PURPOSE: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. METHODS AND MATERIALS: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube≥2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. RESULTS: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving ≤60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. CONCLUSIONS: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.
PURPOSE: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. METHODS AND MATERIALS: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube≥2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. RESULTS: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving ≤60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. CONCLUSIONS: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.
Authors: Arlene A Forastiere; Helmuth Goepfert; Moshe Maor; Thomas F Pajak; Randal Weber; William Morrison; Bonnie Glisson; Andy Trotti; John A Ridge; Clifford Chao; Glen Peters; Ding-Jen Lee; Andrea Leaf; John Ensley; Jay Cooper Journal: N Engl J Med Date: 2003-11-27 Impact factor: 91.245
Authors: David L Schwartz; Katherine Hutcheson; Denise Barringer; Susan L Tucker; Merrill Kies; F Christopher Holsinger; K Kian Ang; William H Morrison; David I Rosenthal; Adam S Garden; Lei Dong; Jan S Lewin Journal: Int J Radiat Oncol Biol Phys Date: 2010-06-18 Impact factor: 7.038
Authors: T G Wendt; G G Grabenbauer; C M Rödel; H J Thiel; H Aydin; R Rohloff; T P Wustrow; H Iro; C Popella; A Schalhorn Journal: J Clin Oncol Date: 1998-04 Impact factor: 44.544
Authors: S Staar; V Rudat; H Stuetzer; A Dietz; P Volling; M Schroeder; M Flentje; H E Eckel; R P Mueller Journal: Int J Radiat Oncol Biol Phys Date: 2001-08-01 Impact factor: 7.038
Authors: A S Garden; J Harris; E E Vokes; A A Forastiere; J A Ridge; C Jones; E M Horwitz; B S Glisson; L Nabell; J S Cooper; W Demas; E Gore Journal: J Clin Oncol Date: 2004-07-15 Impact factor: 44.544
Authors: Andy Trotti; Lisa A Bellm; Joel B Epstein; Diana Frame; Henry J Fuchs; Clement K Gwede; Eugene Komaroff; Luba Nalysnyk; Marya D Zilberberg Journal: Radiother Oncol Date: 2003-03 Impact factor: 6.280
Authors: D M Brizel; M E Albers; S R Fisher; R L Scher; W J Richtsmeier; V Hars; S L George; A T Huang; L R Prosnitz Journal: N Engl J Med Date: 1998-06-18 Impact factor: 91.245
Authors: Adam R Burr; Paul M Harari; Alyx M Haasl; Aaron M Wieland; Justine Y Bruce; Randall J Kimple; Gregory K Hartig; Timothy M McCulloch; Matthew E Witek Journal: Head Neck Date: 2020-02-14 Impact factor: 3.147
Authors: Talha Shaikh; Elizabeth A Handorf; Colin T Murphy; Ranee Mehra; John A Ridge; Thomas J Galloway Journal: Int J Radiat Oncol Biol Phys Date: 2016-09-06 Impact factor: 7.038
Authors: Tommy Sheu; Clifton David Fuller; Tito R Mendoza; Adam S Garden; William H Morrison; Beth M Beadle; Jack Phan; Steven J Frank; Ehab Y Hanna; Charles Lu; Charles S Cleeland; David I Rosenthal; G Brandon Gunn Journal: Otolaryngol Head Neck Surg Date: 2014-08-07 Impact factor: 3.497
Authors: Grace L Smith; Shuangshuang Fu; Matthew S Ning; Diem-Khanh Nguyen; Paul M Busse; Robert L Foote; Adam S Garden; Gary B Gunn; Clifton D Fuller; William H Morrison; Gregory M Chronowski; Shalin J Shah; Lauren L Mayo; Jack Phan; Jay P Reddy; James W Snider; Samir H Patel; Sanford R Katz; Alexander Lin; Nasiruddin Mohammed; Roi Dagan; Nancy Y Lee; David I Rosenthal; Steven J Frank Journal: Int J Part Ther Date: 2021-06-25
Authors: Jonathan C Melong; Matthew H Rigby; Martin Bullock; Robert D Hart; Jonathan R B Trites; S Mark Taylor Journal: J Otolaryngol Head Neck Surg Date: 2015-09-30