IMRT – Oral Cancer News

Trial results support ‘new gold standard’ for head and neck cancer radiotherapy

Source: medicalxpress.com Author: Institute of Cancer Research Phase III trial results on a precision radiotherapy technique support a "new gold standard" for treating head and neck cancer patients. The research suggests the new approach can reduce the risk of swallowing problems after radiotherapy, without impacting the success of treatment. The Dysphagia-Aspiration Related Structures (DARS) trial compared dysphagia-optimized intensity-modulated radiotherapy (DO-IMRT) with standard IMRT. Reducing radiation to muscles involved in swallowing DO-IMRT optimizes IMRT to reduce the risk of swallowing difficulties, known as dysphagia. This common side effect of radiotherapy for head and neck cancer can, in some cases, leave patients needing a permanent feeding tube. DO-IMRT lowers the risk of dysphagia by reducing radiation to the pharyngeal muscles, which support swallowing. The DARS study included 112 newly diagnosed participants with oropharyngeal and hypopharyngeal cancers (tumors of the throat) from centers across the U.K. and Ireland. Half received standard IMRT and half received DO-IMRT for six weeks. Final results from the trial, which were published in The Lancet Oncology, revealed that: After two years, patients treated with DO-IMRT were more likely to report better swallowing function than those treated with IMRT. After a year, around three-fifths (62%) of DO-IMRT patients reported high normalcy of diet—meaning they were still able to eat at least some foods that require chewing—and more than 8 in 10 (85%) said they felt comfortable eating in public, compared with just under 45% and 75% of those treated with standard IMRT respectively. After just over three years of [...]

Oral Cancer Foundation News Team - A2023-11-26T15:49:43-07:00November, 2023|Oral Cancer News|

Despite treatment advances, oral mucositis continues to plague patients with head and neck cancer

Source: www.oncnursingnews.com Author: Lindsay Fischer Findings from a cohort study of patients with head and neck cancer (HNC) suggest that severe oral mucositis continues to be a common adverse event in this population. Findings were published in JAMA Network Open. In this single-institution study, 98.6% (n = 568) of patients who underwent definitive or adjuvant intensity-modulated RT (IMRT) for primary HNC between February 9, 2015, and May 2022, developed some degree of oral mucositis, and 62.5% (n = 360) of these patients developed severe oral mucositis. A total of 576 patients were included in this analysis. The median patient age was 62.5 years (IQR, 53.6-69.1) and 78.3% (n = 451) were male. Most patients were White (88.4%). Most patients (80.6%) also received concurrent chemotherapy. Quality-of-Life Parameters Patients were assessed for mouth and soreness (MTS) scores during radiotherapy through the Oral Mucositis Weekly Questionnaire–Head and Neck Cancer survey. Patients who had higher MTS scores were more likely to require a feeding tube (P = .001); the rate of feeding tube utilization with MTS scores 0, 1, 2, 3, and 4, respectively, was 0%, 3.6%, 6.6, 14.7%, and 21.6%. They were also more likely to be hospitalized (P = .02) or require opiate use (P

Oral Cancer Foundation News Team - A2023-11-22T13:11:21-07:00November, 2023|Oral Cancer News|

High rate of severe oral mucositis after IMRT seen in head and neck cancer

Source: www.cancertherapyadvisor.com Author: Andrea S. Blevins Primeau, PhD, MBA Many patients with head and neck cancer develop oral mucositis after intensity-modulated radiation therapy (IMRT), according to a single-center study published in JAMA Network Open. The study also showed that most cases of oral mucositis were severe, and increasing severity of mucositis was associated with a greater likelihood of feeding tube placement, hospitalization, and opiate use. The study included 576 patients who underwent definitive or adjuvant IMRT during 2015-2022. The Oral Mucositis Weekly Questionnaire-Head and Neck Cancer survey was used to categorize the severity of mucositis and throat soreness. Nearly all patients (98.6%) had oral mucositis, and 62.5% developed severe oral mucositis. By the final week of IMRT, 48.6% of patients had difficulty drinking, 56.8% had difficulty swallowing, and 69.4% had difficulty eating. Most patients (76.8%) were consuming a pureed diet and/or had a feeding tube by the end of IMRT. The median time to placing a feeding tube was 32 days from starting IMRT. The proportion of patients with nonprophylactic feeding tube placement was 16.4% of those with severe oral mucositis and 5.6% of those without severe mucositis (P

