Revising the Radiobiological Model of Synchronous Chemotherapy in Head-and-Neck Cancer: A New Analysis Examining Reduced Weighting of Accelerated Repopulation

Revised radiobiological modelling of the contribution of synchronous chemotherapy to the rate of grades 3–4 mucositis in head and neck cancer

“…For the purposes of this study, the methods described by Meade et al were employed but with substitution of appropriate parameters into the linear quadratic equation to take account of the end point being the rate of grades 3-4 mucositis as opposed to local control. 10 Briefly, trials of synchronous chemoradiation with platinum-based regimes in head and neck tumours were identified using a Medline search of trials in addition to meeting abstract databases. Studies that compared radiotherapy alone with platinum-based chemoradiation or those that compared different radiotherapy fractionation schedules with concurrent platinum-based chemotherapy were selected.…”

In Regard to Beitler et al

“…The absence of a benefit for accelerated radiation therapy in the setting of synchronous chemotherapy in the GORTEC-9902 study has been noted (4,5). However, a less frequently noted outcome of this study was the very high rate of 5-year feeding tube dependency (25%) in the accelerated radiation therapyealone arm.…”

“…Early mucosal reactions may indeed predict later sequelae, as do dose, fraction size, and treatment duration (5). As a profession, we have used late effects modeling as "a one size fits all" predictive tool for late-responding tissue, although we know this is naïve (6).…”

Efficacy and mucosal toxicity of concomitant chemo-radiotherapy in patients with locally-advanced squamous cell carcinoma of the head-and-neck in the light of a novel mathematical model

“…Unfortunately, these models are not available for CRT schedules. Hartley and colleagues (Hartley et al, 2010) reported a linear increase on Table 4. the toxicity rates for each EQD 2 increment as well as on local control (Meade et al, 2013). Unfortunately, this model does not take into consideration the type of CT.…”

“…In fact, 5y-OS rates were similar for concomitant low doses DDP-versus carbo-based CRT (Ghi and Floriani, 2011), but a statistically higher 5y-OS was observed when few administrations and the high DDP doses were used. Indeed, this treatment strategy currently represents the gold standard CRT for LA-HNSCC patients (Meade et al, 2013). Of note, our analysis includes a single trial with low doses DDP-or Carbobased CRT.…”