intensity-modulated radiotherapy

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|

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|

Lower radiation reduces xerostomia in head/neck cancer patients

Source: www.drbicuspid.com Author: DrBicuspid Staff Lowering the radiation dose to the submandibular gland of patients with head and neck cancer decreases xerostomia, according to a study presented on April 20 at the European Society for Radiotherapy and Oncology (ESTRO) meeting in Geneva. Radiation oncologists at University Medical Center Utrecht (UMCU) showed for the first time that it is possible to reduce xerostomia in patients treated with radiotherapy for head and neck cancer if the radiation dose to a salivary gland (the submandibular gland) on the opposite side to the tumor is minimized, stated a university press release. It is the largest study yet to show a correlation between radiation doses to the submandibular glands and their output of saliva. Guidelines for the recommended maximum dose could potentially be issued for use in clinical practice to benefit patients, according to the researchers. Approximately 40% of head and neck cancer patients suffer from xerostomia in the long term, which causes problems with eating, sleeping, speech, tooth loss, and oral hygiene, leading to diminished quality of life, social isolation, and difficulty in the ability to work. Attempts to treat xerostomia and its consequences can be costly and are not very effective, the study noted. Therefore, the UMCU researchers looked at using intensity-modulated radiotherapy (IMRT) to treat the tumors and spare the submandibular gland on the opposite side of the tumor and both parotid glands. They also wanted to determine the maximum radiation dose and how the treatment would affect patients' xerostomia. They analyzed [...]

Oral Cancer Foundation News Team - A2013-04-24T12:19:16-07:00April, 2013|Oral Cancer News|

IMRT provides better QOL in head and neck cancers

Source: www.oncologyreport.com/ AUthor: Miriam E. Tucker Intensity-modulated radiotherapy is more expensive than 3-D–conformal radiotherapy is and has not been shown to improve standard outcomes in patients with head and neck cancer. But it results in better quality of life. These findings from two studies presented at the Multidisciplinary Head and Neck Cancer Symposium raise the question: Does improved quality of life justify the greater expense of intensity modulated radiotherapy (IMRT), which has been rapidly adopted for the treatment of head and neck cancer? Because IMRT spares surrounding tissues, it reduces the likelihood of developing xerostomia, noted Dr. Nathan C. Sheets, who presented data on billing charges associated with IMRT, compared with 3-D–conformal radiotherapy (CRT). IMRT is reimbursed at a substantially higher level than CRT, however, and it is unclear how to assess this cost relative to other aspects of care in this population, said Dr. Sheets, a radiation oncology resident at the University of North Carolina, Chapel Hill. A separate study presented by Dr. Allen M. Chen compared quality of life in patients who received IMRT vs. CRT. "There’s very little data to suggest IMRT is better than non-IMRT using traditional end points. But the question is: How do you define ‘better’?" said Dr. Chen, director of the radiation oncology residency training program at the University of California, Davis in Sacramento. "IMRT might not particularly involve better cure rates, but it could make a difference in terms of other end points, such as quality of life, which we all know [...]

Oral Cancer Foundation News Team - A2012-02-12T09:20:40-07:00February, 2012|Oral Cancer News|

Study IDs dysphagia risk after head/neck cancer treatment

Source: www.DrBicuspid.com February 28, 2011 -- A team of Danish researchers has developed a predictive model for determining which head and neck cancer patients are at risk of developing dysphagia (swallowing disfunction) following intensity-modulated radiotherapy (IMRT). Hanna Rahbek Mortensen, PhD, and colleagues presented results from a large prospective trial, the DAHANCA 6 & 7 study, at last week's International Conference on Innovative Approaches in Head and Neck Oncology in Barcelona, Spain. "We followed 1,476 patients with squamous cell carcinoma of the head and neck, and found out the existence of factors related to the cancer itself, to the patient and to the treatment influencing the development of dysphagia," Mortensen said in a press release. Dysphagia may be acute or late. Risk factors for developing severe acute dysphagia were large tumors, spreading of cancer cells to the lymph nodes, swallowing problems at the time of diagnosis, six treatments per week, and tumor location other than the vocal cords, the researchers noted. Risk factors for developing late dysphagia were large tumors, swallowing problems at the time of diagnosis, and tumor location other than the vocal cords. Although 83% of all head and neck cancer patients develop some kind of dysphagia, this predictive model will have a major impact on patient quality of life, the researchers noted. "These results are very important," said Dr. J.A. Langendijk from the University Medical Center of Groningen. "Today, with the increasing use of IMRT, the dose to the salivary glands is reduced, resulting in lower risks on xerostomia. [...]

