Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Locoregionally Advanced Laryngeal and Hypopharyngeal Cancers

Lee, Nancy Y.; O'Meara, W; Chan, Kelvin K.; Della-Bianca, Cesar; Mechalakos, James; Zhung, J.; Wolden, Suzanne L.; Narayana, Ashwatha; Kraus, Dennis H.; Shah, Jatin P.; Pfister, David G.

doi:10.1016/j.ijrobp.2007.03.013

Cited by 133 publications

(116 citation statements)

References 32 publications

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“…Sensorineural hearing loss has been shown to result in significant cognitive impairment, depression and reduction in functional status [53]. Planning studies indicate that the dose to the cochlea can be reduced with the use [86] 31 III-IV 100% 84% 63% 46 % (2 year) Studer et al [87] 123 I-IV 86% 77% 83% 6% (1 year) CRT, concomitant radiotherapy; LRC, locoregional control (excluding laryngectomy); OS, overall survival.…”

Section: Parotid Tumoursmentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Bhide

Newbold²,

Harrington³

et al. 2012

BJR

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ABSTRACT. Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area. Intensity-modulated radiotherapy (IMRT) is an advanced approach to three-dimensional (3D) treatment planning and conformal therapy. It optimises the delivery of irradiation to irregularly shaped volumes and has the ability to produce concavities in radiation treatment volumes. For head and neck cancer, the clinical target volume 1 (CTV1), which includes the primary tumour and the involved nodes, typically receives a higher radiation dose than CTV2. The different doses to CTV1 and 2 can be delivered simultaneously, while sparing the parotid salivary glands and the spinal cord. In the head and neck region, IMRT has a number of potential advantages: (i) it allows for greater sparing of normal structures such as salivary glands, oesophagus, optic nerves, brain stem and spinal cord [7,8]; (ii) it allows treatment to be delivered in a single treatment phase without the requirement for matching additional fields to provide tumour boosts, and eliminates the need for electron fields to the posterior (levels II and V) neck nodes; and (iii) it offers the possibility of simultaneously delivering higher radiation doses to regions of gross disease and lower doses to areas of microscopic disease-the so-called simultaneous integrated boost (SIB) IMRT [9].IMRT can be delivered using linear accelerators with static multileaf collimators (MLCs; step and shoot IMRT) or dynamic leaf MLCs, tomotherapy machines or volumetric modulated arc therapy (VMAT). Tomotherapy enables the simultaneous use of image guidance and treatment delivery [10]. However, adaptive RT based on image guidance is yet to be clinically optimised in head and neck cancer. VMAT is a newer technique of delivering IMRT. VMAT delivers IMRT-like distributions in a single rotation of the gantry, varying the gantry speed and dose rate during delivery, in contrast to standard IMRT, which uses fixed gantry beams. Planning studies using RT demonstrate shorter planning and treatment time, fewer monitor units for treatment delivery and better dose homogeneity and normal tissue sparing [11,12]. There is a lack of data as regards clinical implementation of this technique.IMRT was first described in 1999; in the last decade numerous retrospective case series (single and multiinstitution) and a few randomised trials have been published studying the clinical implementation of thi...

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Section: Parotid Tumoursmentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Bhide

Newbold²,

Harrington³

et al. 2012

BJR

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“…IMRT increased the rate of laryngeal preservation and decreases the incidence of late toxicity. [25][26][27] …”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of the clinical efficacy of concurrent weekly cisplatinum – radiotherapy for patients with laryngeal carcinoma

Aboziada

Elyamany

2016

JST

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Introduction and aim: Laryngeal preservation with concurrent chemo-radiation is an effective, alternative management for cancer larynx. Three weekly cis-platinum concurrent with radiotherapy (RT) considered the standard. However, weekly cisplatinum has proven very effective for advanced head and neck carcinoma. We review our data to prove the efficacy and safety of weekly cis-platinum plus RT for laryngeal preservation. Patients and methods: Untreated 64 patients with advanced laryngeal carcinoma were retrospectively analyzed. Patients offered for 6 weeks of cis-platinum 40 mg/m 2 concurrent with conformal RT; 70 Gy delivered to gross primary and lymph nodes.Results: Forty-six (71.8%) patients had complete remission (CR). Early stages had better CR than late stages. Median follow up was 40 months. Three years DFS and OS were 69% and 77% respectively. Larynx preservation survival at 3 years was 73%. Protocol of treatment was tolerable, grade 3 or 4 acute and late toxic effects were reported in 25% of the included cases. Conclusion: Weekly cis-platinum could be effective and safe. We need to evaluate this protocol prospectively and compare it with three-weekly high dose cis-platinum with concomitant radiotherapy.

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“…(6) It has been hypothesized that the closely apposed mucosal surfaces of the hypopharynx, especially in the post cricoid area, is responsible for the increased rate of strictures in this area, (7) which probably further extends into the proximal segment of the esophagus. Prolonged apposition of ulcerated mucosa favours circumferential scarring.…”

Section: Discussionmentioning

confidence: 99%

Upper Esophageal Stricture Post Chemoirradiation in Patients With Carcinoma Hypopharynx

Radhakrisha¹,

S²,

Ahmed³

2014

jemds

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BACKGROUND: Concurrent chemo irradiation is the standard treatment for patients with head & neck cancer (HNC). Dysphagia is a common late toxicity of treatment. 7-21% of these patients have treatment induced stricture of the upper esophagus causing dysphagia, with a high incidence of the same in cases of carcinoma hypopharynx. The objective of the present study was to identify the incidence of treatment related stricture of the upper esophagus in patients with hypopharyngeal cancer in our institution. METHODS: A retrospective analysis on patients treated for carcinoma hypopharynx, in the department of Radiotherapy at our Institute, between 2008-12 was conducted. All patients who had received chemo irradiation were included Patients who had developed upper esophageal stricture post treatment diagnosed by upper GI endoscopy and required periodic dilatation were analyzed using Fisher's exact test. RESULTS: 377 patients of H&N cancers were evaluated, out of which 15.38 % (58/377) had a hypopharyngeal primary. 51 patients were evaluable for the current analysis (15 females, 36 males; mean age 57yrs); out of which 10 patients developed treatment related stricture in the proximal esophagus (20%) (4 females, 6 males). Post cricoid primary had a higher incidence of stricture (7/10) (p=0.0012** two-tailed), followed by primary of the pyriform sinus (3/10). Posterior pharyngeal wall malignancies did not have treatment induced strictures. The mean interval between completion of treatment and endoscopic diagnosis of stricture was 4 months. 5 out of 10 patients underwent periodic dilatations up to an average of 13mm. CONCLUSIONS: Upper esophageal stricture is an important late effect of chemo irradiation in patients with carcinoma hypopharynx. Post cricoid cancers have a higher incidence of treatment induced strictures.

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Concurrent Chemotherapy and Intensity-Modulated Radiotherapy for Locoregionally Advanced Laryngeal and Hypopharyngeal Cancers

Cited by 133 publications

References 32 publications

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Retrospective analysis of the clinical efficacy of concurrent weekly cisplatinum – radiotherapy for patients with laryngeal carcinoma

Upper Esophageal Stricture Post Chemoirradiation in Patients With Carcinoma Hypopharynx

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