Gustavo Nader Marta1, Valter Silva2, Heloisa de Andrade Carvalho3, Fernando Freire de Arruda4, Samir Abdallah Hanna5, Rafael Gadia6, João Luis Fernandes da Silva7, Sebastião Francisco Miranda Correa8, Carlos Eduardo Cintra Vita Abreu9, Rachel Riera10. 1. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Instituto do Câncer de São Paulo (ICESP), Brazil. Electronic address: gnmarta@uol.com.br. 2. Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil. Electronic address: v.silva@ymail.com. 3. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil; Radiation Oncology Department, Faculdade de Medicina da Universidade de São Paulo, Brazil. Electronic address: heloisa-carvalho@uol.com.br. 4. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: fer.freire@ig.com.br. 5. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: samir.hanna@hsl.org.br. 6. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: rafagadia@yahoo.com.br. 7. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: jluis@hsl.org.br. 8. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: sf.correa@uol.com.br. 9. Radiation Oncology Department, Hospital Sírio-Libanês, Brazil. Electronic address: cevitabr@yahoo.com.br. 10. Brazilian Cochrane Center and Discipline of Emergency Medicine and Evidence-Based Medicine, Universidade Federal de São Paulo - Escola Paulista de Medicina (UNIFESP-EPM), Brazil. Electronic address: rachelriera@hotmail.com.
Abstract
BACKGROUND AND PURPOSE: Intensity-modulated radiation therapy (IMRT) provides the possibility of dose-escalation with better normal tissue sparing. This study was performed to assess whether IMRT can improve clinical outcomes when compared with two-dimensional (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in patients with head and neck cancer. METHODS AND MATERIALS: Only prospective phase III randomized trials comparing IMRT with 2D-RT or 3D-CRT were eligible. Combined surgery and/or chemotherapy were allowed. Two authors independently selected and assessed the studies regarding eligibility criteria and risk of bias. RESULTS: Five studies were selected. A total of 871 patients were randomly assigned for 2D-RT or 3D-CRT (437), versus IMRT (434). Most patients presented with nasopharyngeal cancers (82%), and stages III/IV (62.1%). Three studies were classified as having unclear risk and two as high risk of bias. A significant overall benefit in favor of IMRT was found (hazard ratio - HR=0.76; 95% CI: 0.66, 0.87; p<0.0001) regarding xerostomia scores grade 2-4, with similar loco-regional control and overall survival. CONCLUSIONS: IMRT reduces the incidence of grade 2-4 xerostomia in patients with head and neck cancers without compromising loco-regional control and overall survival.
BACKGROUND AND PURPOSE: Intensity-modulated radiation therapy (IMRT) provides the possibility of dose-escalation with better normal tissue sparing. This study was performed to assess whether IMRT can improve clinical outcomes when compared with two-dimensional (2D-RT) or three-dimensional conformal radiation therapy (3D-CRT) in patients with head and neck cancer. METHODS AND MATERIALS: Only prospective phase III randomized trials comparing IMRT with 2D-RT or 3D-CRT were eligible. Combined surgery and/or chemotherapy were allowed. Two authors independently selected and assessed the studies regarding eligibility criteria and risk of bias. RESULTS: Five studies were selected. A total of 871 patients were randomly assigned for 2D-RT or 3D-CRT (437), versus IMRT (434). Most patients presented with nasopharyngeal cancers (82%), and stages III/IV (62.1%). Three studies were classified as having unclear risk and two as high risk of bias. A significant overall benefit in favor of IMRT was found (hazard ratio - HR=0.76; 95% CI: 0.66, 0.87; p<0.0001) regarding xerostomia scores grade 2-4, with similar loco-regional control and overall survival. CONCLUSIONS: IMRT reduces the incidence of grade 2-4 xerostomia in patients with head and neck cancers without compromising loco-regional control and overall survival.
Authors: A Fondevilla Soler; J L López-Guerra; A García Fernández; M A Samaniego Conde; M J Belmonte González; J M Praena-Fernandez; E Rivin Del Campo; M Alcaraz; I Azinovic Journal: Clin Transl Oncol Date: 2018-11-30 Impact factor: 3.405
Authors: Molly K Barnhart; Bena Cartmill; Elizabeth C Ward; Elizabeth Brown; Jonathon Sim; George Saade; Sandra Rayner; Rachelle A Robinson; Virginia A Simms; Robert I Smee Journal: Dysphagia Date: 2019-02-11 Impact factor: 3.438
Authors: Irene Jacobi; Arash Navran; Lisette van der Molen; Wilma D Heemsbergen; Frans J M Hilgers; Michiel W M van den Brekel Journal: Eur Arch Otorhinolaryngol Date: 2015-02-01 Impact factor: 2.503