Comparison of radiotherapy strategies for locally advanced hypopharyngeal cancer after resection and ileocolic flap reconstruction

Tai, Hung-Chi; Hsieh, Chen‐Hsi; Chao, K. A.; Liu, Shih-Hua; Leu, Yi-Shing; Chang, Yih-Fang; Hsiao, Hung-Tao; Chang, Yuan‐Ching; Huang, David; Chen, Yu-Jen

doi:10.1080/00016480802163366

Cited by 10 publications

(11 citation statements)

References 12 publications

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“…Advances in radiation technology have provided better conformal dose distribution to simultaneously hit the target lesions and spare critical organs [9-12]. Nonetheless, areas other than the target area are exposed to significant low dose radiation, making radiation oncologists uncomfortable with this uncertainty in daily practice.…”

Section: Discussionmentioning

confidence: 99%

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Abdominal irradiation modulates 5-Fluorouracil pharmacokinetics

Hsieh

Hsieh²,

Liu

et al. 2010

J Transl Med

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BackgroundConcurrent chemoradiation with 5-fluorouracil (5-FU) is widely accepted for treatment of abdominal malignancy. Nonetheless, the interactions between radiation and 5-FU remain unclear. We evaluated the influence of abdominal irradiation on the pharmacokinetics of 5-FU in rats.MethodsThe radiation dose distributions of cholangiocarcinoma patients were determined for the low dose areas, which are generously deposited around the intrahepatic target volume. Then, corresponding single-fraction radiation was delivered to the whole abdomen of Sprague-Dawley rats from a linear accelerator after computerized tomography-based planning. 5-FU at 100 mg/kg was intravenously infused 24 hours after radiation. A high-performance liquid chromatography system equipped with a UV detector was used to measure 5-FU in the blood. Ultrafiltration was used to measure protein-unbound 5-FU.ResultsRadiation at 2 Gy, simulating the daily human treatment dose, reduced the area under the plasma concentration vs. time curve (AUC) of 5-FU by 31.7% compared to non-irradiated controls. This was accompanied by a reduction in mean residence time and incremental total plasma clearance values, and volume of distribution at steady state. Intriguingly, low dose radiation at 0.5 Gy, representing a dose deposited in the generous, off-target area in clinical practice, resulted in a similar pharmacokinetic profile, with a 21.4% reduction in the AUC. This effect was independent of protein binding capacity.ConclusionsAbdominal irradiation appears to significantly modulate the systemic pharmacokinetics of 5-FU at both the dose level for target treatment and off-target areas. This unexpected and unwanted influence is worthy of further investigation and might need to be considered in clinical practice.

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Section: Discussionmentioning

confidence: 99%

“…These therapies are supposed to produce greater target dose conformity and better critical organ sparing effects, allowing target dose escalation, with lower toxicity to normal tissues [9-12]. Nonetheless, each is usually accompanied by general, low-dose distribution to the torso.…”

Section: Introductionmentioning

confidence: 99%

Abdominal irradiation modulates 5-Fluorouracil pharmacokinetics

Hsieh

Hsieh²,

Liu

et al. 2010

J Transl Med

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“…More recently, intensity-modulated radiotherapy (IMRT) has been adopted for reduction of treatment related side-effects in head and neck cancer patients [12-17]. Dosimetry studies have confirmed that IMRT method can deliver more precise dose distribution around the target(s) and maintain lower doses to critical nearby organs [18,19].…”

