Dose-Escalated Intensity-Modulated Radiotherapy Is Feasible and May Improve Locoregional Control and Laryngeal Preservation in Laryngo-Hypopharyngeal Cancers
| Autor: | Catharine H. Clark, Aisha Miah, A. Margaret Bidmead, Jennifer Hickey, Robyn Nicol, Yolanda Barbachano, M. Teresa Guerrero-Urbano, Suzanne St. Rose, Kevin J. Harrington, Roger A'Hern, Shreerang Bhide, Kate Newbold, Mary Anne Lagmay Tanay, Christopher M. Nutting |
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| Rok vydání: | 2012 |
| Předmět: |
Adult
Male Larynx Cancer Research medicine.medical_specialty medicine.medical_treatment Urology Dermatitis Constriction Pathologic Disease-Free Survival Antineoplastic Combined Chemotherapy Protocols medicine Humans Radiology Nuclear Medicine and imaging Stage (cooking) Laryngeal Neoplasms Neoplasm Staging Aged 80 and over Stomatitis Chemotherapy Hypopharyngeal Neoplasms Radiation business.industry Induction chemotherapy Radiotherapy Dosage Induction Chemotherapy Pharyngeal Diseases Middle Aged Dysphagia Surgery Radiation therapy medicine.anatomical_structure Oncology Fluorouracil Concomitant Carcinoma Squamous Cell Feasibility Studies Female Radiotherapy Intensity-Modulated Cisplatin medicine.symptom Deglutition Disorders business Organ Sparing Treatments Follow-Up Studies medicine.drug |
| Zdroj: | International Journal of Radiation Oncology*Biology*Physics. 82:539-547 |
| ISSN: | 0360-3016 |
| DOI: | 10.1016/j.ijrobp.2010.09.055 |
| Popis: | Purpose To determine the safety and outcomes of induction chemotherapy followed by dose-escalated intensity-modulated radiotherapy (IMRT) with concomitant chemotherapy in locally advanced squamous cell cancer of the larynx and hypopharynx (LA-SCCL/H). Methods and Materials A sequential cohort Phase I/II trial design was used to evaluate moderate acceleration and dose escalation. Patients with LA-SCCL/H received IMRT at two dose levels (DL): DL1, 63 Gy/28 fractions (Fx) to planning target volume 1 (PTV1) and 51.8 Gy/28 Fx to PTV2; DL2, 67.2 Gy/28 Fx and 56 Gy/28 Fx to PTV1 and PTV2, respectively. Patients received induction cisplatin/5-fluorouracil and concomitant cisplatin. Acute and late toxicities and tumor control rates were recorded. Results Between September 2002 and January 2008, 60 patients (29 DL1, 31 DL2) with Stage III (41% DL1, 52% DL2) and Stage IV (52% DL1, 48% DL2) disease were recruited. Median (range) follow-up for DL1 was 51.2 (12.1–77.3) months and for DL2 was 36.2 (4.2–63.3) months. Acute Grade 3 (G3) dysphagia was higher in DL2 (87% DL2 vs. 59% DL1), but other toxicities were equivalent. One patient in DL1 required dilatation of a pharyngeal stricture (G3 dysphagia). In DL2, 2 patients developed benign pharyngeal strictures at 1 year. One underwent a laryngo-pharyngectomy and the other a dilatation. No other G3/G4 toxicities were reported. Overall complete response was 79% (DL1) and 84% (DL2). Two-year locoregional progression-free survival rates were 64.2% (95% confidence interval, 43.5–78.9%) in DL1 and 78.4% (58.1–89.7%) in DL2. Two-year laryngeal preservation rates were 88.7% (68.5–96.3%) in DL1 and 96.4% (77.7–99.5%) in DL2. Conclusions At a mean follow-up of 36 months, dose-escalated chemotherapy–IMRT at DL2 has so far been safe to deliver. In this study, DL2 delivered high rates of locoregional control, progression-free survival, and organ preservation and has been selected as the experimental arm in a Cancer Research UK Phase III study. |
| Databáze: | OpenAIRE |
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