intensity-modulated radiation therapy

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|

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|

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|

Unilateral radiation benefited patients with advanced tonsil cancer

Source: www.healio.com Author: staff Unilateral radiotherapy was associated with effective regional control in patients with advanced tonsil cancer, according to study results presented at the 2014 Multidisciplinary Head and Neck Cancer Symposium. Additionally, the results supported previous findings that suggest the primary tumor location, not the extent of ipsilateral neck lymph node involvement on the tumor side of the neck, governs the disease risk in the contralateral side of the neck. Researchers evaluated 153 consecutive patients diagnosed with squamous cell carcinoma of the tonsil who were treated with surgical removal and postoperative intensity-modulated radiation therapy. Forty-six of the patients underwent unilateral radiotherapy. Of these patients, 72% were male. The average patient age was 59 years. Current or former smokers comprised 61% of the study population. Lateralized primary tumors were confirmed in 40 (87%) of the patients. Two (4%) patients had non-lateralized tumors. Lateralization could not be retrospectively ascertained in four patients (9%). The cancer stages for these patients were distributed as follows: TX, 2%; T1, 44%; T2, 41%; and T3, 13%. Lymph node involvement stages were as follows: N0, 11%; N1, 13%; and N2, 76%. The patients underwent radiation doses of 60 Gy to 66 Gy to the postoperative bed and involved neck, and 52 Gy to 54 Gy to the elective region in 30 to 33 fractions using a simultaneous integrated boost technique. Concurrent chemotherapy was administered to 30 of the 46 patients. The median follow-up period was 2.8 years (range, 0.4-8.7 years). Researchers reported no local or regional [...]

Oral Cancer Foundation News Team - A2014-03-26T16:02:26-07:00March, 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|

New indicator may help Identify patients with increased risk from throat cancer

Source: www.onclive.com Author: staff Patients with oropharyngeal squamous cell carcinoma who had "matted" lymph nodes -- nodes that are connected together -- are more likely to metastasize than those without matted lymph nodes, according to a study published online in the journal Head & Neck. Metastases account for about 45% of the deaths among patients with oropharyngeal carcinoma, wrote Douglas B. Chepeha, MD, MPH, an associate professor of Otolaryngology Head and Neck Surgery at the University of Michigan Medical School in Ann Arbor. "Our findings may help doctors identify patients who are at higher risk for having their cancer metastasize and who would benefit from additional systemic therapy," he said, adding that the opposite was also true -- those without matted nodes might benefit from reducing therapy. The researchers tracked 78 patients who were part of a clinical trial evaluating 2 cancer drugs with intensity-modulated radiation therapy. All of the treatment-naive patients had stage III-IV squamous cell carcinoma of the oropharynx. Sixteen of the 78 patients had matted nodes. They found that patients with matted nodes had a 69% survival rate over 3 years, compared with 94% for patients without matted nodes. The risk was independent of other prognostic factors, such as the patient's history of smoking, alcohol use, or human papillomavirus (HPV) infection. Matted nodes appear to be an especially strong indicator of increased risk among patients who are HPV-positive. However, HPVpositive patients had better overall outcomes than HPV-negative patients did. The patients with the best outcomes were HPV-positive [...]

Oral Cancer Foundation News Team - A2012-03-19T07:12:42-07:00March, 2012|Oral Cancer News|

Screen carotids after head and neck radiation

Source: www.oncologyreport.com Author: Neil Osterweil, Oncology Report Digital Network Head and neck cancer patients treated with radiation should be screened routinely for carotid artery stenosis, investigators recommended at the annual meeting of the American Society for Radiation Oncology. Among 225 patients who had received radiation and were screened, an estimated 18% had significant asymptomatic stenosis (50% or greater narrowing) of one or both carotid arteries 3 years after treatment said Dr. Jennifer Dorth, a resident in radiation oncology at Duke University Medical Center in Durham, N.C. "We recommend screening for head and neck cancer patients given that there are high rates of stenosis as well as high rates of progression of stenosis," she said. Factors significantly associated with risk for stenosis included Framingham risk factors (smoking history, hypertension, hyperlipidemia, diabetes mellitus, cardiovascular/peripheral vascular disease, and atrial fibrillation) and radiation dose. The investigators retrospectively reviewed outcomes of asymptomatic, disease-free head and neck cancer patients who had received radiation with curative intent to the neck. The patients were screened with carotid Doppler ultrasound at or after the 1-year follow-up visit, and this was repeated every 2-3 years. Patients with ultrasound evidence of 50% or greater stenosis were referred to vascular surgery. The study identified 225 patients, 139 of whom had received intensity-modulated radiation therapy (IMRT), with the dose calculated separately for each side of the neck. Because of the separate treatment planning, the investigators analyzed the data by creating two separate models: one looking at all patients, and the other looking at [...]

Oral Cancer Foundation News Team - A2011-10-15T05:25:58-07:00October, 2011|Oral Cancer News|

Combined CT, FDG-PET improves head/neck cancer treatments

Source: www.drbicuspid.com Author: staff Combining CT with fluorodeoxyglucose positron emission tomography (FDG-PET) imaging results in significantly more defined tumor outlines and potentially different treatment options in head and neck cancer patients compared with using CT alone, according to research presented April 29 at the Cancer Imaging and Radiation Therapy Symposium in Atlanta. In this trial, conducted at Utrecht University Medical Center, 327 patients were treated with intensity-modulated radiation therapy for head and neck cancer. Based on the combined approach of the CT scan and FDG-PET, the researchers noticed a change in the delineation of the tumor in one out of three patients, resulting in 10% of patients' treatment being changed and 33% of patients having their treatment adjusted. In 17% of the patients, the primary tumor was not visible on the CT scan alone, mostly due to dental inlays. "We expected there to be an improved delineation of the tumor," said Homan Dehnad, MD, study author and radiation oncologist at Utrecht University Medical Center. "However, we never expected it to have such an influence on the treatment options for patients. Each dedicated institute dealing with head and neck cancer should be equipped with multi-imaged facilities."

Oral Cancer Foundation News Team - A2011-04-30T15:34:38-07:00April, 2011|Oral Cancer News|

Molecular imaging allows individualized ‘dose painting’ for head and neck cancers

Source: www.eurekalert.org Author: public release According to research revealed at Society of Nuclear Medecine's 57th Annual Meeting, a multi-tracer molecular imaging technique using positron emission tomography (PET) provides detailed information about the physiological processes of cancerous tumors—and could one day help radiation oncologists treat head and neck cancers with precision external-beam radiation therapy and improve the outcomes of therapy. "The research that we are conducting with Philips is extending the use of molecular imaging for radiotherapy planning, moving closer to more personalized treatment of hard-to-treat cancers based on the biology of each individual patient's tumor," said Kristi Hendrickson, Ph.D., lead author of the study and medical physicist at the University of Washington Medical Center, Seattle, Wash. "By modeling the data acquired from PET scans, we can potentially reduce damage to surrounding healthy tissue, as well as provide the ability to do 'dose painting,' delivering a highly customized form of radiation therapy for each patient." Cancers of the head and neck are notoriously difficult to treat, not only because of their proximity to sensitive anatomical structures, but also because of their tendency to recur. Researchers are working to find the best way to image these tumors in order to provide the most effective treatment. Several forms of radiation therapy are currently available. An approach called intensity modulated radiation therapy (IMRT) is a sophisticated technique which is used to maximize dose delivery to tumors while sparing adjacent normal tissues such as the salivary glands. This therapy uses an external beam of radiation [...]

Oral Cancer Foundation News Team - A2010-06-07T15:05:46-07:00June, 2010|Oral Cancer News|