Oral Cancer Foundation News Team - A2023-10-25T08:24:54-07:00October, 2023|Oral Cancer News|

Dysphagia-optimized IMRT for head and neck cancer beneficial to swallowing function

Source: www.oncologynurseadvisor.com Author: Vicki Moore, PhD Treatment with dysphagia-optimized (DO) intensity-modulated radiotherapy (IMRT) improved patient-reported swallowing function in patients with pharyngeal cancer compared with standard IMRT. These results of a phase 3 study were published in the journal Lancet Oncology. Dysphagia-optimized IMRT was found to reduce radiation dose to the throat structures, thereby improving dysphagia and aspiration function compared with standard IMRT. Source: Getty Image “Our findings suggest that reducing dose to the pharyngeal constrictor muscle translates into patient benefit through improved swallowing function,” the study investigators wrote in their report. The phase 3 DARS study (ISRCTN Registry Identifier: ISRCTN25458988) was conducted across radiotherapy centers in the UK and Ireland. Enrolled patients had biopsy-confirmed squamous cell carcinoma of the oropharynx or hypopharynx in addition to meeting certain eligibility criteria. Patients were randomly assigned 1:1 to receive either DO-IMRT or standard IMRT over 6 weeks. The radiotherapy target dose was 65 Gy to the primary and nodal tumor, while the remaining tumor subsite and nodal regions considered at risk of occult microscopic disease had a target dose of 54 Gy. With DO-IMRT, there was a 50-Gy mean dose constraint for the superior and middle pharyngeal constrictor muscle or inferior pharyngeal constrictor muscle residing beyond the high-dose target volume. The primary endpoint of the study was the MD Anderson Dysphagia Inventory (MDADI) composite score at 12 months following treatment in the modified intention-to-treat population, which included patients completing this assessment. In this study, 112 patients were assigned to treatment, with [...]

Oral Cancer Foundation News Team - A2023-07-30T06:27:06-07:00July, 2023|Oral Cancer News|

ASCO 2020: New optimized precision radiotherapy can reduce swallowing difficulties for head and neck cancer patients

Source: www.icr.ac.uk Author: staff A new optimized intensity-modulated radiation therapy (IMRT) pioneered at The Royal Marsden NHS Foundation Trust and The Institute of Cancer Research, London, has been shown to spare head and neck cancer patients’ adverse life-long side effects post treatment. The initial results from the Dysphagia-Aspiration Related Structures (DARS) trial, funded by Cancer Research UK and the National Institute for Health Research, were presented at the American Society for Clinical Oncology (ASCO) virtual conference this week. The randomized study found patients with head and neck cancer experienced less adverse side effects with the new precision radiotherapy technique optimized to reduce the risk of swallowing difficulties, known as dysphagia. Half of newly diagnosed patients with oropharyngeal and hypopharyngeal cancers (tumors of the throat) recruited to the trial received standard IMRT radiotherapy and the other half received IMRT optimized to reduce the radiation dose to the structures related to swallowing and breathing. The trial recruited 112 patients across 23 UK cancer centres. Difficulties eating and drinking Patients with head and neck cancer have a 90 percent survival rate but can be left with life changing side effects including swallowing problems, making it difficult to eat and drink. The self-reported measure of swallowing ability as perceived by patients themselves was better in the optimised IMRT group. Twelve months after treatment, 40 percent of patients given the optimized form of precision radiotherapy reported their swallowing was as good as ever in comparison to just 15 percent on the standard treatment. The DARS [...]

