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 [...]

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

Reducing xerostomia through advanced technology

Source: The Lancet Oncology Radiation-related xerostomia has been the most significant and disabling side-effect of radiotherapy for head and neck cancer for more than 50 years. With the PARSPORT trial, reported in The Lancet Oncology, the largest and best designed of several randomised trials focusing on xerostomia, radiation oncologists and their partners in physics and dosimetry should take pride that significant progress has been made. Before the introduction of intensity-modulated radiotherapy (IMRT), more than 80% of survivors experienced substantial dry mouth syndrome and associated effects on dental health, swallowing, taste, and quality of life. By contrast, Nutting and colleagues report about 25% of 2-year survivors had significant clinician-rated xerostomia. Taken together with two randomised trials of IMRT for nasopharyngeal cancer, there is now compelling evidence of the power of advanced technology in reducing toxicity from head and neck radiotherapy. Can even better use of technology help us to further reduce xerostomia? The parotid glands provide watery saliva during eating, which is largely replaceable by consuming more water or lubricants. The submandibular, sublingual, and minor salivary glands provide mucinous saliva, associated with the resting sense of moisture and dry mouth symptoms. Future work should systematically explore the prioritisation of different components of the salivary gland system. A clinical benefit from sparing the submandibular glands may be seen, beyond that seen by sparing the parotid glands. The mean dose delivered to the minor salivary glands within the oral cavity has also been reported to be a significant factor in patient-reported xerostomia. Further possibilities include gland repair [...]

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 [...]

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

The Lancet Oncology, Early Online Publication, 13 January 2011 Dr Christopher M Nutting FRCR a b , James P Morden MSc b, Kevin J Harrington FRCR a b, Teresa Guerrero Urbano PhD c, Shreerang A Bhide FRCR a, Catharine Clark PhD d, Elizabeth A Miles MPhil e, Aisha B Miah FRCR a, Kate Newbold FRCR a, MaryAnne Tanay MSc a, Fawzi Adab FRCR f, Sarah J Jefferies FRCR g, Christopher Scrase FRCR h, Beng K Yap FRCR i, Roger P A'Hern MSc b, Mark A Sydenham BSc b, Marie Emson BSc b, Emma Hall PhD b, on behalf of the PARSPORT trial management group† Summary 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. Randomization was by computer-generated permuted blocks and was stratified by centre and tumor site. Our primary endpoint was the proportion of patients with grade 2 or worse xerostomia at 12 months, as assessed by [...]

When East meets West, cancer patients win

Source: www.healthzone.ca Author: Nicole Baute An ancient four-herb formula used in China for 1,800 years might one day be available as a prescription pill to treat side effects caused by cancer chemotherapy, thanks to research from Yale University and a growing international consortium focused on the globalization of Chinese medicine. Huang Qin Tang (pronounced Hu-ang Chin Tong) is made with peonies, a purple flower called skullcap, licorice and fruit from a buckthorn tree. The Chinese medicine has long been used for diarrhea, nausea, vomiting and cramps, which happen to be side effects associated with certain chemotherapy drugs. Now research led by Yung-Chi “Tommy” Cheng, the Henry Bronson Professor of Pharmacology at Yale University, suggests a Western version of this ancient medicine may reduce gut damage caused by chemotherapy in colon and rectal cancer patients. Cheng says a capsule preparation of this formula, called PHY906, inhibits three processes that cause inflammation during chemotherapy and enhances the recovery of damage to tissue. “This is an example of West meeting East for treatment of cancer,” Cheng said, on the phone from Taiwan. Cheng, who has equity interest in the Yale-sponsored company that licenses the technology, is focused on getting PHY906 licensed as a prescription drug in the U.S. — not as a supplement or alternative. A study published in Science Traditional Medicine Wednesday explains how PHY906 restored intestinal damage in mice caused by chemotherapy and also helped trigger the replacement of damaged intestinal stem cells with healthy ones. The drug is now in [...]

2010-09-30T14:18:21-07:00September, 2010|Oral Cancer News|

Featured clinical trial: electroacupuncture for radiation-induced chronic dry mouth

Source: www.cancer.gov/ncicancerbulletin Author: staff Name of the Trial Randomized Pilot Study of Electroacupuncture for Chronic Radiation-induced Xerostomia in Patients with Head and Neck Cancer (MAYO-MCS285). See the protocol summary 1. Why This Trial Is Important Head and neck cancers are often treated with external-beam radiation therapy 2. Although this treatment can be effective in controlling head and neck tumors, it may cause side effects 3 that can compromise a patient’s quality of life. Chronic dry mouth, also called xerostomia, is common among patients treated with radiation to the head and neck. This condition results from damage to the glands that produce saliva. Chronic dry mouth can have a major impact 4 on quality of life by causing pain and discomfort, affecting the ability to sleep, altering taste, and/or increasing the likelihood of dental problems. Some drugs are available for xerostomia induced by radiation therapy, but many patients experience only a partial improvement or no benefit at all. The drug amifostine 5 can help protect the salivary glands of some head and neck cancer patients from radiation damage, but this drug cannot be used in all patients. Some studies have suggested that acupuncture 6 can help relieve the sensation of mouth dryness in cancer patients who have undergone head and neck radiation therapy. Based on these studies and other evidence, researchers at the Mayo Clinic in Scottsdale, AZ, are investigating the ability of a procedure called electroacupuncture to help improve the production of saliva and the quality of life of patients [...]

