Source: www.docguide.com
Author: John Otrompke

Patients with head and neck squamous cell carcinoma who receive an average weekly fractionated radiation dose of more than 10 gy experience significantly better local control at 2 years, unless they are receiving chemotherapy at the same time, according to a study presented here at the American Society of Therapeutic Radiology and Oncology (ASTRO) 51st Annual Meeting.

“We’re not seeing the benefit in those who also receive chemotherapy with the radiation,” said Alek F. Dragovic, MD, Radiation Oncology, University of Alabama at Birmingham, Birmingham, Alabama. If they have low-stage cancer, they may not necessarily need chemotherapy along with radiation. Also, patients are often not healthy enough to receive chemotherapy if they can’t tolerate the side effects, Dr. Dragovic explained in his presentation on November 3.

In the study, 601 patients who received definitive radiotherapy were divided retrospectively into those who received more or less than an average weekly dose of 10 gy.

Patients who received the traditional schedule of once per day made up 45.1% of the patient population, those who received concomitant boost radiation, in which patients get treated twice per day during the last 2 weeks of radiotherapy, were 17.6% of the population; while 17.5% were treated with simultaneous integrated boost, 15.1% received radiation twice daily, and other received other schedules.

Overall, patients who received on average more than 10 gy per week experienced 77.4% local regional control at 2 years, compared with 71.4% who received less than 10 gy per week. For those who received no chemotherapy, however, average weekly dose of more than 10 gy was associated with 80.9% local regional control at 2 years, compared with 60.9% for those who received less.

But for those patients who also received chemotherapy, on the other hand, the numbers were 77.3% and 75.3%, respectively, and the results were not statistically significant,

Additionally, for those treated with concurrent chemotherapy, severe late dysphagia (including difficulty swallowing, scarring of the oesophagus, and dependence on a stomach tube) was found in 38.4% of those who received more than 10 gy per week, compared with 32% of those who received less.

“Those who received the higher dose per week also had more acute toxicity, such as oral ulcers and mucositis, but long-term toxicity does not end up being increased,” concluded Dr. Dragovic.

Note:
1. presented at Presented at ASTRO
2. Presentation title: The Importance of Average Weekly Dose in Patients With Head-and-Neck Cancer Treated With Definitive Radiotherapy. Abstract 66