Section: Introductionmentioning

confidence: 99%

Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation

et al. 2010

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BackgroundThe objective of this retrospective study is to investigate laryngeal preservation and long-term treatment results in hypopharyngeal carcinoma treated with intensity-modulated radiotherapy (IMRT) combined with chemotherapy.MethodsTwenty-seven patients with hypopharyngeal carcinoma (stage II-IV) were enrolled and underwent concurrent chemoradiotherapy. The chemotherapy regimens were monthly cisplatin and 5-fluorouracil for six patients and weekly cisplatin for 19 patients. All patients were treated with IMRT with simultaneous integrated boost technique. Acute and late toxicities were recorded based on CTCAE 3.0 (Common Terminology Criteria for Adverse Events).ResultsThe median follow-up time for survivors was 53.0 months (range 36-82 months). The initial complete response rate was 85.2%, with a laryngeal preservation rate of 63.0%. The 5-year functional laryngeal, local-regional control, disease-free and overall survival rates were 59.7%, 63.3%, 51.0% and 34.8%, respectively. The most common greater than or equal to grade 3 acute and late effects were dysphagia (63.0%, 17 of 27 patients) and laryngeal stricture (18.5%, 5 of 27 patients), respectively. Patients belonging to the high risk group showed significantly higher risk of tracheostomy compared to the low risk group (p = 0.014).ConclusionsAfter long-term follow-up, our results confirmed that patients with hypopharyngeal carcinoma treated with IMRT concurrent with platinum-based chemotherapy attain high functional laryngeal and local-regional control survival rates. However, the late effect of laryngeal stricture remains a problem, particularly for high risk group patients.

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“…With advances in radiotherapy modalities, such as three-dimensional conformal radiotherapy (3DCRT) and IMRT, delivering a good radiation dose to the tumor target volume while sparing the critical organs appears achievable [19,21,22]. With the development of conformal assays, radiation therapy could be an effective choice for selected HCC patients with PVT [20].…”

Section: Introductionmentioning

confidence: 99%

Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma

et al. 2010

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BackgroundTo compare the differences in dose-volume data among coplanar intensity modulated radiotherapy (IMRT), noncoplanar IMRT, and helical tomotherapy (HT) among patients with hepatocellular carcinoma (HCC) and portal vein thrombosis (PVT).MethodsNine patients with unresectable HCC and PVT underwent step and shoot coplanar IMRT with intent to deliver 46 - 54 Gy to the tumor and portal vein. The volume of liver received 30Gy was set to keep less than 30% of whole normal liver (V30 < 30%). The mean dose to at least one side of kidney was kept below 23 Gy, and 50 Gy as for stomach. The maximum dose was kept below 47 Gy for spinal cord. Several parameters including mean hepatic dose, percent volume of normal liver with radiation dose at X Gy (Vx), uniformity index, conformal index, and doses to organs at risk were evaluated from the dose-volume histogram.ResultsHT provided better uniformity for the planning-target volume dose coverage than both IMRT techniques. The noncoplanar IMRT technique reduces the V10 to normal liver with a statistically significant level as compared to HT. The constraints for the liver in the V30 for coplanar IMRT vs. noncoplanar IMRT vs. HT could be reconsidered as 21% vs. 17% vs. 17%, respectively. When delivering 50 Gy and 60-66 Gy to the tumor bed, the constraints of mean dose to the normal liver could be less than 20 Gy and 25 Gy, respectively.ConclusionNoncoplanar IMRT and HT are potential techniques of radiation therapy for HCC patients with PVT. Constraints for the liver in IMRT and HT could be stricter than for 3DCRT.

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Comparison of radiotherapy strategies for locally advanced hypopharyngeal cancer after resection and ileocolic flap reconstruction

Abstract: After major surgery, patients treated with IMRT had less toxicity and better functional restoration than those with 2DRT. IMRT and 3DCRT both showed lower dose to the spinal cord than did 2DRT. Only IMRT showed reduced dose to ileocolic flap.

Cited by 10 publications

References 12 publications

Abdominal irradiation modulates 5-Fluorouracil pharmacokinetics

Abdominal irradiation modulates 5-Fluorouracil pharmacokinetics

Long-term results of intensity-modulated radiotherapy concomitant with chemotherapy for hypopharyngeal carcinoma aimed at laryngeal preservation

Comparison of coplanar and noncoplanar intensity-modulated radiation therapy and helical tomotherapy for hepatocellular carcinoma

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