Comparison of Conventional Fractionation and Accelerated Fractionation With Concomitant Boost for Radiotherapy of Non-metastatic Stage IV Head-and-Neck Cancer

Narvaez, Carlos A; Schild, Steven E.; Rades, Dirk

doi:10.21873/invivo.12272

Cited by 8 publications

(10 citation statements)

References 30 publications

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“…In two retrospective studies by Narvaez et al, a non-significant difference in toxicity was observed between concomitant boost radiotherapy and conventional chemoradiotherapy; however, these studies were limited by a small sample size [ 29 , 30 ].…”

Section: Discussionmentioning

confidence: 99%

A Comparison of the Toxicities in Patients With Locally Advanced Head and Neck Cancers Treated With Concomitant Boost Radiotherapy Versus Conventional Chemoradiation

Sharma¹,

Vats²,

Seam³

et al. 2023

Cureus

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Purpose: To compare the objective and patient-reported toxicities of concomitant boost radiotherapy (CBRT) and concurrent chemoradiation (CRT) in patients with locally advanced head and neck cancers. Methods and material: In this prospective study, 46 patients with histologically proven stage III-IVA head and neck cancer were randomly assigned to receive either concurrent chemoradiation to a dose of 66 Gy in 33 fractions over 6.5 weeks with concurrent cisplatin (40 mg/m2 IV weekly; control arm) or accelerated radiotherapy with concomitant boost radiotherapy (study arm) to a dose of 67.5 Gy in 40 fractions in five weeks. Acute toxicity was evaluated using RTOG toxicity criteria. The assessment was done weekly after initiation of treatment, at the first follow-up (six weeks), and at three months. The four main patient-reported symptoms of pain, hoarseness of voice, dryness of mouth, and loss of taste were also compared between the two groups to assess patient quality of life during treatment. Results: The mean treatment duration was 37 days in the CBRT arm and 49 days in the CRT arm. Treatment-related interruptions were less in the study group,17.3% in the study, and 27.2% in the control with insignificant P-value. Grade III laryngeal toxicity was significantly higher in the study group (P=0.029). Other acute grade I-III toxicities (pharyngeal, skin, mucositis, and salivary) were comparable in both CRT and CBRT arms. Grade IV toxicities were seen only in the CBRT arm but were resolved at the first follow-up. Haematological toxicities and renal toxicities were significantly higher in the CRT arm, with significant P-values of 0.0004 and 0.018, respectively. Conclusion: In patients with locally advanced head and neck cancer, concomitant boost radiotherapy is well tolerated with acceptable local toxicity and minimal systemic toxicity as compared to conventional chemoradiation. It is a feasible option for patients with locally advanced head and neck cancer not fit for concurrent chemoradiation.

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Section: Discussionmentioning

confidence: 99%

A Comparison of the Toxicities in Patients With Locally Advanced Head and Neck Cancers Treated With Concomitant Boost Radiotherapy Versus Conventional Chemoradiation

Sharma¹,

Vats²,

Seam³

et al. 2023

Cureus

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“…Of the other four patients, three received an accelerated regimen with a concomitant boost. Three weeks of conventional fractionation (30 Gy in 15 fractions) were followed by 21.6 Gy (1.8 Gy per fraction in the morning on 12 treatment days) plus two consecutive boosts of 9 Gy each (1.5 Gy per fraction in the afternoon after at least 6 hours on the same treatment day), which resulted in a cumulative total dose of 69.6 Gy (23,24). One patient received conventionally fractionated radiotherapy over 3 weeks (30 Gy in 15 fractions), followed by 40.6 Gy of hyperfractionated-accelerated radiotherapy (1.4 Gy per fraction) over 3 weeks, resulting in a cumulative total dose of 70.6 Gy (25).…”

Section: Methodsmentioning

confidence: 99%

Prognostic Factors for Complete Recovery From Xerostomia After Radiotherapy of Head-and-Neck Cancers