Oral Cancer Foundation News Team - A2020-05-31T07:36:13-07:00May, 2020|Oral Cancer News|

Reducing RT toxicity in head and neck cancer: recent research context

Source: www.medpagetoday.com Author: Kristin Jenkins, contributing writer, MedPage Today In patients with head and neck malignancies, studies show that the significant acute and long-term toxicities and poor quality of life (QOL) associated with postoperative radiation therapy (PORT) can be improved by selectively reducing larger radiotherapy volumes. This includes treating just one side of the neck. In patients with locally advanced head and neck squamous cell carcinoma (HNSCC), however, locoregional failure rates with the omission of PORT to the pathologically uninvolved neck (PN0) have been less clear. As a result, PORT has historically been delivered to the PN0 neck, with several studies showing high rates of regional control ranging from 95% to 100%. Notably, consensus clinical practice guidelines continue to recommend the use of bilateral irradiation of node-negative necks. However, results from a prospective phase II study in 72 patients with primary HNSCC and high-risk pathology features now suggest that PORT to the PNo neck can be eliminated without sacrificing excellent disease control or QOL. At a median follow-up of 53 months, absolute regional control in the unirradiated neck was 97%, even though 67 patients (93%) had stage III/IV disease and 71% of tumors involved or crossed midline. No patient received contralateral neck PORT, and 17 patients (24%) were treated for the primary neck tumor only, said Wade Thorstad, MD, of Washington University in St. Louis, and colleagues. The 5-year rates of local control, regional control, progression-free survival, and overall survival (OS) were 84%, 93%, 60%, and 64%, respectively, they reported [...]

Oral Cancer Foundation News Team - A2019-11-21T12:57:43-07:00November, 2019|Oral Cancer News|

Swallowing exercises can improve quality of life for head and neck cancer patients

Source: www.targetedonc.com Author: Gina Columbus While patients with head and neck cancer are likely to experience difficulty swallowing after undergoing intesity-modulated radiation therapy (IMRT), Lynn Acton, MS, CCC (SLP) says the use of swallowing exercises can drastically improve muscle movement for these patients both during and after radiation therapy (RT). In a study conducted by researchers at Dana-Farber Cancer Institute and Brigham Women’s Hospital, patients with head and neck cancer who underwent RT in a 2-year period were evaluated for swallowing difficulty with a video swallow to score stricture and aspiration. Of the 96 patients evaluated who received IMRT once daily, 32% had some aspiration after therapy, while 37% had evidence of stricture following RT. Studies are currently ongoing to explore the utility of swallowing modalities for these patients. For example, an interventional, randomized, multicenter phase III trial is comparing early-active swallowing therapy versus nonspecific swallowing management (NCT02892487). Researchers are conducting the study to determine that early-active swallowing therapy can improve the quality of life of patients undergoing RT for head and neck cancer. Additionally, a behavioral questionnaire is evaluating adherence to preventative swallowing exercises and the reasons why patients choose not to follow them (NCT03010150). Patients will complete the questionnaire at baseline and again at 6 months following RT that will discuss adherence to swallowing exercises. Acton, a lecturer in surgery (otolaryngology) and speech pathologist at Yale School of Medicine, discussed the significance of swallowing modalities for patients with head and neck cancer during and after RT in an [...]

Oral Cancer Foundation News Team - A2017-05-05T12:37:40-07:00May, 2017|Oral Cancer News|

Low-dose IMRT may be safe for patients with HPV-positive head and neck cancer

Source: www.oncologypractice.com Author: Laura Nikolaides Lower-dose radiation therapy may be safe for some patients with human papillomavirus (HPV)-positive oropharyngeal cancer, decreasing the risk of often long-term side effects, such as trouble swallowing, dry mouth, loss of taste, neck stiffness, and thyroid problems, investigators reported at the annual meeting of the American Society of Clinical Oncology. Two-year overall survival and progression-free survival were 93% and 80%, respectively, among 62 patients with operable stage III/IVA HPV-positive oropharyngeal squamous carcinoma who received lower-dose intensity-modulated radiation therapy (IMRT) after clinical complete response to induction chemotherapy, reported Dr. Anthony Cmelak, professor of radiation oncology at Vanderbilt University, Nashville, Tenn., and medical director of the Vanderbilt-Ingram Cancer Center at Franklin. Overall, the phase II study enrolled 90 patients, median age 57 years, who all received induction chemotherapy with paclitaxel, cisplatin, and cetuximab. The response to induction chemotherapy determined IMRT dose. The 62 patients who had a complete clinical response received a reduced dose (54 Gy) of IMRT, and the rest of the patients received standard dose IMRT (70 Gy). All patients received standard cetuximab along with radiation. Two-year overall survival and progression-free survival for the higher-risk patients who received the standard dose of IMRT were 87% and 65% respectively. Among those patients receiving low-dose IMRT, survival was slightly higher for those with less than 10 pack-years of smoking and earlier-stage disease; in those patients 2-year progression-free and overall survival were 92% and 97%, respectively. However, Dr. Cmelak does not yet recommend modifying regimens for patients with [...]

