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Modulated radiotherapy for head and neck carcinomas: an outcome study

Published online by Cambridge University Press:  26 July 2018

Tejinder Kataria ,
Saumya R. Mishra ,
Deepak Gupta ,
Shikha Goyal ,
Shyam S. Bisht ,
Abhidha Malik ,
Ashu Abhishek ,
Susovan Banerjee ,
Kushal Narang  and
Trinanjan Basu
...Show all authors
Tejinder Kataria
Affiliation:
Medanta, Gurgaon, Haryana, India
Saumya R. Mishra
Affiliation:
Medanta, Gurgaon, Haryana, India
Deepak Gupta*
Affiliation:
Medanta, Gurgaon, Haryana, India
Shikha Goyal
Affiliation:
Medanta, Gurgaon, Haryana, India
Shyam S. Bisht
Affiliation:
Medanta, Gurgaon, Haryana, India
Abhidha Malik
Affiliation:
Medanta, Gurgaon, Haryana, India
Ashu Abhishek
Affiliation:
Medanta, Gurgaon, Haryana, India
Susovan Banerjee
Affiliation:
Medanta, Gurgaon, Haryana, India
Kushal Narang
Affiliation:
Medanta, Gurgaon, Haryana, India
Trinanjan Basu
Affiliation:
Medanta, Gurgaon, Haryana, India
Manoj Tayal
Affiliation:
Medanta, Gurgaon, Haryana, India
*
Author for correspondence: Deepak Gupta, Medanta, The Medicity, Gurgaon, Haryana, India. E-mail: [email protected]
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Abstract

Background

To evaluate the survival outcomes and toxicities experienced by non-metastatic head and neck cancer (HNC) patients receiving modulated radiotherapy (RT).

Materials and methods

A total of 608 HNC patients treated consecutively from March 2010 to December 2014 with common subsites (oral cavity, oropharynx, hypopharynx, larynx and nasopharynx) of HNCs formed the study group. Eligible patients included those treated with radical or postoperative RT between March 2010 and December 2014. More than 90% patients received modulated RT [intensity-modulated radiotherapy (IMRT) or volumetric-modulated arc therapy (VMAT)] with concurrent chemotherapy as per stage guidelines. Demographic parameters and disease-related factors were analysed. Disease-free survival (DFS) was calculated from end date of RT till last follow-up or last date of disease control. Overall survival (OS) was calculated from date of registration to last follow-up date if alive. The primary endpoint was survival. The statistical analyses were performed using SPSS version 20.0 and Kaplan–Meier method was used for calculation survival.

Results

Among the evaluable patients, the median age was 60 years (range: 16–93) with male preponderance (male:female – 513:95). Majority were squamous cell carcinoma 93·4% (568/608). The subsites treated were oral cavity 36·8% (224). oropharynx 26·4% (161), larynx 19·7% (120), hypopharynx 10% (62) and nasopharynx 6·4% (41). RT intent was radical in 63·5% (386) and postoperative in 36·5% (222), with 59·5% (362) receiving concurrent chemotherapy. At last follow-up, 348 (57·2%) patients were alive, 169 (27·7%) patients had succumbed to disease and 120 (24·6%) patients had recurrent disease. Out of 120 recurrent cases loco-regional recurrence, nodal recurrence and distant metastases were seen in 62 (51·7%), 25 (20·8%), 33 (27·5%), respectively. In the entire study cohort at 2 year OS and DFS was 80 and 79% whereas 3 years OS and DFS was 70 and 75%, respectively.

Conclusions

In our study, 2 years and 3 years OS and DFS rates are found comparable to the international data with acceptable toxicity profile with the use of modulated RT. It seems to be possible because of stringent departmental protocols and good medical physics support. Our data re-validates need and benefit of advanced RT techniques like IG-IMRT and VMAT for both postoperative and radical HNC treatment at the cost of minimal long-term side effects. Future stringent follow-up and quality of life issues are being considered in a prospective manner.

