Hostname: page-component-76fb5796d-9pm4c Total loading time: 0 Render date: 2024-04-25T15:53:30.472Z Has data issue: false hasContentIssue false
  • English
  • Français

Gap compensation during accelerated hypofractionated radiotherapy in head and neck cancer

Published online by Cambridge University Press:  01 March 2008

Paul Sanghera ,
John Arnfield ,
Chris McConkey  and
Andrew Hartley
Paul Sanghera
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
John Arnfield
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
Chris McConkey
Affiliation:
Clinical Trials Unit, University of Warwick, UK
Andrew Hartley*
Affiliation:
Cancer Centre, Queen Elizabeth Hospital, Birmingham, UK
*
Correspondence to: Andrew Hartley, Cancer Centre at Queen Elizabeth Hospital, Birmingham B15 2TH, UK. Email: Andrew.Hartley@uhb.nhs.uk
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction: In squamous-cell carcinoma (SCC) of the head and neck, unplanned gaps risk prolongation of the overall treatment time (OTT) and reduction in tumour control. This audit determines whether further acceleration can safely be employed to compensate for missed treatments during accelerated hypofractionated radiotherapy.

Methods: Patients receiving accelerated hypofractionated radiotherapy for SCC of the head and neck were prospectively audited. Outcome measures were OTT, degree of compensation and acute toxicity determined by incidence of grade 3 mucositis, prolonged grade 3 mucositis, grade 3 dysphagia and pain.

Results: In the 87 patients identified, the dose administered was 55 Gy in 20 fractions (81 patients), 50 Gy in 20 fractions (1 patient) and 50 Gy in 16 fractions (5 patients). Of those patients receiving 20 fractions, 94% completed within 28 days. Grade 3 mucositis was seen in 56 patients (64%). Compensating for unplanned gaps did not result in any significant increase in toxicity. Administering 6 fractions/week, as compensation, was associated with a lower pain score (p = 0.003) as was receiving 2 fractions on the same day (p = 0.0004).

Conclusions: Accelerated hypofractionation is tolerable with most patients completing treatment within the planned OTT. When unplanned gaps occur, then compensation by further acceleration is possible.

Keywords

Accelerationhead and neck cancerhypofractionationRadiotherapysquamous-cell carcinoma
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 7 , Issue 1 , March 2008 , pp. 31 - 38
Copyright
Copyright © Cambridge University Press 2008

