Comparison of two schedules of hypo-fractionated radiotherapy in locally advanced head-and-neck cancers

Adlakha, Pramila; Maheshwari, Guncha; Dhanawat, Aditya; Sinwer, Rajesh; Singhal, Mukesh Kumar; Jakhar, Shankar Lal; Sharma, Neeti; Kumar, Harvindra Singh

doi:10.4103/jcrt.jcrt_1793_20

Cited by 3 publications

(2 citation statements)

References 16 publications

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“…Conventional RT in metastatic HNSCC was previously seen as a palliative measure, with hypofractionated RT also utilized for symptom relief ( 162 ). However, SBRT may generate impressive local control of metastatic disease.…”

Section: Radiotherapy and Immunotherapy In Clinical Trialsmentioning

confidence: 99%

The immunogenic radiation and new players in immunotherapy and targeted therapy for head and neck cancer

Sharon,

Daher-Ghanem,

Zaid

et al. 2023

Front. Oral. Health

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Although treatment modalities for head and neck cancer have evolved considerably over the past decades, survival rates have plateaued. The treatment options remained limited to definitive surgery, surgery followed by fractionated radiotherapy with optional chemotherapy, and a definitive combination of fractionated radiotherapy and chemotherapy. Lately, immunotherapy has been introduced as the fourth modality of treatment, mainly administered as a single checkpoint inhibitor for recurrent or metastatic disease. While other regimens and combinations of immunotherapy and targeted therapy are being tested in clinical trials, adapting the appropriate regimens to patients and predicting their outcomes have yet to reach the clinical setting. Radiotherapy is mainly regarded as a means to target cancer cells while minimizing the unwanted peripheral effect. Radiotherapy regimens and fractionation are designed to serve this purpose, while the systemic effect of radiation on the immune response is rarely considered a factor while designing treatment. To bridge this gap, this review will highlight the effect of radiotherapy on the tumor microenvironment locally, and the immune response systemically. We will review the methodology to identify potential targets for therapy in the tumor microenvironment and the scientific basis for combining targeted therapy and radiotherapy. We will describe a current experience in preclinical models to test these combinations and propose how challenges in this realm may be faced. We will review new players in targeted therapy and their utilization to drive immunogenic response against head and neck cancer. We will outline the factors contributing to head and neck cancer heterogeneity and their effect on the response to radiotherapy. We will review in-silico methods to decipher intertumoral and intratumoral heterogeneity and how these algorithms can predict treatment outcomes. We propose that (a) the sequence of surgery, radiotherapy, chemotherapy, and targeted therapy should be designed not only to annul cancer directly, but to prime the immune response. (b) Fractionation of radiotherapy and the extent of the irradiated field should facilitate systemic immunity to develop. (c) New players in targeted therapy should be evaluated in translational studies toward clinical trials. (d) Head and neck cancer treatment should be personalized according to patients and tumor-specific factors.

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Section: Radiotherapy and Immunotherapy In Clinical Trialsmentioning

confidence: 99%

The immunogenic radiation and new players in immunotherapy and targeted therapy for head and neck cancer

Sharon,

Daher-Ghanem,

Zaid

et al. 2023

Front. Oral. Health

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“…The goal of the treatment is to palliate symptoms like pain, dysphagia, dyspnea , bleeding, and ulceration and improve quality of life. Radiotherapy (RT) and chemotherapy are the useful modality of [6]. The present study was undertaken to compare the efficacy and toxicity of two hypo-fractionated palliative RT regimens in such patients.…”

Section: Introductionmentioning

confidence: 99%

Comparative Evaluation of Octa Shot Versus Quad Shot Palliative Radiotherapy for Advanced Head and Neck Cancer Patients

Jakhar,

Dhaka,

Dhaka

et al. 2023

Asian Pac J Cancer Care

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Background: Majority of Head and Neck Squamous Cell Cancer patients in India present in advanced stages. They are not candidates for multimodality treatment due to loco-regionally advanced disease and poor performance status. Hypo-fractionated regimens have been used for palliation of advanced head and neck cancers. Purpose: The purpose of this study to compare the acute and late toxicity and overall response of octa shot and quad shot radiation therapy as palliative regime in locally advanced head and neck cancers.Materials and methods: A hospital based prospective, randomized study was conducted with 50 patients of advanced Squamous cell carcinoma of head and neck, 25 patients taken in each arm. Two fractions(3.5Gy/#) per day six hours apart was given in four consecutive days (Octa shot). Two fractions (3.5Gy/#) per day six hours apart was given in two consecutive days repeated for one more cycle with a interval of two weeks (Quad shot). Acute toxicities monitored at day 15 &30 and late at 3 & 6 months after the treatment started. Results: Octa shot had slightly better loco-regional control but the difference was statistically insignificant. Octa shot had more grade 2 skin and mucosal reaction than Quad shot. Symptomatic relief, subjective regression and improved QOL were better in Octa shot than Quad shot. Conclusion: The study concludes that “octa shot” is an effective palliative radiotherapy regime with greater yet manageable toxicity in comparison to Quad shot regimen. This regime not only strikes a balance between the economic burden, treatment time, machine load but also helps in selecting patients for further dose escalation based on treatment response and symptomatic relief. However more such trials with longer follow up and larger sample size are required for stronger evidences.

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Quality Assurance in Radiotherapy (RT)-Specific Trials: Indian Scenario

Mahata,

Chakraborty,

Mandal

et al. 2024

Clinical Oncology

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Comparison of two schedules of hypo-fractionated radiotherapy in locally advanced head-and-neck cancers

Cited by 3 publications

References 16 publications

The immunogenic radiation and new players in immunotherapy and targeted therapy for head and neck cancer

The immunogenic radiation and new players in immunotherapy and targeted therapy for head and neck cancer

Comparative Evaluation of Octa Shot Versus Quad Shot Palliative Radiotherapy for Advanced Head and Neck Cancer Patients

Quality Assurance in Radiotherapy (RT)-Specific Trials: Indian Scenario

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