Keywords

head and neck cancerhigh precision radiotherapymodulated radiotherapysurvival outcometoxicity
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 17 , Issue 4 , December 2018 , pp. 384 - 389
Copyright
© Cambridge University Press 2018 

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References

1. Fitzmaurice C, Allen C et al. Global Burden of Disease Cancer Collaboration. Global, regional, and national cancer incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years for 32 cancer groups, 1990 to 2015: a systematic analysis for the global burden of disease study. JAMA Oncol 2017; 3 (4): 524–548.Google Scholar
2. Shah, S B, Sharma, S, D’Cruz, A K. Head and neck oncology: the Indian scenario. South Asian J Cancer 2016; 5: 104–105.Google Scholar
3. Cognetti, D M, Weber, R S, Lai, S Y. Head and neck cancer: an evolving treatment paradigm. Cancer 2008; 113 (70): 1911–1932.Google Scholar
4. Kulkarni, M R. Head and neck cancer burden in India. Int J Head Neck Surg 2013; 4 (1): 29–35.Google Scholar
5. Kataria, T, Gupta, D, Bisht, S S et al. Chemoradiation in elderly patients with head and neck cancers: a single institution experience. Am J Otolaryngol 2015; 36: 117.Google Scholar
6. Kataria, T, Gupta, D, Goyal, S et al. Clinical outcomes of adaptive radiotherapy in head and neck cancers. Br J Radiol 2016; 89: 0085–0086.Google Scholar
7. Edge, S B, Byrd, D R, Compton, C C, Fritz, AG, Greene, FL, Trotti, A. (editors) AJCC Cancer Staging Manual, 7th edition. France: Springer, 2010.Google Scholar
8. Grégoire, V, Levendag, P, Ang, KK et al. CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC, RTOG consensus guidelines. Radiother Oncol 2003; 69: 227–236.Google Scholar
9. Grégoire, V, Ang, K, Budach, W et al. Delineation for neck node levels for head and neck tumors: a 2013 update DAHANCA, EORTC, HKNPCSG, NCIC CTG, NCRI, RTOG, TROG consensus guidelines. Radiother Oncol 2014; 110: 172–181.Google Scholar
10. Grégoire, V, Eisbruch, A, Hamoir, M, Levendag, P. Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck. Radiother Oncol 2006; 79: 15–20.Google Scholar
11. Grégoire, V, Coche, E, Cosnard, G, Hamoir, M, Reychler, H. Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience. Radiother Oncol 2000; 56: 135–150.Google Scholar
12. Cooper, J S, Pajak, T F, Forastiere, A A et al. Postoperative concurrent radiotherapy and chemotherapy for high risk squamous cell carcinoma of the head and neck. N Eng J Med 2004; 350: 1937–1944.Google Scholar
13. Bernier, J, Domenge, C, Ozsahin, M et al. Postoperative irradiation with or without concomitant chemotherapy for locally advanced head and neck cancer. N Eng J Med 2004; 350: 1945–1952.Google Scholar
14. Eisenhauer, EA, Therasse, P, Bogaerts, J et al. New response evaluation criteria in solid tumours: Revised RECIST guideline (version 1.1). Eur J Cancer 2009: 228–247.Google Scholar
15. National Cancer Institute (U.S.). Common Terminology Criteria for Adverse Events: (CTCAE). Bethesda, MD: U.S. Department of Health and Human Services, 2010.Google Scholar
16. Fletcher, GH, Evers, WT. Radiotherapeutic management of surgical recurrences and postoperative residuals in tumors of the head and neck. Radiology 1970; 95: 185–188.Google Scholar
17. Eisbruch, A, Rhodus, N, Rosenthal, D et al. How should we measure and report radiotherapy-induced xerostomia? Semin Radiat Oncol 2003; 13: 226–234.Google Scholar
18. Eisbruch, A, Ship, J A, Martel, M K et al. Parotid gland sparing in patients undergoing bilateral head and neck irradiation: techniques and early results. Int J Radiat Oncol Biol Phys 1996; 36: 469–480.Google Scholar
19. Hammerlid, E, Silander, E, Hornestam, L, Sullivan, M. Health-related quality of life three years after diagnosis of head and neck cancer – a longitudinal study. Head Neck 2001; 23: 113–125.Google Scholar
20. Hammerlid, E, Taft, C. Health-related quality of life in long-term head and neck cancer survivors: a comparison with general population norms. Br J Cancer 2001; 84: 149–156.Google Scholar
