Hypofractionated accelerated radiotherapy with concurrent carboplatin for locally advanced squamous cell carcinoma of the head and neck
Chan, A. K., Sanghera, Paul, Choo, B. A., McConkey, Christopher C., Mehanna, Hisham M., Parmar, Satyesh, Pracy, P., Glaholm, John and Hartley, Andrew. (2011) Hypofractionated accelerated radiotherapy with concurrent carboplatin for locally advanced squamous cell carcinoma of the head and neck. Clinical Oncology, Volume 23 (Number 1). pp. 34-39. ISSN 0936-6555Full text not available from this repository.
Official URL: http://dx.doi.org/10.1016/j.clon.2010.07.015
Aims: Hypofractionated accelerated radiotherapy with concurrent carboplatin utilises both advantages of altered fractionation and synchronous chemotherapy to maximise local control in locally advanced head and neck cancer. Such fractionation schedules are increasingly used in the intensity-modulated radiotherapy era and the aim of this study was to determine the outcome of hypofractionated accelerated radiotherapy with carboplatin. Materials and methods: One hundred and fifty consecutive patients with squamous cell carcinoma of the larynx, oropharynx, oral cavity and hypopharynx (International Union Against Cancer [IUAC] stage II-IV) treated with 55 Gy in 20 fractions over 25 days with concurrent carboplatin were analysed. Outcome measures were 2 year overall survival, local control and disease-free survival. Results: The median follow-up in surviving patients was 25 months. IUAC stages: II n = 15; III n = 42; IV n = 93. Two year overall survival for all patients was 74.9% (95% confidence interval 66.0-81.7%). Two year local control was 78.3% (95% confidence interval 69.6-84.8%). Two year disease-free survival was 67.2% (95% confidence interval 58.3-74.7%). There were 135 patients with stage III and IV disease. For these patients, the 2 year overall survival, local control and disease-free survival were 74.3% (95% confidence interval 64.7-81.6%), 79.1% (95% confidence interval 69.8-85.9%) and 67.6% (95% confidence interval 58.0-75.4%), respectively. Prolonged grade 3 and 4 mucositis seen at >= 4 weeks were present in 9 and 0.7%, respectively. Late feeding dysfunction (determined by dependence on a feeding tube at 1 year) was seen in 13% of the surviving patients at 1 year. Conclusion: Hypofractionated accelerated radiotherapy with concurrent carboplatin achieves a high local control. This regimen should be considered for a radiotherapy dose-escalation study using intensity-modulated radiotherapy. (C) 2010 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.
|Item Type:||Journal Article|
|Subjects:||R Medicine > RC Internal medicine > RC0254 Neoplasms. Tumors. Oncology (including Cancer)|
|Divisions:||Faculty of Medicine > Warwick Medical School|
|Library of Congress Subject Headings (LCSH):||Squamous cell carcinoma, Head -- Cancer -- Radiotherapy, Neck -- Cancer -- Radiotherapy, Antineoplastic agents|
|Journal or Publication Title:||Clinical Oncology|
|Publisher:||Elsevier Science London|
|Page Range:||pp. 34-39|
|Access rights to Published version:||Restricted or Subscription Access|
|Funder:||Roche, Schering-Plough International|
|References:|| Pignon J, Bourhis J, Domenge C, Designe L. Chemotherapy added to locoregional treatment for head and neck squamous cell carcinoma: three meta-analyses of updated individual data. Lancet 2000;355:949e955.  Pignon J, Le Maitre A, Maillard E, Bourhis J. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 2009;92:4e14.  BudachW, Hehr T, Budach V, Belka C, Dietz K. A meta-analysis of hyperfractionated and accelerated radiotherapy and combined chemotherapy and radiotherapy regimens in unresected locally advanced squamous cell carcinoma of the head and neck. BMC Cancer 2006;6:28.  James ND, Robertson G, Squire CJ, Forbes H, Jones K, Cottier B. A national audit of radiotherapy fractionation in head and neck cancer. J Clin Oncol 2003;15:41e46.  Ho KF, Fowler JF, Sykes AJ, Yap BK, Lee LW, Slevin NJ. IMRT dose fractionation for head and neck cancer: variation in current approaches will make standardisation difficult. Acta Oncol 2009;48:431e439.  Fowler JF. Is there an optimum overall time for head and neck radiotherapy? A review, with new modelling. Clin Oncol (R Coll Radiol) 2007;19:8e22.  