Rades

Warwas

Gerull

et al. 2022

In Vivo

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Background/Aim: Radiotherapy of head-and-neck cancers can cause xerostomia. This study investigated potential prognostic factors for complete recovery from this complication. Patients and Methods: Eighty head-and-neck cancer patients with radiation-induced xerostomia were retrospectively evaluated. Thirteen characteristics were analyzed for complete recovery (to grade 0) from xerostomia including age, sex, tumor site and stage, nodal stage, upfront surgery, mean dose to ipsilateral, contralateral and both parotid glands, chemotherapy, radiation type and dose, and initial grade of xerostomia. Results: Fifteen patients (18.8%) experienced complete recovery of xerostomia. Significant associations with complete recovery were found for initial grade 1 xerostomia (p<0.001), mean dose to contralateral parotid gland of <20 Gy (p=0.034), and radiation treatment without chemotherapy (p=0.047). Conclusion: Almost every fifth patient experienced complete recovery of xerostomia. Prognostic factors were identified that can guide radiation oncologists during the process of treatment planning.Radiotherapy is frequently used to treat head-and-neck cancers and is associated with significant side-effects (1). An important and debilitating late toxicity is radiation-induced xerostomia, which can even lead to additional complications including oral infections and dental loss (2-5). Several studies have evaluated the prevalence and risk factors of post-radiotherapy xerostomia. After 2-dimensional radiotherapy (2D-RT) or 3-dimensional conformal radiotherapy (3D-CRT) for cancers or lymphomas of the head-and-neck, xerostomia occurred in a considerable number of patients (6-10). In another study, where patients received modern precision techniques including intensitymodulated radiation therapy (IMRT), volumetric modulated arc therapy, and proton therapy, the prevalence of moderate to severe xerostomia was 39.1% ( 11).An important question, particularly for the affected patients, is whether xerostomia will remain, improve, or deteriorate following their treatment. Several studies investigated the course of xerostomia after radiotherapy for head-and-neck cancers (12)(13)(14)(15)(16)(17)(18)(19)(20)(21)(22). Most of these studies found at least moderate improvement of xerostomia or salivary gland function over time in some patients. However, in other studies, no improvement of xerostomia was observed after higher mean doses to the parotid gland(s) (10,12,19). Moreover, in a randomized trial, improvement of xerostomia patients was not observed in patients treated with 2-dimensional conventional radiotherapy (18). In a retrospective study of 251 patients with cancer of the nasopharynx, xerostomia was consistent over time (21,22). Data regarding complete recovery of xerostomia are scarce. In a study of patients with cancer of the nasopharynx, stimulated parotid saliva flow reached or exceeded pre-radiotherapy levels in 14 of 32 patients (44%) (16).In most studies investigating potential prognostic factors for improvement of radiation-induced xe...

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“…Seven of the 138 patients treated with EBRT alone received conventionally fractionated radiotherapy (30 Gy in 15 fractions over 3 weeks) followed by a concomitant boost resulting in a cumulative dose of 69.6 Gy (20,21), three patients received conventionally fractionated radiotherapy (30 Gy in 15 fractions over 3 weeks) followed by hyperfractionated-accelerated irradiation (2×1.4 Gy per day) resulting in a cumulative dose of 70.6 Gy (22), and one patient received conventionally fractionated radiotherapy (52 Gy in 26 fractions) followed by hyperfractionated-accelerated irradiation (2×1.5 Gy per day) resulting in a cumulative dose of 70.0 Gy. In the 7 patients receiving a brachytherapy boost (high-dose rate with iridium-192), EBRT doses ranged between 50 and 66 Gy and brachytherapy doses (mainly administered to the primary tumor) between 10 and 15 Gy (2×2.5 Gy per day).…”

Section: Methodsmentioning

confidence: 99%

Impact of Dose-Volume Parameters of Parotid Glands on Xerostomia in Patients Irradiated for Head-and-Neck Cancer

et al. 2022

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Background/Aim: Optimal planning of radiotherapy for head-and-neck cancers should consider the risk of xerostomia. This study investigated the prognostic value of dosevolume parameters of the parotid glands. Patients and Methods: Dose-volume parameters were evaluated for xerostomia in 145 patients including D40 (minimum dose to 40% of corresponding parotid volume), D60 (minimum dose to 60%), D80 (minimum dose to 80%), and mean dose of ipsilateral, contralateral, and bilateral parotid glands. Results: Grade ≥2 xerostomia was significantly associated with D40 of ipsilateral and all parameters of bilateral glands; trends were found for all other parameters. Grade ≥3 xerostomia was significantly associated with D80 of bilateral glands; trends were found for other parameters of ipsilateral and bilateral glands. Conclusion: Since grade ≥2 xerostomia was associated with all parameters, D40, D60, and D80 did not provide additional information to mean doses. D80 of bilateral glands is a new factor and more predictive than mean dose regarding grade ≥3 xerostomia.

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Comparison of Conventional Fractionation and Accelerated Fractionation With Concomitant Boost for Radiotherapy of Non-metastatic Stage IV Head-and-Neck Cancer

Cited by 8 publications

References 30 publications

A Comparison of the Toxicities in Patients With Locally Advanced Head and Neck Cancers Treated With Concomitant Boost Radiotherapy Versus Conventional Chemoradiation

A Comparison of the Toxicities in Patients With Locally Advanced Head and Neck Cancers Treated With Concomitant Boost Radiotherapy Versus Conventional Chemoradiation

Prognostic Factors for Complete Recovery From Xerostomia After Radiotherapy of Head-and-Neck Cancers

Impact of Dose-Volume Parameters of Parotid Glands on Xerostomia in Patients Irradiated for Head-and-Neck Cancer

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