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Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks)

An alternative in the treatment of locally advanced head and neck cancer

Akzelerierte Strahlentherapie in Concomitant-Boost-Technik (69,5 Gy/5 Wochen) als Therapiealternative für lokal fortgeschrittene Kopf-Hals-Tumoren

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Background and Purpose

To present the feasibility and results of accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks) in the treatment of locally advanced head and neck cancer.

Patients and Methods

A total of 65 patients were treated between June 2006 and August 2009. The distribution of clinical stages was as follows: II 11%, III 23%, IV 61%, and not defined 5%.

Results

The median follow-up was 30.5 months. The treatment plan was completed in 94% of patients. Patients were treated using the conformal or intensity-modulated radiotherapy (IMRT) technique. The median overall treatment time was 37 days (13–45 days). The mean radiotherapy dose was 68.4 Gy (16–74 Gy). Overall survival was 69% after 2 years. Disease-free survival was 62% after 2 years. Acute toxicity ≥ grade 3(RTOG scale) included mucositis (grade 3: 42.6%), pharynx (grade 3: 42.3%), skin (grade 3: 9.5%), larynx (grade 3: 4%), while late toxicity affected skin (grade 3: 6.25%) and salivary glands (grade 3: 3.7%).

Conclusion

Accelerated radiotherapy with concomitant boost technique is feasible in patients with locally advanced head and neck cancer, has an acceptable toxicity profile, and yields promising treatment results.

Hintergrund und Ziel

Präsentation von Durchführbarkeit und Ergebnissen der Strahlentherapie mit Concomitant-Boost-Technik (69,5 Gy/5 Wochen) bei der Behandlung von lokal fortgeschrittenen Kopf-Hals-Tumoren.

Patienten und Methodik

Im Zeitraum 6/06 bis 8/09 wurden 65 Patienten behandelt. Stadienverteilung: II in 11%, III in 23%, IV in 61% und undefinierbar in 5% der Fälle.

Ergebnisse

Mediane Beoachtungszeit: 30,5 Monate. Die geplante Therapie ließ sich bei 94% der Patienten durchführen. Die Patienten wurden mit 3D-konformaler oder IMRT-Technik bestrahlt. Der Median der Bestrahlungsdauer betrug 37 Tage (13–45 Tage). Die applizierte durchschnittliche Dosis betrug 68,4 Gy (16–74 Gy). Das gesamte 2-Jahres-Überleben betrug 69%, Das krankheitsfreie 2-Jahres-Überleben 62%. Akuttoxizitäten von mindestens Grad 3 (RTOG Skala) betrafen Mukositis (Grad 3: 42%), Pharynx (Grad 3: 42,3%) Haut (Grad 3: 9,5%) und Kehlkopf (Grad 3: 4%). Die Spättoxizitäten betrafen Haut (Grad 3: 9,5%) und Speicheldrüsen (Grad 3: 3,7%).

Schlussfolgerung

Die akzelerierte Strahlentherapie mit der Concomitant-Boost-Technik ist bei Patienten mit Kopf- und Halstumoren durchführbar. Diese Technik hat ein akzeptables Toxizitätsprofil und gute Heilungsergebnisse.

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References

  1. Bonner JA, Harari PM, Giralt J. Radiotherapy plus cetuximab for squamous-cell carcinoma of the head and neck. N Engl J Med 2006;354:567–78.

    Article  PubMed  CAS  Google Scholar 

  2. Bourhis J, Etessami A, Wilbault P et al. Altered fractionated radiotherapy in the management of head and neck carcinomas: advantages and limitations. Curr Opin Oncol 2004;16:215–9.

    Article  PubMed  Google Scholar 

  3. Denham JW, Kron T. Extinction of the weakest. Int J Radiat Oncol Biol 2001;51:807-19.

    Google Scholar 

  4. Dische S, Saunders M, Barrett A et al. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiother Oncol 1997 44:123–36.

    Article  PubMed  CAS  Google Scholar 

  5. Eriksena JG, Steinicheb T, Overgaard J. The influence of epidermal growth factor receptor and tumor differentiation on the response to accelerated radiotherapy of squamous cell carcinomas of the head and neck in the randomized DAHANCA 6 and 7 study. Radiother Oncol 2005;74:93–100.

    Article  Google Scholar 

  6. Farrag A, Voordeckers M, Tournel K et al. Pattern of failure after helical tomotherapy in head and neck cancer. Strahlenther Onkol 2010;186:511–6.

    Article  PubMed  Google Scholar 

  7. Fowler JW. Optimum overall times II: extended modelling for head and neck radiotherapy. Clin Oncol 2008;20:113–26.

    Article  CAS  Google Scholar 

  8. Fowler JW. Is there an optimal overall time for head and neck radiotherapy? A review, with new modelling. Clin Oncol 2007;19:8–22.

