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

Vreugdenhil, M.; Fong, C.; Sanghera, Paul; Hartley, A.; Dunn, Janet A.; Mehanna, Hisham

doi:10.1016/j.oraloncology.2020.105112

Cited by 18 publications

(15 citation statements)

References 35 publications

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Section: Discussionmentioning

confidence: 99%

“…24,25 However, the recent PET NECK trial update provided solidarity toward using hypofractionated radiotherapy with concurrent chemotherapy without compromising local control, OS, and quality of life. 26 Despite extensive patient education and safety measures, unfortunately, three patients developed mildly symptomatic incurrent COVID-19 infection. Although various international guidelines suggest noninterruption of OS (months) radiotherapy by treating these patients with adequate personal protective equipment at the end of the day in a dedicated vault, implementing the same in a resourcelimited setting is not feasible.…”

Section: Venkatasai Et Almentioning

confidence: 99%

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Impact of COVID-19 Pandemic on Patterns of Care and Outcome of Head and Neck Cancer: Real-World Experience From a Tertiary Care Cancer Center in India

Venkatasai

John

Kondavetti

et al. 2022

JCO Global Oncology

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PURPOSE The COVID-19 pandemic has caused unprecedented health, social, and economic unrest globally, particularly affecting resource-limited low-middle–income countries. The resultant curfew had made the access to and delivery of cancer care services an arduous task. We have reported the patterns of care and 1-year outcome of head and neck squamous cell carcinoma (HNSCC) treatment before and during COVID-19 lockdown at our institution. MATERIALS AND METHODS Patients who underwent radiation therapy (RT) for nonmetastatic HNSCC between March 1, 2020, and July 31, 2020, were included in the COVID-RT group, and those who were treated between October 1, 2019, and February 29, 2020, were included in the preCOVID-RT group. RESULTS A total of 25 patients were in the COVID-RT group, and 51 patients were in the preCOVID-RT group. An increase in the incidence of locally advanced cancers across all subsites was observed in the COVID-RT group. There was a steep increase in the median overall RT treatment duration (52 v 44) and median break days during RT (10 v 2) in the COVID-RT group. The median follow-up period of all patients was 18 months. The progression-free survival at 1 year in the COVID-RT group and preCOVID-RT group was 84% and 90%, respectively ( P = .08), and overall survival at 1 year was 86% and 96%, respectively ( P = .06). CONCLUSION Our study elucidates the adverse impact of the COVID-19 curfew on cancer care and has demonstrated safe delivery of RT for HNSCC without major acute adverse effects. Despite a significant increase in treatment breaks, early outcome data also suggest that 1-year progression-free survival and overall survival are comparable with that of the pre–COVID-19 times; however, longer follow-up is warranted.

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Section: Discussionmentioning

confidence: 99%

Section: Venkatasai Et Almentioning

confidence: 99%

Impact of COVID-19 Pandemic on Patterns of Care and Outcome of Head and Neck Cancer: Real-World Experience From a Tertiary Care Cancer Center in India

Venkatasai

John

Kondavetti

et al. 2022

JCO Global Oncology

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“…The 55 Gy at 2.75 Gy per fraction scheme over 4 weeks has also been proposed for other types of H&N cancer in several studies (14,(37)(38)(39)(40)(41)(42). In these studies, the mean age is <60 years, and specific references on elderly patients are not discussed in details However, these studies showed an overall good tolerability and could enhance elderly patients' compliance by reducing the number of needed accesses to the radiotherapy facility.…”

Section: Discussionmentioning

confidence: 99%

Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Piras¹,

Boldrini

Menna

et al. 2021

Front. Oncol.

