Hartley, Andrew, Sanghera, Paul, Kazi, W., Mehanna, Hisham M., McConkey, Christopher C., Glaholm, John and Fowler, J. (Jack). (2011) Correlation of currently used radiobiological parameters with local control and acute and late mucosal toxicity in randomised studies of altered fractionation for locally advanced head and neck cancer. Clinical Oncology, Volume 23 (Number 1). pp. 29-33. ISSN 0936-6555

Full text not available from this repository.

Abstract

Aims: There has been a resurgence in interest in radiobiological modelling in head and neck cancer. The aim of this study was to determine if currently used parameters accurately predict both tumour and toxicity outcomes. Materials and methods: Trials were identified from a recent meta-analysis of altered fractionation. The tumour biologically effective dose (tBED; alpha/beta= 10 Gy, t(k) [onset time of accelerated repopulation] = 22 days, t(p) [average doubling time during accelerated repopulation] = 3 days, alpha = 0.3 Gy(-1)), acute mucosal biologically effective dose (amBED; alpha/beta= 10 Gy, t(k)= 7 days, t(p)= 2.5 days, alpha = 0.3 Gy(-1)) and late mucosal biologically effective dose (ImBED; alpha/beta= 3 Gy) were calculated for each arm of each trial. The correlation between the absolute percentage difference in BED between treatment arms and the observed percentage difference in local control, acute grade 3 mucositis and late grade 3 mucosal reaction was then assessed. Results: A strong correlation was observed between the percentage difference in tBED and the percentage difference in local control (P= 0.006). A trend towards a correlation was seen between the percentage difference in amBED and the percentage difference in acute grade 3 mucositis (P= 0.06). A significant correlation was observed between the percentage difference in ImBED and the percentage difference in grade 3 late mucosal toxicity (P= 0.02). However, a 15% decrease in ImBED between control and experimental arms of the study was necessary for any sparing of late mucosal toxicity to be observed. Conclusions: Currently used parameters for tumour accurately predict outcomes in randomised trials of altered fractionation. Although the relationship may be more complex for late mucosal reaction, the presence of a correlation is noteworthy given the infrequent reporting or occurrence of this toxicity. In the future, radiobiological modelling with the addition of volumetric parameters will be highly relevant, given attempts to dose escalate with intensity-modulated radiotherapy in poor risk patients and de-escalate in patients with an excellent prognosis. (C) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Item Type:	Journal Article
Subjects:	R Medicine > R Medicine (General) R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)
Divisions:	Faculty of Medicine > Warwick Medical School
Library of Congress Subject Headings (LCSH):	Mucous membranes -- Diseases, Head -- Cancer, Neck -- Cancer, Radiobiology -- Mathematical models, Squamous cell carcinoma
Journal or Publication Title:	Clinical Oncology
Publisher:	Elsevier Science London
ISSN:	0936-6555
Date:	February 2011
Volume:	Volume 23
Number:	Number 1
Page Range:	pp. 29-33
Identification Number:	10.1016/j.clon.2010.08.007
Status:	Peer Reviewed
Publication Status:	Published
Access rights to Published version:	Restricted or Subscription Access
References:	[1] Kasibhatla M, Kirkpatrick J, Brizel D. How much radiation is the chemotherapy worth in advanced head and neck cancer? Int J Radiat Oncol Biol Phys 2007;68:1491e1495. [2] Fowler J. Correction to Kasibhatla et al. (Int J Radiat Oncol Biol Phys 2007;68:1491e1495). How much radiation is the chemotherapy worth in advanced head and neck cancer? Int J Radiat Oncol Biol Phys 2008;71:326e329. [3] Lee I, Eisbruch A. Mucositis versus tumor control: the therapeutic index of adding chemotherapy to irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 2009;75(4): 1060e1063. [4] Hartley A, Sanghera P,Glaholm J, et al. Radiobiologicalmodelling of the therapeutic ratio for the addition of synchronous chemotherapy to radiotherapy in locally advanced squamous cell carcinoma of the head and neck. Clin Oncol 2010;22:125e130. [5] Bourrhis J, Overgaard J, Audry H, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a metaanalysis. Lancet 2006;368(9538):843e854. [6] Bourrhis J, Lapeyre M, Tortochaux J, et al. Phase III randomized trial of very accelerated radiation therapy compared with conventional radiation therapy in squamous cell head and neck cancer: a GORTEC trial. J Clin Oncol 2006;24:2873e2878. [7] Horiot JC, Le Fur 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;25:231e241. [8] 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(2): 123e136. [9] Bentzen S, Saunders M, Dische S, et al. Radiotherapy-related early morbidity in head and neck cancer: quantitative clinical radiobiology as deduced from the CHART trial. Radiother Oncol 2001;60:123e135. [10] Poulsen MG, Denham JW, Peters LJ, et al. A randomised trial of accelerated and conventional radiotherapy for stage III and IV squamous carcinoma of the head and neck: a Trans-Tasman Radiation Oncology Group study. Radiother Oncol 2001;60: 113. [11] Overgaard J, Hansen H, Specht L, et al. Five compared with six fractions per week of conventional radiotherapy of squamouscell carcinoma of head and neck: DAHANCA 6&7 randomised controlled trial. Lancet 2003;362:933e940. [12] Fu K, Pajak T, 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;48:7e16. [13] Horiot J, Bontemps P, van den Bogaert W, et al. Accelerated fractionation (AF) compared to conventional fractionation (CF) improves locoregional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomised trial. Radiother Oncol 1997;44:111e121. [14] Fakhry C, Westra W, Li S, et al. Improved survival of patients with human papillomavirus-positive head and neck squamous cell carcinoma in a prospective clinical trial. J Natl Cancer Inst 2008;100:261e269. [15] Caudell J, Meredith R, Spencer S, et al. Margin on gross tumor volume and risk of local recurrence in head and neck cancer. Int J Radiat Oncol Biol Phys 2010;76:164e168. [16] Lee I. In reply to Dr Hartley. Int J Radiat Oncol Biol Phys 2009;75:315. [17] Dorr W, Hamilton C, Boyd T, et al. Radiation induced changes in cellularity and proliferation in human oral mucosa. Int J Radiat Oncol Biol Phys 2002;52:911e917. [18] Fowler JF, Harari PM, Leborgne F, et al. Acute radiation reactions in oral and pharyngeal mucosa: tolerable levels in altered fractionation schedules. Radiother Oncol 2003;69: 161e168. [19] Fowler JF. Is there an optimum overall time for head and neck radiotherapy. A review with new modelling. Clin Oncol 2007; 19:8e22.
URI:	http://wrap.warwick.ac.uk/id/eprint/41625

Data sourced from Thomson Reuters' Web of Knowledge

Request changes to a record

Actions (login required)

View Item