W Dobrowsky1, J Naudé. 1. Department of Radiotherapy and Radiobiology, University of Vienna, Allgemeines Krankenhaus der Stadt Wien, Waehringer Guertel 18-20, A-1090 Vienna, Austria.
Abstract
BACKGROUND AND PURPOSE:Radiation therapy is often the primary treatment for advanced cases of head and neck cancers not considered suitable for radical surgery. In these cases locoregional tumour control rates are low and has warranted innovative treatment modifications, such as altered fractionation schedules and combination with chemotherapy. PATIENTS AND METHODS: From October 1990 to December 1997, 239 patients with squamous cell cancers originating in the head and neck region were randomized to one of three treatment options. Standard therapy consisting of conventional fractionation with 70 Gy in 7 weeks in 35 fractions (CF). The second treatment option consisted of a continuous hyperfractionated accelerated radiotherapy delivering a total dose of 55.3 Gy in 33 fractions over 17 consecutive days (V-CHART). The third study arm had identical fractionation and dose as the above accelerated treatment, with the additional administration of 20 mg/m(2) mitomycin C (MMC) on day 5 of treatment (V-CHART+MMC). RESULTS: Main toxicity resulted from accelerated fractionation in confluent mucositis (Grade 3-4 in 95%) requiring nasogastral tube feeding, analgetics and antiphlogistics in the majority of cases. Haematological toxicity Grade 3-4 was seen after MMC administration in 18%. MMC administration did not influence mucosal reaction. Overall duration of mucositis was not different in the three treatment groups. Loco-regional tumour control was 31% after CF, 32% after V-CHART and 48% after V-CHART+MMC, respectively (P<0.05). Overall crude survival was 24% after CF, 31% following V-CHART and 41% after V-CHART+MMC, respectively (P<0.05). Median follow up was 48 months (assessment performed in February 1999). CONCLUSION: Following shortening overall treatment time from 7 weeks to 17 consecutive days and dose of radiotherapy from 70 to 55.3 Gy the results in the radiotherapy only treated patients are identical. A significant improvement regarding local tumour control and survival was seen following administration of MMC to the accelerated fractionated treatment.
RCT Entities:
BACKGROUND AND PURPOSE: Radiation therapy is often the primary treatment for advanced cases of head and neck cancers not considered suitable for radical surgery. In these cases locoregional tumour control rates are low and has warranted innovative treatment modifications, such as altered fractionation schedules and combination with chemotherapy. PATIENTS AND METHODS: From October 1990 to December 1997, 239 patients with squamous cell cancers originating in the head and neck region were randomized to one of three treatment options. Standard therapy consisting of conventional fractionation with 70 Gy in 7 weeks in 35 fractions (CF). The second treatment option consisted of a continuous hyperfractionated accelerated radiotherapy delivering a total dose of 55.3 Gy in 33 fractions over 17 consecutive days (V-CHART). The third study arm had identical fractionation and dose as the above accelerated treatment, with the additional administration of 20 mg/m(2) mitomycin C (MMC) on day 5 of treatment (V-CHART+MMC). RESULTS: Main toxicity resulted from accelerated fractionation in confluent mucositis (Grade 3-4 in 95%) requiring nasogastral tube feeding, analgetics and antiphlogistics in the majority of cases. Haematological toxicity Grade 3-4 was seen after MMC administration in 18%. MMC administration did not influence mucosal reaction. Overall duration of mucositis was not different in the three treatment groups. Loco-regional tumour control was 31% after CF, 32% after V-CHART and 48% after V-CHART+MMC, respectively (P<0.05). Overall crude survival was 24% after CF, 31% following V-CHART and 41% after V-CHART+MMC, respectively (P<0.05). Median follow up was 48 months (assessment performed in February 1999). CONCLUSION: Following shortening overall treatment time from 7 weeks to 17 consecutive days and dose of radiotherapy from 70 to 55.3 Gy the results in the radiotherapy only treated patients are identical. A significant improvement regarding local tumour control and survival was seen following administration of MMC to the accelerated fractionated treatment.
Authors: Joshua M Bauml; Ravi Vinnakota; Yeun-Hee Anna Park; Susan E Bates; Tito Fojo; Charu Aggarwal; Sewanti Limaye; Nevena Damjanov; Jessica Di Stefano; Christine Ciunci; Eric M Genden; Juan P Wisnivesky; Rocco Ferrandino; Ronac Mamtani; Corey J Langer; Roger B Cohen; Keith Sigel Journal: J Natl Cancer Inst Date: 2019-05-01 Impact factor: 13.506
Authors: Hans Christiansen; Robert M Hermann; Andrea Hille; Heinz Schmidberger; Alexios Martin; Mirko Nitsche; Clemens F Hess; Olivier Pradier Journal: J Cancer Res Clin Oncol Date: 2005-11-15 Impact factor: 4.553
Authors: Bertrand Baujat; Jean Bourhis; Pierre Blanchard; Jens Overgaard; Kian K Ang; Michelle Saunders; Aurélie Le Maître; Jacques Bernier; Jean Claude Horiot; Emilie Maillard; Thomas F Pajak; Michael G Poulsen; Abderrahmane Bourredjem; Brian O'Sullivan; Werner Dobrowsky; Hliniak Andrzej; Krzystof Skladowski; John H Hay; Luiz Hj Pinto; Karen K Fu; Carlo Fallai; Richard Sylvester; Jean Pierre Pignon Journal: Cochrane Database Syst Rev Date: 2010-12-08
Authors: Benjamin Lacas; Alexandra Carmel; Cécile Landais; Stuart J Wong; Lisa Licitra; Jeffrey S Tobias; Barbara Burtness; Maria Grazia Ghi; Ezra E W Cohen; Cai Grau; Gregory Wolf; Ricardo Hitt; Renzo Corvò; Volker Budach; Shaleen Kumar; Sarbani Ghosh Laskar; Jean-Jacques Mazeron; Lai-Ping Zhong; Werner Dobrowsky; Pirus Ghadjar; Carlo Fallai; Branko Zakotnik; Atul Sharma; René-Jean Bensadoun; Maria Grazia Ruo Redda; Séverine Racadot; George Fountzilas; David Brizel; Paolo Rovea; Athanassios Argiris; Zoltán Takácsi Nagy; Ju-Whei Lee; Catherine Fortpied; Jonathan Harris; Jean Bourhis; Anne Aupérin; Pierre Blanchard; Jean-Pierre Pignon Journal: Radiother Oncol Date: 2021-01-27 Impact factor: 6.280
Authors: Thomas Kuhnt; Axel Becker; Marc Bloching; Johannes Schubert; Gunther Klautke; Rainer Fietkau; Juergen Dunst Journal: Med Oncol Date: 2006 Impact factor: 3.738