Trevor J Bledsoe1, Anisha R Noble2, Chandana A Reddy3, Brian B Burkey4, John F Greskovich3, Tobenna Nwizu5, David J Adelstein5, Jerrold P Saxton3, Shlomo A Koyfman6. 1. Department of Therapeutic Radiology, Yale University School of Medicine, New Haven, CT, U.S.A. 2. Case Western Reserve University, School of Medicine, Cleveland, OH, U.S.A. 3. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A. 4. Department of Otolaryngology and Head and Neck Surgery, Cleveland Clinic, Cleveland, OH, U.S.A. 5. Department of Solid Tumor Oncology, Taussig Cancer Institute, Cleveland Clinic, Cleveland, OH, U.S.A. 6. Department of Radiation Oncology, Taussig Cancer Institute, Cleveland, OH, U.S.A. koyfmas@ccf.org.
Abstract
BACKGROUND: Achieving locoregional control in high-risk patients with head and neck cancer who are poor candidates for standard continuous-course (chemo) radiotherapy due to advanced age, comorbidities, or very advanced disease is challenging. At our Institution, we have significant experience with a regimen of split-course, accelerated, hypofractionated radiotherapy (SCAHRT) for these patients. PATIENTS AND METHODS: The SCAHRT regimen consisted of 60-72 Gy in 20-24 fractions separated by several weeks mid-course to allow for toxicity recovery and disease reassessment. It was used for patients with advanced age, significant co-morbidities, anticipated intolerance to definitive (chemo)radiation, and those with oligometastatic disease. Disease-free and overall survival rates were calculated using Kaplan-Meier analysis. RESULTS: Fifty-eight out of 65 patients (89%) completed both courses of treatment. Patients without metastatic or recurrent disease were evaluated for treatment response and survival (n=39). Among this group, total tumor response was 91%, and median locoregional failure-free survival and overall survival were 25.7 and 8.9 months, respectively. CONCLUSION: In high-risk patients unable to tolerate continuous-course definitive (chemo)radiation, SCAHRT is a safe, well-tolerated and effective method of achieving durable locoregional disease control. In properly selected patients, this regimen is preferable to purely palliative approaches. Copyright
BACKGROUND: Achieving locoregional control in high-risk patients with head and neck cancer who are poor candidates for standard continuous-course (chemo) radiotherapy due to advanced age, comorbidities, or very advanced disease is challenging. At our Institution, we have significant experience with a regimen of split-course, accelerated, hypofractionated radiotherapy (SCAHRT) for these patients. PATIENTS AND METHODS: The SCAHRT regimen consisted of 60-72 Gy in 20-24 fractions separated by several weeks mid-course to allow for toxicity recovery and disease reassessment. It was used for patients with advanced age, significant co-morbidities, anticipated intolerance to definitive (chemo)radiation, and those with oligometastatic disease. Disease-free and overall survival rates were calculated using Kaplan-Meier analysis. RESULTS: Fifty-eight out of 65 patients (89%) completed both courses of treatment. Patients without metastatic or recurrent disease were evaluated for treatment response and survival (n=39). Among this group, total tumor response was 91%, and median locoregional failure-free survival and overall survival were 25.7 and 8.9 months, respectively. CONCLUSION: In high-risk patients unable to tolerate continuous-course definitive (chemo)radiation, SCAHRT is a safe, well-tolerated and effective method of achieving durable locoregional disease control. In properly selected patients, this regimen is preferable to purely palliative approaches. Copyright
Authors: Daniel R Dickstein; Eric J Lehrer; Kristin Hsieh; Alexandra Hotca; Brianna M Jones; Ann Powers; Sonam Sharma; Jerry Liu; Vishal Gupta; Loren Mell; Zain Husain; Diana Kirke; Krzysztof Misiukiewicz; Marshall Posner; Eric Genden; Richard L Bakst Journal: Cancers (Basel) Date: 2022-06-05 Impact factor: 6.575