Oral Cancer Foundation News Team - A2011-02-28T16:49:12-07:00February, 2011|Oral Cancer News|

Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentre randomised controlled trial

Source: www.thelancet.com Authors: Dr Christopher M Nutting FRCR et al. Background: Xerostomia is the most common late side-effect of radiotherapy to the head and neck. Compared with conventional radiotherapy, intensity-modulated radiotherapy (IMRT) can reduce irradiation of the parotid glands. We assessed the hypothesis that parotid-sparing IMRT reduces the incidence of severe xerostomia. Methods: We undertook a randomised controlled trial between Jan 21, 2003, and Dec 7, 2007, that compared conventional radiotherapy (control) with parotid-sparing IMRT. We randomly assigned patients with histologically confirmed pharyngeal squamous-cell carcinoma (T1—4, N0—3, M0) at six UK radiotherapy centres between the two radiotherapy techniques (1:1 ratio). A dose of 60 or 65 Gy was prescribed in 30 daily fractions given Monday to Friday. Treatment was not masked. Randomisation was by computer-generated permuted blocks and was stratified by centre and tumour site. Our primary endpoint was the proportion of patients with grade 2 or worse xerostomia at 12 months, as assessed by the Late Effects of Normal Tissue (LENT SOMA) scale. Analyses were done on an intention-to-treat basis, with all patients who had assessments included. Long-term follow-up of patients is ongoing. This study is registered with the International Standard Randomised Controlled Trial register, number ISRCTN48243537. Findings: 47 patients were assigned to each treatment arm. Median follow-up was 44·0 months (IQR 30·0—59·7). Six patients from each group died before 12 months and seven patients from the conventional radiotherapy and two from the IMRT group were not assessed at 12 months. At 12 months xerostomia side-effects were reported in [...]

Oral Cancer Foundation News Team - A2011-02-04T12:18:59-07:00February, 2011|Oral Cancer News|

Less xerostomia occurs with IMRT in head and neck cancer

Source: www.medscape.com Author: Roxanne Nelson Intensity-modulated radiotherapy (IMRT) might be a better treatment option for patients with squamous cell carcinoma of the head and neck. Compared with conventional radiation therapy, IMRT significantly decreases the incidence of xerostomia and improves quality of life, according to a study published online January 13 in the Lancet Oncology. British researchers report that at 12 months, grade 2 or higher xerostomia was significantly lower with IMRT than with conventional radiotherapy (38% vs 74%; P = .0027). At 2 years, the incidence of grade 2 or higher xerostomia continued to be significantly less common with IMRT than with standard radiotherapy; 9 patients (29%) reported xerostomia in the IMRT group, compared with 20 (83%) in the conventional therapy group. The authors note that there were no significant differences in locoregional control or overall survival between the 2 patient groups. Lead author Christopher M. Nutting, MD, FRCR, consultant and honorary senior lecturer in clinical oncology at the Royal Marsden Hospital and Institute of Cancer Research, London, United Kingdom, and colleagues note that their results "strongly support a role for IMRT in squamous cell carcinoma of the head and neck." Spares the Parotid Gland, Similar Outcomes Head and neck oncology expert Ted Teknos, MD, agrees. "One of the advantages of IMRT is that you can deliver radiation very accurately and you can spare normal structures to a much higher degree than conventional radiation therapy," said Dr. Teknos, director of the Division of Head and Neck Surgery at Ohio State [...]

Oral Cancer Foundation News Team - A2011-01-23T18:03:06-07:00January, 2011|Oral Cancer News|

Marginal misses after postoperative intensity-modulated radiotherapy for head and neck cancer