    Article  CAS  Google Scholar 

  9. Fowler JF, Harari PM, Leborgne F et al. Acute radiation reactions in oral and pharyngeal mucosa: tolerable levels in Alfred fractionation Schedule. Radiotherap Oncol 2009;69:161–8.

    Article  Google Scholar 

  10. Fu KK, Pajak TF, Trotti A et al. A Radiation Therapy Oncology Group (RTOG) phase III randomized study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7–16.

    Article  PubMed  CAS  Google Scholar 

  11. Ghoshal JS, Goda I, Mallick TS et al. Concomitant boost radiotherapy compared with conventional radiotherapy in squamous cell carcinoma of the head and neck: a phase III trial from a single institution in India. Clin Oncol 2008;20:212–20.

    Article  CAS  Google Scholar 

  12. Giro C, Berger B, Bölke E et al. High rate of severe radiation dermatitis during radiation therapy with concurrent cetuximab in head and neck cancer: results of a survey in EORTC institutes. Radiother Oncol 2009;90:166–71.

    Article  PubMed  CAS  Google Scholar 

  13. Gun GB, Endres JE, Parker B et al. A phase I/II study of altered fractionated IMRT alone for intermediate T-stage oropharyngeal carcinoma. Strahlenther Onkol 2010;:489–95.

    Article  Google Scholar 

  14. Hendry JH, Roberts SA, Slevin NJ et al. Influence of radiotherapy treatment time on control of laryngeal cancer: comparisons between centres in Manchester, UK and Toronto, Canada. Radiother Oncol 1994;31:14–22.

    Article  PubMed  CAS  Google Scholar 

  15. Horiot JC, LeFur R, N’Guyen T et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 1992;25:231–41.

    Article  PubMed  CAS  Google Scholar 

  16. Overgaard J, Hansen HS, Specht L et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet 2003;20:933–40.

    Article  Google Scholar 

  17. Pignon JP, Bourhis J, Domenge C, et al., on behalf of the MACH-NC Collaborative Group. Chemotherapy added to locoregional treatment for head and neck squamous-cell carcinoma: three meta-analyses of updated individual data. Lancet 2000;355:949–55.

    PubMed  CAS  Google Scholar 

  18. Roberts SA, Hendry JH, Brewster AE et al. The influence of radiotherapy treatment time on the control of laryngeal cancer: a direct analysis of data from two British Institute of Radiology trials to calculate the lag period and the time factor. Br J Radiol 1994;67:790–4.

    Article  PubMed  CAS  Google Scholar 

  19. Skladowski K, Macejewski B, Pileski B et al. Randomized clinical trial of accelerated 7 days per week fractionation in radiotherapy for head and neck cancer. Preliminary report on therapy toxicity. Radiother Oncol 1996;40:137–45.

    Article  PubMed  Google Scholar 

  20. Steinmann D, Cerny B, Karstens JH et al. Chemoradiotherapy with weekly cisplatin 40 mg/m2 in 103 head-and-neck cancer patients. Strahlenther Onkol 2009;185:682–8.

    Article  PubMed  Google Scholar 

  21. Terhaard CH, Kal HB, Hordijk GJ. Why to start the concomitant boost in accelerated radiotherapy for advanced laryngeal cancer in week 3. Int J Radiat Oncol Biol Phys 2005;62:62–9.

    Article  PubMed  Google Scholar 

  22. Tribius S, Kronemann S, Kilic Y et al. Radiochemotherapy including cisplatin alone versus cisplatin + 5-fluorouracil for locally advanced unresectable stage IV squamous cell carcinoma of the head and neck. Strahlenther Onkol 2009;185:675–81.

    Article  PubMed  Google Scholar 

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Authors and Affiliations

  1. Institute of Radiation Oncology, Faculty Hospital Na Bulovce and 1st Faculty of Medicine Charles University, Prague, The Czech Republic

    Jiri Kubes MD, PhD, Vladimir Vondracek & Miloslav Pala

  2. Department of Oncology, Faculty Hospital Ostrava, Ostrava, The Czech Republic

    Jakub Cvek & David Feltl

  3. Institute of Radiation Oncology, Faculty Hospital Na Bulovce, Budínova 2, Prague 8, 18000, The Czech Republic

    Jiri Kubes MD, PhD

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  1. Jiri Kubes MD, PhD
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  2. Jakub Cvek
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  3. Vladimir Vondracek
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  4. Miloslav Pala
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  5. David Feltl
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Correspondence to Jiri Kubes MD, PhD.

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Kubes, J., Cvek, J., Vondracek, V. et al. Accelerated radiotherapy with concomitant boost technique (69.5 Gy/5 weeks). Strahlenther Onkol 187, 651–655 (2011). https://doi.org/10.1007/s00066-011-2246-2

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  • DOI: https://doi.org/10.1007/s00066-011-2246-2

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