Oral Cancer Foundation News Team - A2014-06-03T05:55:31-07:00June, 2014|Oral Cancer News|

MD Anderson Research Shows More Targeted Form of Radiation Improves Survival in Patients With Head, Neck Cancers

Source: Bio News - TexasPublished: January 15, 2014By: Ayesha Khan Recent research conducted at the University of Texas MD Anderson Cancer Center suggests clinical outcomes in patients receiving intensity-modulated radiation therapy (IMRT) for head and neck cancers is more effective when compared to patients who receive traditional radiation therapy, thanks to the advanced technology of IMRT. IMRT precisely targets malignant cells without affecting the normal surrounding tissue, thereby reducing the risk of adverse effects and improving therapy associated effects. The results of this study were published online in the peer-reviewed journal Cancer. What is IMRT? Intensity-modulated radiation therapy, or IMRT, limits the exposure of radiation to normal tissue by employing multiple beams of radiotherapy that helps in setting the dosage by radiologists in accordance with the site and size of tumor. Assistant professor at MD Anderson’s Radiation Oncology, Beth Beadle explained: “Previous studies indicated that patients treated with IMRT did better when it came to treatment-related side effects, however these studies were not designed to examine survival. The survival data was not well-known because IMRT is intended to spare normal tissues but still deliver radiation to the tumor so previous models assumed it was equivalent survival at best.” The technique was approved in 1999, and since then has become increasingly popular mainly because of the high benefits and low toxicity profile. The risk of several common but problematic complications (such as tissue fibrosis, dry mouth, dental issues and musculoskeletal flexibility) can be significantly reduced when compared to conventional radiotherapy. Details [...]

Charlotte Parker2014-01-16T18:00:40-07:00January, 2014|Oral Cancer News|

IMRT plus chemotherapy offers high locoregional control in advanced nasopharyngeal carcinoma

Source: www.healio.com Treatment with intensity-modulated radiotherapy and concurrent weekly chemotherapy improved xerostomia and dysphagia in patients with advanced nasopharyngeal carcinoma, according to study results presented at the WIN Symposium. Researchers in China recruited 310 patients with stages III to IVb nasopharyngeal carcinoma. All patients received curative IMRT plus weekly chemotherapy with cisplatin (40 mg/m2). Patients received doses of 66 to 70.4 Gy to the gross tumor volume, 60 Gy to the first clinical target, and 54 to 56 Gy to the second clinical target. “The medial group retropharyngeal nodes were never contoured as clinical target volume, aiming to spare the pharyngeal constrictors unless they were involved,” the researchers wrote. “[The] level 1b node was selectively contoured as clinical target volume in order to spare the submandibular glands and oral cavity.” Patient-reported and observer-related scores assessed swallowing and salivary gland function at baseline and periodically up to 3 years after treatment. Median follow-up was 39 months. At 3 years, researchers reported a local RFS rate of 93.6%, a regional RFS rate of 95.8% and a distant metastases-free survival rate of 80%. Researchers reported no marginal or out-of-field relapses. Patients’ dysphagia and xerostomia worsened during late courses of treatment, as well as after treatment, yet scores gradually improved after therapy. Dysphagia was minimal or absent at 9 months post radiotherapy, whereas xerostomia improved from 3 to 15 months post radiotherapy and remained steadily until the conclusion of follow-up. “IMRT concurrent with weekly chemotherapy aiming to reduce xerostomia and dysphagia can be safely [...]

Charlotte Parker2013-07-19T07:42:19-07:00July, 2013|Oral Cancer News|