IMRT – Page 2 – 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|

Newer radiation technology improves head and neck cancer patients’ long-term quality of life

Source: Eurekalert.org Patients treated with IMRT for head and neck cancer report an increasingly better quality of life post-treatment when compared to patients receiving other forms of radiation therapy, according to a study presented at the Multidisciplinary Head and Neck Cancer Symposium, sponsored by AHNS, ASCO, ASTRO and SNM. Intensity modulated radiation therapy, or IMRT, is a highly specialized form of external beam radiation therapy that allows the radiation beam to better target and conform to a tumor. It is a newer treatment that has become widely adopted for treating head and neck cancer. Prior studies have shown that IMRT decreases the probability of radiation therapy related side effects, including dry mouth and chewing and swallowing problems, but no study has been conducted to measure long-term quality of life in head and neck cancer patients treated with various forms of radiation therapy. Investigators from the University of California, Davis, School of Medicine, prospectively administered the University of Washington Quality of Life instrument, a standardized, previously validated questionnaire that patients complete after radiation therapy, to 155 patients undergoing treatment for cancers of the head and neck and analyzed the scores over time. Fifty-four percent of patients were initially treated with IMRT and 46 percent were treated with non-IMRT techniques. The researchers showed that the early quality of life gains associated with IMRT not only are maintained but become more magnified over time. At one-year post-treatment, 51 percent of IMRT patients rated their quality of life as very good or outstanding compared [...]

Charlotte Parker2012-01-27T11:29:03-07:00January, 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|

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|

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|

New report compares radiation approaches in head and neck cancer

Source: MedScape Today Author: Nick Mulcahy June 1, 2010 — Intensity-modulated radiation therapy (IMRT) for head and neck cancer leads to fewer cases of xerostomia, but has not yet been proven to be more successful than any other kind of radiation therapy in reducing tumors or improving survival, according to a new comparative-effectiveness review funded by the federal Agency for Healthcare Research and Quality (AHRQ). The review compares the effectiveness of 4 types of radiotherapy (IMRT, 3DCRT, 2DRT, and proton-beam therapy) in terms of tumor control, overall survival, adverse events, and quality-of-life issues. Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissue than either 3DCRT or 2DRT, but more research is needed, the authors of the report point out. The report, entitled Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, is authored by the Blue Cross and Blue Shield Association's Technology Evaluation Center Evidence-Based Practice Center. The late adverse effect of xerostomia, also known as dry mouth, is less common than in the past because the use of IMRT has allowed radiation oncologists to spare most patients' salivary glands from radiation as part of treatment planning, an expert recently told Medscape Oncology. Sparing salivary glands has become standard among clinicians who use IMRT, said Avraham Eisbruch, MD, professor of radiation oncology at the University of Michigan Medical School and Comprehensive Cancer Center in Ann Arbor. Dr. Eisbruch's comments came in the context of his study on the use of IMRT [...]

Charlotte Parker2010-06-04T16:26:20-07:00June, 2010|Oral Cancer News|