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

Withers, HR, Taylor, JM, Maciejewski, B.The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;27:131–146.Google Scholar
Hendry, JH, Bentzen, SM, Dale, RG, Fowler, JF, Wheldon, TE, Jones, B, Munro, AJ, Slevin, NJ, Robertson, AG. A modelled comparison of the effects of using different ways to compensate for missed treatment days in radiotherapy. Clin Oncol 1996;8:297–307.Google Scholar
Slevin, NJ, Hendry, JH, Roberts, SA, Agren-Cronqvist, A.The effect of increasing the treatment time beyond three weeks on the control of T2 and T3 laryngeal cancer using radiotherapy. Radiother Oncol 1992;24:215–220.Google Scholar
Overgaard, J, Hansen, HS, Specht, L. et al. Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6&7 randomised control trial. Lancet 2003;362:933–940.Google Scholar
Fu, KK, Pajak, TF, Trotti, A, Jones, CU, Spencer, SA, Phillips, TL, Garden, AS, Ridge, JA, Cooper, JS, Ang, KK. A Radiation therapy oncology group (RTOG) phase III randomised study to compare hyperfractionation and two variants of accelerated fractionation to standard fractionation radiotherapy for head and neck squamous cell carcinomas: First report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:7–16.Google Scholar
Guidelines for the management of the unscheduled interruption or prolongation of a radical course of radiotherapy, 2nd edition., London:The Royal College of Radiologists, 2002.Google Scholar
Dale, RG, Jones, B, Sinclair, JA, Comins, C, Antoniou, E. Results of a UK survey on methods for compensating for unscheduled treatment interruptions and errors in treatment delivery. Br J Radiol 2007;80:367–370.Google Scholar
Dale, RG, Hendry, JH, Jones, B, Robertson, AG, Deehan, C, Sinclair, JA. Practical methods for compensating for missed treatment days in radiotherapy, with particular reference to head and neck schedules. Clin Oncol 2002;14:382–393.Google Scholar
Trotti, A, Byhardt, R, Stetz, J. et al. Common toxicity criteria: version 2.0. An improved reference for grading the acute effects of cancer treatment: impact on radiotherapy. Int J Radiat Oncol Biol Phys 2000;47:13–47.Google Scholar
Bourhis, J, Overgaard, J, Audry, H. et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet 2006;368:843–854.Google Scholar
Huang, J, Barbera, L, Brouwers, M, Browman, G, Mackillop, WJ. Does delay in starting treatment affect the outcomes of radiotherapy? A systematic review. J Clin Oncol 2003;21:555–563.Google Scholar
Robertson, C, Robertson, AG, Hendry, JH, Roberts, SA, Slevin, NJ, Duncan, WB, MacDougall, RH, Kerr, GR, O'Sullivan, B, Keane, TJ. Similar decreases in local tumor control are calculated for treatment protraction and for interruptions in the radiotherapy of carcinoma of the larynx in four centers. Int J Radiat Oncol Biol Phys 1998; 40:319–329.Google Scholar
Sanghera, P, McConkey, C, Ho, KF, Glaholm, J, Hartley, A. Hypofractionated accelerated radiotherapy with concurrent chemotherapy for locally advanced squamous cell carcinoma of the head and neck. Int J Radiat Oncol Biol Phys 2007;67:1342–1351.Google Scholar
Sykes, AJ, Slevin, NJ, MacDougall, RH, Ironside, JA, Mais, KL. Results of a phase I study to determine the maximum tolerated dose of capecitabine when given concurrently with radical radiotherapy in the treatment of squamous cell carcinoma of the head and neck. Radiother Oncol 2004;71:81–84.Google Scholar
Khalil, AA, Bentzen, SM, Bernier, J, Saunders, MI, Horiot, JC, Van Den Bogaert, W, Cummings, BJ, Dische, S.Compliance to the prescribed dose and overall treatment time in five randomized clinical trials of altered fractionation in radiotherapy for head-and-neck carcinomas. Int J Radiat Oncol Biol Phys 2003;55:568–575.Google Scholar
Skladowski, K, Law, MG, Maciejewski, B, Steel, GG. Planned and unplanned gaps in radiotherapy: the importance of gap position and gap duration. Radiother Oncol 1994;30:109–120.Google Scholar
Dische, S, Saunders, M, Barrett, A, Harvey, A, Gibson, D, Parmar, M. A randomised multicentre trial of CHART versus conventional radiotherapy in head and neck cancer. Radiother Oncol 1997;44:123–136.Google Scholar
Horiot, JC, Bontemps, P, van den Bogaert, W. et al. Accelerated fractionation (AF) compared to conventional fractionation (CF) improves loco-regional control in the radiotherapy of advanced head and neck cancers: results of the EORTC 22851 randomized trial. Radiother Oncol 1997;44:111–121.Google Scholar
Horiot, JC, Le Fur, R, N'Guyen, T. et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: final analysis of a randomized trial of the EORTC cooperative group of radiotherapy. Radiother Oncol 1992;25:231–141.Google Scholar
Fowler, JF. Is there an optimum overall time for head and neck radiotherapy? A review, with new modelling. Clin Oncol 2007;19:8–22.CrossRefGoogle ScholarPubMed
Bentzen, SM, Overgaard, M. Relationship between early and late normal-tissue injury after postmastectomy radiotherapy. Radiother Oncol 1991; 20:159–165.Google Scholar
Maciejewski, B, Skladowski, K, Pilecki, B, Taylor, JM, Withers, RH, Miszczyk, L, Zajusz, A, Suwinski, R. Randomized clinical trial on accelerated 7 days per week fractionation in radiotherapy for head and neck cancer. Preliminary report on acute toxicity. Radiother Oncol 1996;40:137–145.Google Scholar
Wang, CJ, Leung, SW, Chen, HC, Sun, LM, Fang, FM, Huang, EY, Hsiung, CY, Changchien, CC. The correlation of acute toxicity and late rectal injury in radiotherapy for cervical carcinoma: evidence suggestive of consequential late effect (CQLE). Int J Radiat Oncol Biol Phys 1998;40:85–91.Google Scholar
Withers, HR, Peters, LJ, Taylor, JM, Owen, JB, Morrison, WH, Schultheiss, TE, Keane, T, O'Sullivan, B, van Dyk, J, Gupta, N. Late normal tissue sequelae from radiation therapy for carcinoma of the tonsil: patterns of fractionation study of radiobiology. Int J Radiat Oncol Biol Phys 1995;33:563–568.Google Scholar