Source: Int J Radiat Oncol Biol Phys, July 23, 2010 Author: AM Chen et al. Purpose: To describe the spatial distribution of local-regional recurrence (LRR) among patients treated postoperatively with intensity-modulated radiotherapy (IMRT) for head and neck cancer. Methods and materials: The medical records of 90 consecutive patients treated by gross total resection and postoperative IMRT for squamous cell carcinoma of the head and neck from January 2003 to July 2009 were reviewed. Sites of disease were the oral cavity (43 patients), oropharynx (20 patients), larynx (15 patients), and hypopharynx (12 patients). Fifty patients (56%) received concurrent chemotherapy. Results: Seventeen of 90 patients treated with postoperative IMRT experienced LRR, yielding a 2-year estimate of local regional control of 80%. Among the LRR patients, 11 patients were classified as in-field recurrences, occurring within the physician-designated clinical target volume, and 6 patients were categorized as marginal recurrences. There were no out-of-field geographical misses. Sites of marginal LRRs included the contralateral neck adjacent to the spared parotid gland (3 patients), the dermal/subcutaneous surface (2 patients), and the retropharyngeal/retrostyloid lymph node region (1 patient). Conclusions: Although the incidence of geographical misses was relatively low, the possibility of this phenomenon should be considered in the design of target volumes among patients treated by postoperative IMRT for head and neck cancer. Authors: AM Chen, DG Farwell, Q Luu, LM Chen, S Vijayakumar, and JA Purdy Authors' affiliaton: Department of Radiation Oncology, University of California Davis School of Medicine, Sacramento, California

Oral Cancer Foundation News Team - A2010-08-03T18:25:07-07:00August, 2010|Oral Cancer News|

Varian Medical Systems: Head & neck cancer patient in Switzerland becomes world’s first UNIQUE radiotherapy patient

Source: www.tradingmarkets.com Author: press release A 55-year-old female head & neck cancer patient has become the first person in the world to be treated clinically using a new, advanced radiotherapy delivery device from Varian Medical Systems. Clinicians in Switzerland carried out the treatment this week using a UNIQUE(tm) single energy medical linear accelerator to deliver fast and precise RapidArc(r) radiotherapy, the leading solution for arc-based treatments. The treatment took place at the Istituto Oncologico della Svizzera Italiana (IOSI) radiation oncology unit here in Bellinzona, a public comprehensive cancer center serving 330,000 inhabitants in southern Switzerland, and part of Ente Ospedaliero Cantonale at San Giovanni Hospital. Varian's new UNIQUE treatment unit, a cost effective single energy (6 MV) system with the ability to deliver advanced treatments such as RapidArc, has been introduced by Varian to help bring advanced cancer care to more patients. "The UNIQUE system is an important asset in the clinical portfolio of the center in order to offer the best level of cancer care to all patients in the region," says Dr. Michele Morisoli, Director of San Giovanni hospital. "UNIQUE is a very capable machine that will enable us to treat most of our patients with a very advanced technique," says Dr. Antonella Fogliata, head medical physicist at IOSI. "RapidArc offers our patients a high standard of treatment delivery and less time spent on the treatment couch, which helps to keep discomfort t to a minimum. On the technical side we are really pleased with the performance and [...]

Oral Cancer Foundation News Team - A2010-06-20T08:50:11-07:00June, 2010|Oral Cancer News|

Radiation planning reduces dysphagia in oropharyngeal cancer

Source: www.medscape.com Author: Nick Mulcahy In patients with oropharyngeal cancer, modifying radiotherapy to spare swallowing structures appears to be an effective strategy to reduce the long-term dysphagia that accompanies chemoradiotherapy, according to a small longitudinal study. Importantly, the strategy did not come at the expense of locoregional control, report investigators in a study published online April 26 in the Journal of Clinical Oncology. Dysphagia has emerged as perhaps the most important late adverse effect in this setting, supplanting xerostomia, said the study's senior author, Avraham Eisbruch, MD, professor of radiation oncology at the University of Michigan Medical School and Comprehensive Cancer Center in Ann Arbor. "Aggressive chemoradiotherapy approaches produce more dysphagia than in the past," he told Medscape Oncology. Meanwhile, the late adverse effect of xerostomia is on the wane, because the use of intensity-modulated radiotherapy (IMRT) has allowed radiation oncologists to spare most patients' salivary glands from radiation, he said. To address the problem of dysphagia, Dr. Eisbruch and colleagues at the University of Michigan used IMRT in combination with chemotherapy. Their treatment planning for 73 patients with stages III to IV oropharyngeal cancer included sparing any swallowing structure that did not have tumor involvement. The structures included pharyngeal constrictors, glottic and supraglottic larynx, and esophagus. One year after concurrent chemotherapy and IMRT, all 73 of the patients had either absent or minimal observer-rated dysphagia (scores, 0 to 1), with the exception of 4 people: 1 who was feeding-tube dependent and 3 who required a soft diet. The results [...]

Oral Cancer Foundation News Team - A2010-05-19T20:47:25-07:00May, 2010|Oral Cancer News|