Fowler JF. Optimum overall times II: extended modelling for head and neck radiotherapy. Clin Oncol (R Coll Radiol) 2008; 20:113e126.  Madhava K, Hartley A, Wake M, Watkinson JC, Glaholm J. Carboplatin and hypofractionated accelerated radiotherapy: a dose escalation study of an outpatient chemoradiation schedule for squamous cell carcinoma of the head and neck. Clin Oncol (R Coll Radiol) 2006;18:77e81.  Sanghera P, McConkey C, Ho KF, Glaholm J, Hartley A. Hypofractionated accelerated radiotherapy with concurrent chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2007;67: 1342e1351.  Dische S, Saunders M, Barrett A, Harvey A, Gibson D, Parmar M. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiother Oncol 1997;44:123e136.  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.  Fu KK, Pajak TF, Trotti A, et al. A Radiation Therapy Oncology Group (RTOG) phase III randomised 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.  Calais G, Alfonsi M, Bardet E, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma. J Natl Cancer Inst 1999;91:2081e2086.  Jeremic B, Milicic B, Dagovic A, Vaskovic Z, Tadic L. Radiation therapy with or without concurrent low-dose daily chemotherapy in locally advanced, nonmetastatic squamous cell carcinoma of the head and neck. J Clin Oncol 2004;22: 3540e3548.  Bourhis J, Calais G, Lapeyre M, et al. Concomitant radiochemotherapy or accelerated radiotherapy: analysis of two randomised trials of the French Head and Neck Group (GORTEC). Semin Oncol 2004;31:822e826.  Brizel DM, Albers ME, Fisher SR, et al. Hyperfractionation irradiation with or without concurrent chemotherapy for locally advanced head and neck cancer. N Engl J Med 1998; 338:1798e1804.  Staar S, Rudat V, Steutzer H, et al. Intensified hyperfractionated accelerated radiotherapy limits the additional benefit of simultaneous chemotherapy d results of multicentric randomised German trial in advanced head and neck cancer. Int J Radiat Oncol Biol Phys 2001;50:1161e1171.  Huguenin P, Beer KT, Allal A, et al. Concomitant cisplatin significantly improves locoregional control in advanced head and neck cancers treated with hyperfractionated radiotherapy. J Clin Oncol 2004;22:4665e4673.  Budach V, Stuschke M, Budach W, et al. Hyperfractionated accelerated chemoradiation with concurrent fluorouracilmitomycin is more effective than dose escalated radiation therapy alone in locally advanced head and neck cancer: final results of the radiotherapy cooperative clinical trials group of the German Cancer Society 95-06 prospective trial. J Clin Oncol 2005;23:1125e1135.  Eisbruch A, Harris J, Garden A, et al. Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys 2010;76:1333e1338.  Gupta NK, Swindell R. Concomitant methotrexate and radiotherapy in advanced head and neck cancer: 15-year follow-up of a randomized clinical trial. Clin Oncol (R Coll Radiol) 2001;13:339e344.  Tobias J, Monson K, Gupta N, et al. Chemoradiotherapy for locally advanced head and neck cancer: 10-year follow-up of the UK Head and Neck (UKHAN1) trial. Lancet Oncol 2010;11:66e74.  Sykes A, Slevin NJ, MacDougall RH, Ironside JA, Mais KL. Results of a phase I study to determine the maximum tolerated dose of capecitabine when given concurrently with radical radiotherapy in the treatment of squamous cell carcinoma of the head and neck. Radiother Oncol 2004;71:81e84.  Koukourakis MI, Tsoutsou PG, Karpouzis A. Radiochemotherapy with cetuximab, cisplatin, and amifostine for locally advanced head and neck cancer: a feasibility study. Int J Radiat Oncol Biol Phys 2010;77:9e15.  Khalil AA, Bentzen SM, Bernier J, et al. Compliance to the prescribed dose and overall treatment time in five randomized clinical trials of altered fractionation in radiotherapy for head and neck carcinomas. Int J Radiat Oncol Biol Phys 2003; 55:568e575.  Newman L, Vieira F, Schwiezer V, et al. Eating and weight changes following chemoradiation therapy for advanced head and neck cancer. Arch Otolaryngeal Head Neck Surg 1998;124: 589e592.  Denham JW, Peters LJ, Johansen J, et al. Do acute mucosal reactions lead to consequential late reactions in patients with head and neck cancer? Radiother Oncol 1999;52:157e164.|
Actions (login required)