Increasing Toxicity in Nonoperative Head and Neck Cancer Treatment: Investigations and Interventions

Bentzen, Søren M.; Rosenthal, David I.; Weymuller, Ernest A.; Trotti, Andy

doi:10.1016/j.ijrobp.2007.04.080

Cited by 26 publications

(19 citation statements)

References 20 publications

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“…Overall treatment intensity of HNSCC is close to patient tolerance (10, 11) and new strategies are warranted in an attempt to optimize benefit/risk ratios at the individual patient level. Detailed patterns of failure studies can help determine where the radiation dose will help most in terms of prolonging the time to loco-regional progression.…”

Section: Discussionmentioning

confidence: 99%

Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake

Due

Vogelius

Aznar

et al. 2014

Radiotherapy and Oncology

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109

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Background and Purpose To analyze the recurrence pattern in relation to target volumes and 18F-fluorodeoxyglucose (FDG) uptake on positron emission tomography in head and neck squamous cell carcinoma (HNSCC) patients treated with definitive chemoradiation. Material and Methods 520 patients received radiotherapy for HNSCC from 2005–2009. Among 100 patients achieving complete clinical response and a later recurrence, 39 patients with 48 loco-regional failures had a recurrence CT scan before any salvage therapy. The estimated point of origin of each recurrence was transferred to the planning CT by deformable image co-registration. The recurrence position was then related to the delineated target volumes and iso-SUV-contours relative to the maximum standard uptake value (SUV). We defined the recurrence density as the total number of recurrences in a sub-volume divided by the sum of that volume for all patients. Results 54% (95% CI 37–69%) of recurrences originated inside the FDG-positive volume and 96% (95% CI 86–99%) in the high dose region. Recurrence density was significantly higher in the central target volumes (P<0.0001) and increased with increasing FDG avidity (P=0.036). Conclusions The detailed pattern-of-failure data analysis suggest that most recurrences occur in the FDG PET positive areas or the solid tumor.

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Section: Discussionmentioning

confidence: 99%

Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake

Due

Vogelius

Aznar

et al. 2014

Radiotherapy and Oncology

Self Cite

109

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“…There is a lack of consensus regarding the best dysphagia measures or the optimal adverse event tool, and there is no standardization for the timing of dysphagia evaluation. Consequently, there is a lack of uniform assessment and reporting,12, 13 resulting in the incidence of dysphagia being underreported 13. These limitations in dysphagia toxicity reporting hamper our understanding of and our ability to appropriately counsel patients regarding cure rates and toxicities among the various combined modality management options.…”

Section: Discussionmentioning

confidence: 99%

Combined antegrade and retrograde esophageal dilation for head and neck cancer‐related complete esophageal stenosis

et al. 2009

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CARD was safe and effective. Intraoperative patency was achieved in 91% of patients. Eighty percent resumed oral intake. The majority of patients had their GTs removed and resumed a soft or regular diet. Dilation failure was associated with laryngeal, pharyngeal, and excessively long esophageal stenosis, often resulting from radionecrosis. Complications were minor. CARD should be considered before relegating patients with complete esophageal stenosis to chronic GT dependence or subjecting them to laryngopharyngo esophagectomy.

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“…One of the goals of QUANTEC is to summarize the available 3D dose/volume/outcome data. At the same time, increasing use of combined modality therapy has often increased the burden of early and late toxicities 1 . Understanding the trade-off between an expected decrease in toxicity resulting from an improved dose distribution, and the possible increase in toxicity with systemic agents, is an increasingly pertinent, yet poorly researched, area.…”

Section: Why Quantec?mentioning

confidence: 99%

Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues

Bentzen

Constine

Deasy

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

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939

627

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Advances in dose/volume/outcome (or normal tissue complication probability, NTCP) modeling since the seminal Emami paper from 1991 are reviewed. There has been some progress with an increasing number of studies on large patient samples with three-dimensional dosimetry. Nevertheless, NTCP models are not ideal. Issues related to the grading of side effects, selection of appropriate statistical methods, testing of internal and external model validity, and quantification of predictive power and statistical uncertainty, all limit the usefulness of much of the published literature. Synthesis (meta-analysis) of data from multiple studies is often impossible due to sub-optimal primary analysis, insufficient reporting and variations in the models and predictors analyzed. Clinical limitations to the current knowledge-base includes the need for more data on the effect of patient-related co-factors, interactions between dose-distribution and cytotoxic or molecular targeted agents, and the effect of dose fractions and overall treatment time in relation to non-uniform dose distributions. Research priorities for the next 5 to 10 years are proposed.

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Increasing Toxicity in Nonoperative Head and Neck Cancer Treatment: Investigations and Interventions

Cited by 26 publications

References 20 publications

Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake

Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake

Combined antegrade and retrograde esophageal dilation for head and neck cancer‐related complete esophageal stenosis

Quantitative Analyses of Normal Tissue Effects in the Clinic (QUANTEC): An Introduction to the Scientific Issues

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