IMRT dose fractionation for head and neck cancer: Variation in current approaches will make standardisation difficult

Abstract

This variability in IMRT fractionation makes any meaningful comparison of treatment results difficult. Some standardization is needed particularly for design of multi-centre randomized clinical trials.

Regional Relapse After Intensity-Modulated Radiotherapy for Head-and-Neck Cancer

“…Studies with $50 patients undergoing IMRT that had a clear distinction between isolated regional relapse vs. failure and combined locoregional relapse vs. failure were selected for this comparison. The variety of fractionation schemes, tumor sites, stage distribution, and patient characteristics among the series made comparison of the clinical outcomes difficult (14). Of six series, five provided only absolute numbers without actuarial estimates and therefore might have been biased by short observation times (Table 7).…”

“…Guidelines for the delineation of the cervical lymph node levels (12,13) have strived toward uniform target definition for the elective neck. In contrast, a variety of dose and fractionation schedules is still used for neck irradiation (14).…”

A Mathematical Study to Select Fractionation Regimen Based on Physical Dose Distribution and the Linear–Quadratic Model

“…This trend makes hypofractionated radiotherapy feasible without increasing toxicity of normal tissue (8,9). However, there is still some controversy with this issue clinically (10).…”

Sites de récidive après radiothérapie conformationnelle avec modulation d’intensité des carcinomes épidermoïdes des voies aérodigestives supérieures

“…Le taux de rechute locorégional isolé estimé à 18% est comparable à celui observé dans notre cohorte (22,8%). Toutefois, les comparaisons entre plusieurs études des résultats thérapeutiques de la RCMI doivent rester prudentes puisqu'il existe une très grande variabilité en termes de caractéristiques de patients, de sites et stade tumoral, d'histologie, mais surtout de doses de radiothérapie et de fractionnement [22]. D'autre part, notre cohorte était constituée en majorité de patients atteints d'un cancer des voies aérodigestives supérieures localement évolué de stade III ou IV (74%) de la classification internationale AJCC.…”