21. Almi, Y P, Horowitz, Z, Bedrin, L et al. Quality of life of nasopharyngeal carcinoma patients. Cancer 2002; 94: 1012–1017.Google Scholar
22. Veldeman, L, Madani, I, Hulstaert, F, De Meerleer, G, Mareel, M, De Neve, W. Evidence behind the use of intensity-modulated radiotherapy: a systematic review of comparative clinical studies. Lancet Oncol 2008; 9: 367–375.Google Scholar
23. Staffurth, J, Radiotherapy Development Board. A review of the clinical evidence for intensity-modulated radiotherapy. Clin Oncol 2010; 22: 643–657.Google Scholar
24. Guerrero Urbano, M T, Nutting, C M. Clinical use of intensity-modulated radiotherapy: part I. Br J Radiol 2004; 77: 88–96.Google Scholar
25. Guerrero Urbano, M T, Nutting, C M. Clinical use of intensity-modulated radiotherapy: part II. Br J Radiol 2004; 77: 177–182.Google Scholar
26. Otto, K. Volumetric modulated arc therapy: IMRT in a single gantry arc. Med Phys 2008; 35: 310–317.Google Scholar
27. Teoh, M, Clark, C H, Wood, K, Whitaker, S, Nisbet, A. Volumetric modulated arc therapy: a review of current literature and clinical use in practice. Br J Radiol 2011; 84: 967–996.Google Scholar
28. Vanetti, E, Clivio, A, Nicolini, G et al. Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009; 92: 111–117.Google Scholar
29. Verbakel, W F, Cuijpers, J P, Hoffmans, D, Bieker, M, Slotman, B J, Senan, S. Volumetric intensity-modulated arc therapy vs. conventional IMRT in head-and-neck cancer: a comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys 2009; 74: 252–259.Google Scholar
30. Dobrossy, L. Epidemiology of head and neck cancer: magnitude of the problem. Cancer Metastasis Rev 2005; 1: 9–17.Google Scholar
31. Warnakulasuriya, S. Global epidemiology of oral and oropharyngeal cancer. Oral Oncol 2009; 4: 309–316.Google Scholar
32. Albano, P M, Lumang-Salvador, C, Orosa, J et al. Overall survival of Filipino patients with squamous cell carcinoma of the head and neck: a single-institution experience. Asian Pac J Cancer Prev 2013; 14: 4769–4774.Google Scholar
33. Chaturvedi, A K, Engels, E A, Pfeiffer, R M et al. Human papilloma virus and rising oropharyngeal cancer in the United States. J Clin Oncol 2011; 29: 4294–4294.Google Scholar
34. Gillison, M L. Human papillomavirus-associated head and neck cancer is a distinct epidemiologic, clinical, and molecular entity. Semin Oncol 2004; 31: 744–754.Google Scholar
35. Hauswald, H, Simon, C, Hecht, S, Debus, J, Lindel, K. Long-term outcome and patterns of failure in patients with advanced head and neck cancer. Radiat Oncol 2011; 6: 70.Google Scholar
36. Noronha, V, Joshi, A, Patil, V M et al Once-a-week versus once-every-3-weeks cisplatin chemoradiation for locally advanced head and neck cancer: a phase III randomized noninferiority trial. J Clin Oncol 2017; 35: 6007.Google Scholar
37. Muller, P, Belot, A, Morris, M et al Net survival and probabilityof cancer deaths from rare cancers. http://csg.Ishtm.ac.uk/rare-cancers. Accessed on July 2016.Google Scholar
38. Blanchard, P, Baujat, B, Holostenco, V et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site. Radiother Oncol 2011; 100: 33–40.Google Scholar
39. Blanchard, P, Lee, A, Marguet, S et al. Chemotherapy and radiotherapy in nasopharyngeal carcinoma: an update of the MAC-NPC meta-analysis. Lancet Oncol 2015; 16: 645–655.Google Scholar
40. De Castro, G Jr., Snitcovsky, I M, Gebrim, E M et al. High-dose cisplatin concurrent to conventionally delivered radiotherapy is associated with unacceptable toxicity in unresectable, non-metastatic stage IV head and neck squamous cell carcinoma. Eur Arch Otorhinolaryngol 2007; 264 (12): 1475–1482.Google Scholar
41. Nutting, C M, Morden, J P, Harrington, K J et al. Parotid-sparing intensity modulated versus conventional radiotherapy in head and neck cancer (PARSPORT): a phase 3 multicentrerandomised controlled trial. Lancet Oncol 2011; 12: 127–136.Google Scholar