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 [...]

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

Advanced type of cancer radiation reduces side effects, but impact on controlling cancer is unclear

Source: www.sunherald.com Author: press release An advanced type of cancer radiation is more successful than traditional radiation in avoiding "dry mouth" when treating head and neck cancers, but it is unknown whether the treatment is better or worse at reducing the size of tumors, according to a new comparative effectiveness review funded by HHS' Agency for Healthcare Research and Quality. The report finds that intensity-modulated radiation therapy (IMRT) leads to fewer cases of xerostomia, commonly known as dry mouth, than other types of radiation. Xerostomia, a potential side effect to radiation when salivary glands are damaged, can affect basic functions like chewing, swallowing and breathing; senses such as taste, smell and hearing; and can significantly alter a patient's appearance and voice. However, the report did not find evidence that IMRT is more successful than any other kind of radiation therapy in reducing tumors. Many scientists consider IMRT to be theoretically better able to target cancerous cells while sparing healthy tissues, but more research is needed, the report said. The comparative effectiveness review, Comparative Effectiveness and Safety of Radiotherapy Treatments for Head and Neck Cancer, was authored by the Blue Cross and Blue Shield (BC/BS) Association, Technology Evaluation Center in Chicago. "The development of new technologies to treat cancer has been one of the true success stories of American medical research," said AHRQ Director Carolyn M. Clancy, M.D. "This report provides patients and their doctors with more information about these advances, which they can use to make more informed choices about [...]

Time-released muco-adhesive patch more effective than oral rinse for xerostomia

Source: www.news-medical.net/news Author: press release A newly developed time-released muco-adhesive patch for treating oral health conditions, including the widespread condition of dry mouth (xerostomia), has been shown to be more effective than a leading oral rinse, according to a newly-published study. As increasing segments of the population consume more medications (one of the leading causes of dry mouth), the results of this study could potentially help provide relief for millions of Americans. Chronic dry mouth impacts the quality of life and for some, can be debilitating. Published in the March 2010 issue of Quintessence International, the study found that chronic dry mouth sufferers can now get a statistically significant reduction of mouth dryness from a new time-released muco-adhesive patch (OraMoist Dry Mouth Patch), compared with the leading oral rinse which has been on the market for nearly two decades. Overall, patients with xerostomia treated with the muco-adhesive patch reported a statistically significant reduction in mouth dryness sensation with elevated salivary flow rate (150%) after just 30 minutes, which was considered clinically outstanding by the study authors, since the product does not contain any cholinergic agonist, a drug often used to treat dry mouth. OraMoist, a new time-released, non-drug formula, not only outperformed the mouthwash, one of the most often used delivery formats for treating dry mouth, but unlike dry mouth sprays, rinses or gels, which need to be applied frequently – sometimes every 20 minutes – OraMoist works to increase moisture and help restore a healthy oral environment for hours [...]

Advances in radiation therapy enable doctors to improve the quality of treatments for patients with head and neck cancer

Source: www.prnewswire.com Author: press release Noted clinical experts detail recent developments at the annual ASTRO meeting in Chicago Clinical studies suggest that advanced treatments like intensity-modulated radiotherapy (IMRT) and image-guided radiotherapy (IGRT) are enabling radiation oncologists to enhance post-treatment health-related quality of life for patients with head and neck cancer. In an educational session for radiotherapy professionals, delivered by two noted experts during the annual meeting of the American Society for Radiation Oncology (ASTRO) in Chicago last week, Avraham Eisbruch, M.D., professor at the University of Michigan, discussed how careful implementation of IMRT in the treatment of head and neck cancer can achieve high tumor control rates while minimizing xerostomia, a dry mouth condition that occurs when salivary glands are damaged. Citing a new report summarizing results from RTOG 0022, a multi-institutional study comparing IMRT with earlier forms of treatment for head and neck cancer, Dr. Eisbruch said that IMRT for head and neck cancer achieved important goals in reducing treatment toxicity, notably xerostomia, and in yielding a high tumor control rate of 90%.(1) For patients enrolled in the study and treated with IMRT, only 55% experienced Grade 2 or worse xerostomia at six months after treatment, as compared with 84% of patients treated with earlier forms of radiotherapy -- a reduction of 35%. For the IMRT group, the percentage of patients with Grade 2 or worse xerostomia decreased steadily, to 25% at 12 months and 16% at 24 months. "This kind of improvement over time is not something we [...]

2009-11-13T13:30:22-07:00November, 2009|Oral Cancer News|
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