Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer

Ang, K. Kian; Trotti, Andy; Brown, Barry W.; Garden, Adam S.; Foote, Robert L.; Morrison, William H.; Geara, Fady; Klotch, Douglas W.; Goepfert, Helmuth; Peters, Lester J.

doi:10.1016/s0360-3016(01)01690-x

Cited by 575 publications

(434 citation statements)

References 17 publications

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“…Several studies referred the impact of a prolonged interval between surgery and postoperative radiotherapy on a prognosis [26][27]. Protracted waiting time on radiotherapy is associated with significantly lower locoregional control and overall survival.…”

Section: Discussionmentioning

confidence: 99%

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Pála

Odrážka²,

Holečková³

et al. 2012

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The objective of this study was to evaluate the feasibility, toxicity and efficacy of postoperative radiochemotherapy with weekly cisplatin in locoregionally advanced or high risk head and neck cancer in a single institutional setting.Patients with head and neck cancer of stage III/IV or patients with insufficient margins of resection were included in the study. Radiotherapy consisted of 70 Gy/ 7 weeks/ 35 fraction after R1/2 resection and 60-64 Gy/ 6-6,5 weeks/ 30-32 fraction after R0 resection, respectively. All patients received concurrent cisplatin 40 mg/m 2 weekly. Between 7/2002 and 12/2008, 100 consecutive patients [WHO ≤ 2, male to female ratio 84/16, median age 54 years] were treated. Tumors of the oropharynx were the most frequent (49%) and stage IV was predominant (86%). 96% patients received the full radiation treatment as planned, median total tumor dose was 66 Gy. Omission of weekly cisplatin had been occurring frequently, the most frequent reason for its early cessation were hematological toxicities (34%). Grade 3/4 mucosal toxicity developed in 32%. No death was observed during the treatment. The late toxicities were acceptable, predominantly subcutaneous fibrosis and xerostomia in most of the cases. We recorded six cases of osteonecrosis. Two and half year overall survival, locoregional control, time to progression and disease free survival were 64%, 88%, 79% and 59%, respectively.Postoperative radiochemotherapy with weekly cisplatin is toxic, but tolerable and highly effective in terms of locoregional control and survival. Multivariete analysis revealed that the only prognostic factor for survival was primary surgery at the University centre.

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Section: Discussionmentioning

confidence: 99%

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Pála

Odrážka²,

Holečková³

et al. 2012

neo

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“…From 1988 until 1991, routine fractionation was 1.8 Gy mostly prescribed to the 95% isodose five, six, or seven times per week (applying two fractions on 1 or 2 days/week with an interval of at least 6 h). Hyperfractionation has been used since 1988, applying two daily fractions of 1.20 Gy on 5 days/week with an interfraction interval of at least 6 h. Since 1991, also moderately accelerated fractionation has been used: 1.8 Gy seven times per week or 2.0 Gy six times per week or the concomitant boost regime of the MDA Hospital in Houston, TX, USA [1]. The latter was preferred for postoperative irradiation in high-risk stages (28 ϫ 1.80 Gy plus 9 ϫ 1.50 Gy to a total dose between 63.9 and 70.5 Gy in 5.2-6 weeks).…”

Section: Radiotherapymentioning

confidence: 99%

Osteoradionecrosis of the Mandibula in Patients Treated with Different Fractionations

2004

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“…Likewise, Ang et al [18] found that the subset of patients who delayed the start of RT benefit more from AF, confirming the importance of the treatment package time from surgery to postoperative treatment.…”

Section: State Of the Artmentioning

confidence: 85%

“…Altered fractionation (AF) treatments have been widely studied in HNC to minimize the effect of tumor repopulation [17,18,19,20]. They are based on the radiobiological concept of increasing the tumor control rate when the same dose is delivered over a shorter time; AF consists of shortening RT duration or increasing the total RT dose, leaving the treatment time unchanged, in order to counteract tumor cell repopulation.…”

Section: State Of the Artmentioning

confidence: 99%

See 1 more Smart Citation

Postoperative Therapy in Head and Neck Cancer: State of the Art, Risk Subset, Prognosis and Unsolved Questions

et al. 2011

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Head and neck cancer may be easily controlled at early stages, but resectable locally advanced disease often relapses at T and N sites. Therefore, adequate adjuvant treatment is of crucial importance for improving local control and/or survival. Unfortunately, little data are available on the adjuvant setting. Adjuvant radiotherapy is regarded as a standard approach for patients with locally advanced radically resected head and neck cancer, while postoperative chemotherapy alone cannot be considered outside of clinical trials. However, chemoradiotherapy is widely considered superior to radiotherapy in patients at a high risk of relapse and may be considered the standard treatment in this population. In this respect, in the last few decades, there has been a growing interest due to the emerging data on both tumor biology and clinical trials. Several pathological and molecular factors, affecting behavior and head and neck cancer prognosis, could allow for a better selection of postoperative treatment. More recently, new prognostic and predictive factors were identified, including biomolecular aspects, human papillomavirus infection and lifestyle. The integration of these new factors deserves dedicated clinical studies, but the available knowledge already allows some deductive hypotheses. We performed a review of the literature to analyze the role of therapy in the postoperative setting and to discuss both the possibility of a different approach to each class of risk and the unsolved question for which randomized trials are warranted.

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Randomized trial addressing risk features and time factors of surgery plus radiotherapy in advanced head-and-neck cancer

Cited by 575 publications

References 17 publications

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Postoperative Radiochemotherapy With Weekly Cisplatin in Patients With Head and Neck Cancer Single-Institution Outcome Analysis

Osteoradionecrosis of the Mandibula in Patients Treated with Different Fractionations

Postoperative Therapy in Head and Neck Cancer: State of the Art, Risk Subset, Prognosis and Unsolved Questions

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