Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Gupta, Tejpal; Kannan, Sadhana; Ghosh‐Laskar, Sarbani; Agarwal, Jai Prakash

doi:10.1016/j.clon.2015.09.002

Cited by 23 publications

(22 citation statements)

References 43 publications

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“…1 Studies on oral mucositis (OM). Incidence of OM was investigated in patients with hematopoietic stem cell transplantation (HSCT) in 14 studies (32.6%) [3,5,14,17,19,28,31,36,37,39,44,56,62,67], in head and neck cancer (HNC) patients in 13 studies (30.2%) [18,21,29,40,50,51,55,59,60,61,63,70,73], in patients with chemotherapy in 13 studies (30.2%) [15,16,22,23,24,25,30,34,38,46,48,58,71], with mixed tumor types and treatment in 1 study (2.3%) [13] and with palliative care in 2 studies (4.7%) [32,57]. Cost related to OM in patients undergoing HSCT was the focus in 4 studies [7,14,17,54], in HNC patients in 2 studies [43,47], in patients with chemotherapy in 6 studies [9,10,11,12,42,49,68], and in patients with mixed tumor types and treatment in 2 studies [20,45].…”

Section: Resultsmentioning

confidence: 99%

“…There were 7 studies covering 2 topics each [3,13,14,15,16,17,18] and 7 meta-analyses [19,20,21,22,23,24,25]. 20 studies (29.4%) were from Europe [3,5,9,10,11,12,15,22,26,27,28,29,30,31,32,33,34,35,36,37,38,] 20 from the US [4,14,17,19,20,24,39,40,41,42,43,44,45,46,47,48,49,50,51,52], 3 studies (4.4%) from US plus Europe [23,53,54], 6 studies (8.8%) from Japan [16,55,56,57,58,59], 6 studies (8.8%) from China [18,25,60,61,62,63], 2 studies (3.0%) from Hong Kong [13,64,65], 3 studies (4.4%) from Canada [66,67,68], 3 studies (4.4%) from India [21,69,70] and 5 studies (7.4%) from other countries [7,71,72,73,74]. 21 studies (30.9%) used the National Cancer Institute - Common Terminology Criteria for Adverse Events (NCI-CTCAE) scale for assessment of OM.…”

Section: Resultsmentioning

confidence: 99%

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Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

et al. 2018

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Background: Surprisingly little is known about the burden of oral mucositis (OM). We provide a systematic review of studies on the burden of OM (incidence, economic impact, health-related quality of life (HRQoL)). Methods: Systematic literature searches were made in BIOSIS, EMBASE, and MEDLINE. Inclusion criteria were studies on OM in hematology/oncology patients of ≥ 18 years, journal articles, English language, and published between 2000 and 2016; OM treatment studies were excluded. Quality assessment was performed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results: We screened 4,996 hits, and identified 68 studies of which 13 were without transparency on OM grading. The evidence level of 65 studies was rated ‘low' or ‘very low' in 58.5%, ‘moderate' in 20% and ‘high' in 21.5%. Mean value of incidence (7 studies) was 83.5% for all grades of OM with hematopoietic stem cell transplantation. OM incidence for all grades in head and neck cancer patients was 59.4-100%. Considering the economic impact, 16 studies showed highly variable numbers. HRQoL was measured in 16 studies using 13 different instruments. Statistically significant changes in HRQoL scores were demonstrated. Conclusion: OM is common, burdensome, costly and imposes major reductions in HRQoL. However, from a quality standpoint, the level of current evidence in OM is disappointing. The field needs continued attention to address methodological challenges.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

et al. 2018

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“…A meta-analysis showed that conventionally fractionated concurrent chemoradiotherapy improved survival outcome for locoregionally advanced HNC [36]. However, improved results are related to higher toxicity like myelosuppression and infections.…”

Section: Chemoradiotherapymentioning

confidence: 97%

Early death among head and neck cancer patients

Farnebo

Malila

Mäkitie

et al. 2016

Current Opinion in Otolaryngology & Head and Neck Surgery

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“…In summary, multiple meta-analyses have reported that alternated radiotherapy could not appeal its merit if combined with chemotherapy [29, 51]. For example, Gupta et al carried out a meta-analysis including five RCTs, involving 1117 patients and 627 deaths [50].…”

Section: Alternate Fractionation: Influence Of Ott and Fraction Sizementioning

confidence: 99%

“…CRT did not elevate the ratio of severe acute toxicity (dermatitis and mucositis); however, hematological toxicity, nephrotoxicity and late xerostomia were significantly increased with CRT. At present, no form of acceleration can potentially compensate fully for the lack of concurrent chemotherapy [29, 51]. …”

Section: Alternate Fractionation: Influence Of Ott and Fraction Sizementioning

confidence: 99%

Radiotherapy for laryngeal cancer—technical aspects and alternate fractionation

Yamazaki

Suzuki

Nakamura

et al. 2017

Journal of Radiation Research

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Early laryngeal, especially glottic, cancer is a good candidate for radiotherapy because obvious early symptoms (e.g. hoarseness) make earlier treatment possible and with highly successful localized control. This type of cancer is also a good model for exploring the basic principles of radiation oncology and several key findings (e.g. dose, fractionation, field size, patient fixation, and overall treatment time) have been noted. For example, unintended poor outcomes have been reported during transition from 60Cobalt to linear accelerator installation in the 1960s, with usage of higher energy photons causing poor dose distribution. In addition, shell fixation made precise dose delivery possible, but simultaneously elevated toxicity if a larger treatment field was necessary. Of particular interest to the radiation therapy community was altered fractionation gain as a way to improve local tumor control and survival rate. Unfortunately, this interest ceased with advancements in chemotherapeutic agents because alternate fractionation could not improve outcomes in chemoradiotherapy settings. At present, no form of acceleration can potentially compensate fully for the lack of concurrent chemotherapy. In addition, the substantial workload associated with this technique made it difficult to add extra fractionation routinely in busy clinical hospitals. Hypofractionation, on the other hand, uses a larger single fractionation dose (2–3 Gy), making it a reasonable and attractive option for T1–T2 early glottic cancer because it can improve local control without the additional workload. Recently, Japan Clinical Oncology Group study 0701 reprised its role in early T1–T2 glottic cancer research, demonstrating that this strategy could be an optional standard therapy. Herein, we review radiotherapy history from 60Cobalt to modern linear accelerator, with special focus on the role of alternate fractionation.

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Systematic Review and Meta-analysis of Conventionally Fractionated Concurrent Chemoradiotherapy versus Altered Fractionation Radiotherapy Alone in the Definitive Management of Locoregionally Advanced Head and Neck Squamous Cell Carcinoma

Cited by 23 publications

References 43 publications

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

Burden of Oral Mucositis: A Systematic Review and Implications for Future Research

Early death among head and neck cancer patients

Radiotherapy for laryngeal cancer—technical aspects and alternate fractionation

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