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ObjectiveRadiotherapy (RT) in the head and neck (H&N) site are undoubtedly the most challenging treatments for patients. Older and frail patients are not always able to tolerate it, and there are still no clear guidelines on the type of treatments to be preferred for them. The recommendations for Risk-Adapted H&N Cancer Radiation Therapy during the coronavirus disease 2019 (COVID-19) pandemic provided by the ASTRO-ESTRO consensus statement achieved a strong agreement about hypofractionated RT (HFRT). A systematic literature review was conducted in order to evaluate the feasibility and safety of HFRT for older patients affected by H&N malignancies.Materials and MethodsA systematic database search was performed on PubMed and Embase according to Preferred Reporting Items for Systematic Reviews and Meta‐analyses (PRISMA) guidelines. Original studies, case series, and case reports describing the use of HFRT (with at least 2.2 Gy fractions) in patients with mean age ≥65 years were included. The analysis was based on the type of study, number of patients, mean age, tumor site, histology, performance status (PS), RT details, concomitant chemotherapy (CT), and described clinical outcomes. All the reported doses have been calculated in equivalent dose in 2 Gy fractions (EQD2) and biologically effective dose (BED) using α/β = 10 Gy or α/β = 12 Gy.ResultsWe selected 17 papers that met the inclusion criteria and divided them in 4 categories: 6 articles analyze HFRT performed twice daily in repeated cycles, 3 once a day in repeated cycles, 4 in alternative days, and the last 4 in consecutive days.ConclusionHFRT seems to be a good treatment with an acceptable prolonged disease control. In older patients fit for radical treatments, a 55 Gy in 20 fractions regimen can be proposed as a valid alternative to the standard fractionated RT, but there are a multitude of hypofractionated regimens, ranging from single fraction, quad shot, and 1-, 2-, 3-, 4-, and 5-week schedules that all may be appropriate. The correct regimen for a patient depends on many factors, and it represents the result of a more specific and complex decision.

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“…In this matter, there are an increasing number of studies, e.g., the multicentric trial of hypo-vs normo-fractionated RT in HNSCC, HYPNO (NCT0765503) study, applying 55Gy in 20 fractions and 4 weeks, addressing these questions. So far, no significant disadvantages in terms of local control, overall survival and quality of life have been found [38,39], and there is evidence that intensifying the treatment by either altering RT fractions or adding concurrent therapies might even improve the outcome in patients [38]. The optimal radiation dose and fractionation for combination of RT with ICM still has to be identified [40].…”

Section: Introductionmentioning

confidence: 99%

Hypofractionated Radiotherapy Upregulates Several Immune Checkpoint Molecules in Head and Neck Squamous Cell Carcinoma Cells Independently of the HPV Status While ICOS-L Is Upregulated Only on HPV-Positive Cells

Wimmer¹,

Deloch²,

Häder³

et al. 2021

IJMS

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While the treatment of squamous cell carcinoma of the head and neck (HNSCC) with radiotherapy (RT) is complemented more and more by immunotherapy in clinical trials, little is known about the impact of the human papillomavirus (HPV) status or the applied RT scheme on the immune phenotype of the tumor cells. Therefore, we aimed to examine the impact of the HPV status of four human HNSCC cell lines on cell death and the expression of immune checkpoint molecules (ICMs) after RT with either hypofractionation irradiation (5x3.0Gy) or a high single dose (1x19.3Gy) via multicolor flow cytometry and quantitative PCR at an early time point after therapy. In our study, 5x3.0Gy RT induced high numbers of early and late apoptotic cells independent of the HPV status, but necrosis was only increased in the HPV-positive UM-Scc-47 cells. Generally, the immune stimulatory ICMs (CD70, CD137-L, ICOS-L) were less affected by RT compared to the immune suppressive ones (PD-L1, PD-L2, and the herpesvirus entry mediator (HVEM)). A significant higher surface expression of the analyzed ICMs was found after hypofractionated RT compared to a single high dose; however, regardless of the HPV status, with the exception of ICOS-L. Here, HPV-positive HNSCC tumor cells showed a stronger response to 5x3.0Gy than HPV-negative ones. On the RNA level, only minor alterations of ICMs were observed following RT, with the exception of the HPV negative cell line CAL33 treated with 5x3.0Gy, where PD-L2, HVEM and CD70 were significantly increased. We conclude that the HPV status may not distinctly predict immunological responses following RT, and thus cannot be used as a single predictive marker for therapy responses in HNSCC. In contrast, the patient-specific individual expression of ICMs following RT is preferable for the targeted patient selection for immune therapy directed against distinct ICM.

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

Cited by 18 publications

References 35 publications

Impact of COVID-19 Pandemic on Patterns of Care and Outcome of Head and Neck Cancer: Real-World Experience From a Tertiary Care Cancer Center in India

Impact of COVID-19 Pandemic on Patterns of Care and Outcome of Head and Neck Cancer: Real-World Experience From a Tertiary Care Cancer Center in India

Hypofractionated Radiotherapy in Head and Neck Cancer Elderly Patients: A Feasibility and Safety Systematic Review for the Clinician

Hypofractionated Radiotherapy Upregulates Several Immune Checkpoint Molecules in Head and Neck Squamous Cell Carcinoma Cells Independently of the HPV Status While ICOS-L Is Upregulated Only on HPV-Positive Cells

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