Hypofractionated Accelerated Chemoradiation for Oropharyngeal Cancer and the 2016 Royal College of Radiologists’ Fractionation Guidelines

Fong, C.; Boon, Ian S; Boon, Cheng; Benghiat, Helen; Hickman, M.; Hartley, A.; Sanghera, Paul

doi:10.1016/j.clon.2017.02.003

Cited by 3 publications

(7 citation statements)

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“…The long term results of both these studies are yet to be published. However, the use of this regime in two randomised trials, together with data from single centre series and the data from this study would appear to justify the use of this moderate hypofractionated acceleration in the absence of direct phase 3 comparisons [13] , [21] , [22] , [23] …”

Section: Discussionmentioning

confidence: 83%

“…The 4 week regime 55 Gy in 20# over 25 days has historically been used with several single agents including methotrexate, cetuximab, carboplatin and capecitabine for locally advanced disease disease [28] , [29] , [30] , [31] , [32] , [33] . More recent IMRT series have used 55 Gy in 20 fractions with synchronous single agent cisplatin, carboplatin and cetuximab [13] , [34] , [35] . The number of patients treated with the 4 week regime and synchronous cisplatin or carboplatin in the PET NECK study is too small to draw conclusions and there remains the possibility of a type II error.…”

Section: Discussionmentioning

confidence: 99%

“…There was concern among panellists regarding the possible lack of benefit for synchronous chemotherapy with more marked accelerated hypofractionation and the possible worse late toxicity. In contrast in the U.K, the Royal College of Radiologists listed a more profoundly hypofractionated schedule 55 Gy in 20# as a potential option with synchronous chemotherapy although it had been removed from college guidelines for routine use in 2016 [11] , [13] .…”

Section: Introductionmentioning

confidence: 99%

“…As this was primarily a pragmatic surgical study, there was no specific radiotherapy contouring protocol or contouring or delivery quality assurance. Three fractionation schemes were permitted to be administered with synchronous chemotherapy, 68–70 Gy in 34–35 fractions (#), 60–66 Gy in 30# and 55 Gy in 20# in keeping with Royal College of Radiologist guidelines cotemporaneous with the study recruitment period [13] . In the UK during this time Intensity Modulated Radiotherapy (IMRT) was gradually replacing three dimensional conformal radiotherapy (3DCRT).…”

Section: Introductionmentioning

confidence: 99%

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Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

et al. 2021

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Section: Discussionmentioning

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

et al. 2021

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“…Similarly, the inclusion of large numbers of patients with small volume good prognosis tumours may also mask any benefit. These regimes should initially be tested therefore in poor prognosis groups in the absence of neoadjuvant chemotherapy such as the ongoing international COMPARE study [ 20 , 21 ].…”

Section: Discussionmentioning

confidence: 99%

Revised Modelling of the Addition of Synchronous Chemotherapy to Radiotherapy in Squamous Cell Carcinoma of the Head and Neck—A Low α/β?

et al. 2018

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Background: The effect of synchronous chemotherapy in squamous cell carcinoma of the head and neck (SCCHN) has been modelled as additional Biologically Effective Dose (BED) or as a prolonged tumour cell turnover time during accelerated repopulation. Such models may not accurately predict the local control seen when hypofractionated accelerated radiotherapy is used with synchronous chemotherapy. Methods: For the purposes of this study three isoeffect relationships were assumed: Firstly, from the RTOG 0129 trial, synchronous cisplatin chemotherapy with 70 Gy in 35 fractions over 46 days results in equivalent local control to synchronous cisplatin chemotherapy with 36 Gy in 18# followed by 36 Gy in 24# (2# per day) over a total of 39 days. Secondly, in line with primary local control outcomes from the PET-Neck study, synchronous cisplatin chemotherapy with 70 Gy in 35# over 46 days results in equivalent local control to synchronous cisplatin chemotherapy delivered with 65 Gy in 30# over 39 days. Thirdly, from meta-analysis data, 70 Gy in 35# over 46 days with synchronous cisplatin results in equivalent local control to 84 Gy in 70# over 46 days delivered without synchronous chemotherapy. Using the linear quadratic equation the above isoeffect relationships were expressed algebraically to determine values of α, α/β, and k for SCCHN when treated with synchronous cisplatin using standard parameters for the radiotherapy alone schedule (α = 0.3 Gy−1, α/β = 10 Gy, and k = 0.42 Gy10day−1). Results: The values derived for α/β, α and k were 2 Gy, 0.20 and 0.21 Gy−1, and 0.65 and 0.71 Gy2day−1. Conclusions: Within the limitations of the assumptions made, this model suggests that accelerated repopulation may remain a significant factor when synchronous chemotherapy is delivered with radiotherapy in SCCHN. The finding of a low α/β for SCCHN treated with cisplatin suggests a greater tumour susceptibility to increasing dose per fraction and underlines the importance of the completion of randomized trials examining the role of hypofractionated acceleration in SCCHN.

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A Phase II Trial of Moderate Hypofractionated Chemoradiation In Postoperative Cases of Carcinoma Oral Cavity

Raza

2023

CTOIJ

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Introduction: Conventional fractionation in post-operative adjuvant radiotherapy (usually 60 Gy in 2 Gy per fraction delivered over six weeks) remains the standard in carcinoma oral cavity. Post-operative hypofractionated radiotherapy is less explored especially in post-operative oral cavity cancers. The aim of this study is to evaluate postoperative moderate hypofractionation as the adjuvant treatment in post-operative oral cavity cancer.Method: Patients of oral cavity cancers meriting adjuvant postoperative irradiation were inducted in the study. Hypofractionation consisted of a total dose of 52 Gy in 20 fractions over 4 weeks with concurrent chemotherapy. The primary endpoint was acute toxicity and late toxicity according to CTCAE V4.03 classification. The secondary endpoints included progression free survival at 1 year. Acute toxicity within 3 months of treatment and late toxicity at 1year follow up.Result: Thirty patients were recruited over 18 months. All patients completed a minimum of 1 year of follow-up. Twenty-Nine patients completed planned radiotherapy doses within a median treatment time of 30 days (27)(28)(29)(30)(31)(32)(33). Grade 2, 3and 4 skin reactions were seen in 86.2%, 10.34%, and 3.4% respectively. Grade 2,3,4 mucositis was seen in 55.17%, 41.3%, 3.4% patients respectively during treatment (acute toxicity). Recurrence was seen in 17% of patients at 3 months. Progression free survival at 1 year was 51%. Overall survival in 1 year was 79%. Conclusion:The schedule of 52 Gy in 20 fractions with concomitant chemotherapy is tolerable in patients with better compliance and equivalent PFS to conventional fractionation postoperative radiotherapy. Phase 3 trial is required for further validation of results.

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Hypofractionated Accelerated Chemoradiation for Oropharyngeal Cancer and the 2016 Royal College of Radiologists’ Fractionation Guidelines

Cited by 3 publications

References 4 publications

Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

Hypofractionated chemoradiation for head and cancer: Data from the PET NECK trial

Revised Modelling of the Addition of Synchronous Chemotherapy to Radiotherapy in Squamous Cell Carcinoma of the Head and Neck—A Low α/β?

A Phase II Trial of Moderate Hypofractionated Chemoradiation In Postoperative Cases of Carcinoma Oral Cavity

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