reported in 10% of patients after partial resection and in 7% of patients after total resection, whereas microscopically positive margins were observed in 31% and 20% of cases, respectively. Extracapsular extension was observed in 22% of patients. In order to estimate local and nodal recurrence risk rates, criteria developed by Peters were used. Five-year local control (LC) was achieved in 88% of patients, disease-free survival (DFS) in 68% of patients and overall survival (OS) in 73% of patients. In the case of macroscopically positive margins, the 5-year DFS was 33% lower compared to radical surgery and 25% lower in the case of microscopically positive margins. The 5-year DFS was reduced by 29% due to extracapsular extension. Cox model analysis indicated that the degree of recurrence risk was the most potent independent prognostic factor for postoperative radiation therapy in laryngeal cancer. Negative histopathological factors influencing results of combined treatment of laryngeal cancer include macro-and microscopically positive margins, neck lymph node involvement and extracapsular extension.

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Section: Discussionsupporting

confidence: 79%

Section: Discussionmentioning

confidence: 99%

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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“…This suggests that the length of the actual radiation treatment time is more significant than the surgery-radiotherapy gap probably due to occurrence of an accelerated repopulation process during the actual postoperative radiation treatment time similar to that thought to occur during radical radiotherapy of HNC (Withers et al, 1988). In case of radical radiotherapy of HNC, the influence of pretreatment tumour proliferation parameters on the treatment outcome is a controversial issue (Awwad et al, 1992;Lochin et al, 1992;Bourhis et al, 1993;Eschwege et al, 1997;Zackrisson et al, 1997;Høyer et al, 1998). A multicenter analysis of 476 patients in which 11 centres participating failed to demonstrate an association (Begg et al, 1999).…”

Section: Discussionmentioning

confidence: 99%

“…Standard postoperative radiotherapy techniques (Awwad et al, 1992) were applied using a Philips 6 MV linear accelerator, a Varian simulator and a Multidata computer treatment planning system. Custommade plastic shells for head and neck immobilization were applied during treatment.…”

Section: Postoperative Radiotherapy Schedules and Techniquesmentioning

confidence: 99%

“…An active proliferation process is expected to prevail in tumour cell aggregates left in the surgical field in view of a small cell number, a large growth fraction and possibly also a low cell loss factor (Awwad et al, 1992;Peters and Withers, 1997;Ang et al, 2001). The present study aims at testing the possibility of improving the postoperative radiotherapy results in locally advanced HNC by applying an accelerated fractionation scheme.…”

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confidence: 99%

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Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation

Awwad¹,

Lotayef²,

Shouman³

et al. 2002

Br J Cancer

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Based on the assumption that an accelerated proliferation process prevails in tumour cell residues after surgery, the possibility that treatment acceleration would offer a therapeutic advantage in postoperative radiotherapy of locally advanced head and neck cancer was investigated. The value of T pot in predicting the treatment outcome and in selecting patients for accelerated fractionation was tested. Seventy patients with (T2/N1 -N2) or (T3-4/any N) squamous cell carcinoma of the oral cavity, larynx and hypopharynx who underwent radical surgery, were randomized to either (a) accelerated hyperfractionation: 46.2 Gy per 12 days, 1.4 Gy per fraction, three fractions per day with 6 h interfraction interval, treating 6 days per week or (b) Conventional fractionation: 60 Gy per 6 weeks, 2 Gy per fraction, treating 5 days per week. The 3-year locoregional control rate was significantly better in the accelerated hyperfractionation (88+4%) than in the CF (57+9%) group, P=0.01 (and this was confirmed by multivariate analysis), but the difference in survival (60+10% vs 46+9%) was not significant (P=0.29). The favourable influence of a short treatment time was further substantiated by demonstrating the importance of the gap between surgery and radiotherapy and the overall treatment time between surgery and end of radiotherapy. Early mucositis progressed more rapidly and was more severe in the accelerated hyperfractionation group; reflecting a faster rate of dose accumulation. Xerostomia was experienced by all patients with a tendency to be more severe after accelerated hyperfractionation. Fibrosis and oedema also tended to be more frequent after accelerated hyperfractionation and probably represent consequential reactions. T pot showed a correlation with disease-free survival in a univariate analysis but did not prove to be an independent factor. Moreover, the use of the minimum and corrected P-values did not identify a significant cut-off. Compared to conventional fractionation, accelerated hyperfractionation did not seem to offer a survival advantage in fast tumours though a better local control rate was noted. This limits the use of T pot as a guide for selecting patients for accelerated hyperfractionation. For slowly growing tumours, tumour control and survival probabilities were not significantly different in the conventional fractionation and accelerated hyperfractionation groups. A rapid tumour growth was associated with a higher risk of distant metastases (P=0.01). In conclusion, tumour cell repopulation seems to be an important determinant of postoperative radiotherapy of locally advanced head and neck cancer despite lack of a definite association between T pot and treatment outcome. In fast growing tumours accelerated hyperfractionation provided an improved local control but without a survival advantage. To gain a full benefit from treatment acceleration, the surgery-radiotherapy gap and the overall treatment time should not exceed 6 and 10 weeks respectively.

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A randomized trial of a nonabsorbable antibiotic lozenge given to alleviate radiation-induced mucositis

Okuno

Foote

Loprinzi

et al. 1997

Cancer

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Accelerated versus conventional fractionation in the postoperative irradiation of locally advanced head and neck cancer: influence of tumour proliferation

Cited by 68 publications

References 8 publications

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Accelerated hyperfractionation (AHF) compared to conventional fractionation (CF) in the postoperative radiotherapy of locally advanced head and neck cancer: influence of proliferation

A randomized trial of a nonabsorbable antibiotic lozenge given to alleviate radiation-induced mucositis

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