Sewit Teckie1, Benjamin H Lok2, Shyam Rao2, Stanley I Gutiontov3, Yoshiya Yamada2, Sean L Berry4, Michael J Zelefsky2, Nancy Y Lee5. 1. Department of Radiation Medicine, Northwell Health, New York, NY, United States; Hofstra Northwell School of Medicine, Hempstead, NY, United States; Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. 2. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. 3. Department of General Surgery, Weill Cornell Medicine, 525 East 68th Street, F-734, Box 207, New York, NY 10021, United States. 4. Department of Medical Physics, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. 5. Department of Radiation Oncology, Memorial Sloan Kettering Cancer Center, 1275 York Avenue, New York, NY 10065, United States. Electronic address: leen2@mskcc.org.
Abstract
OBJECTIVES: High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. MATERIALS AND METHODS: We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8Gray per fraction), for HN malignancies. RESULTS: A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3months among five survivors and 6.0months in the remaining patients. Median RT dose was 30Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6Gray was associated with control (p=0.04) and previous radiation was associated with inferior control (p=0.04). Patients who achieved complete response to RT had longer survival than those who did not (p=0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8Gray; only re-irradiation increased toxicity rates. CONCLUSION: Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.
OBJECTIVES: High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. MATERIALS AND METHODS: We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8Gray per fraction), for HN malignancies. RESULTS: A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3months among five survivors and 6.0months in the remaining patients. Median RT dose was 30Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6Gray was associated with control (p=0.04) and previous radiation was associated with inferior control (p=0.04). Patients who achieved complete response to RT had longer survival than those who did not (p=0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8Gray; only re-irradiation increased toxicity rates. CONCLUSION: Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.
Authors: R De Crevoisier; C Domenge; P Wibault; S Koscielny; A Lusinchi; F Janot; S Bobin; B Luboinski; F Eschwege; J Bourhis Journal: Cancer Date: 2001-06-01 Impact factor: 6.860
Authors: Sharon A Spencer; Jonathan Harris; Richard H Wheeler; Mitchell Machtay; Christopher Schultz; William Spanos; Marvin Rotman; Ruby Meredith; Kie-Kian Ang Journal: Head Neck Date: 2008-03 Impact factor: 3.147
Authors: Robert Timmerman; Lech Papiez; Ronald McGarry; Laura Likes; Colleen DesRosiers; Stephanie Frost; Mark Williams Journal: Chest Date: 2003-11 Impact factor: 9.410
Authors: R De Crevoisier; J Bourhis; C Domenge; P Wibault; S Koscielny; A Lusinchi; G Mamelle; F Janot; M Julieron; A M Leridant; P Marandas; J P Armand; G Schwaab; B Luboinski; F Eschwege Journal: J Clin Oncol Date: 1998-11 Impact factor: 44.544
Authors: Ayman Oweida; Andy Phan; Benjamin Vancourt; Tyler Robin; Mohammad K Hararah; Shilpa Bhatia; Dallin Milner; Shelby Lennon; Laura Pike; David Raben; Bryan Haugen; Nikita Pozdeyev; Rebecca Schweppe; Sana D Karam Journal: Thyroid Date: 2018-06 Impact factor: 6.568
Authors: Muhammad Shahid Iqbal; Nick West; Neil Richmond; Josef Kovarik; Isabel Gray; Nick Willis; David Morgan; Gozde Yazici; Mustafa Cengiz; Vinidh Paleri; Charles Kelly Journal: Br J Radiol Date: 2020-09-24 Impact factor: 3.039