Prevention of normal tissue complications in radiation therapy of head and neck cancer : the role of 3D conformal radiation therapy (3DCRT)

In The Netherlands. head and neck cancer (3.9%) ranks the eighth most frequemly diagnoscd malignant tumor. Radiation therapy (IIT) plays an important role in the treatmem of patients with head and neck cancer, as they constitute approximately 6% of those treated in a routine radiation therapy department. Radiation therapy can be used as a single treatment modality. but is also often combined with surgery and/or chemotherapy ( chemoradiation) in multimodaliry treatment protocols. Radiation therapy and (concurrent) chemotherapy play an important role in organ preservation protocols. The effect of ionizing radiation is unfortunately not limited to the malignant cells: it also affeers normal surrounding tissues which can lead to acute and late normal tissue complications. The head and neck region harbors organs ancl strucrures essential for basic functions, such as swallowing, speech and respiration. Preservation of quality of life (QOL) in conjunction with cure. i.e. complication-free survival. has become a key-issue in cancer treatment. ln radiation oncology the rapid technological development in linear accelerators and treatment planning systems (TPS) have significantly increased the accuracy and applicability of high doses of radiation. Highclose. high-precision RT has come with.in reach for many patients. This so called 3D conformal radiation therapy (3DCIIT) enables one to conform the dose distribution to the target volume (rumor) and therewith a better sparing (avoidance) of the surrounding normal structures is achieved. In this thesis the capabilities of 3DCIIT for sparing normal tissue structures, such as the major salivary glands. are explored. Also examples of dose-escalation wimout increased toxicity are presented. Moreover. the merit of other preventative measures to limit acute normal tissue complications. such as the use of antibiotics to eliminate severe mucositis. is reported

Does multidisciplinary videoconferencing between a head-and-neck cancer centre and its partner hospital add value to their patient care and decision-making? A mixed-method evaluation

OBJECTIVES: Given the difficulties in diagnosing and treating head-and-neck cancer, care is centralised in the Netherlands in eight head-and-neck cancer centres and six satellite regional hospitals as preferred partners. A requirement is that all patients of the partner should be discussed in a multidisciplinary team meeting (MDT) with the head-and-neck centre as part of a Dutch health policy rule. In this mixed-method study, we evaluate the value that the video-conferenced MDT adds to the MDTs in the care pathway, quantitative regarding recommendations given and qualitative in terms of benefits for the teams and the patient. DESIGN: A sequential mixed-method study. SETTING: One oncology centre and its partner in the Northern part of the Netherlands. PARTICIPANTS: Head-and-neck cancer specialists presenting patient cases during video-conferenced MDT over a period of 6 months. Semistructured interviews held with six medical specialists, three from the centre and three from the partner. PRIMARY AND SECONDARY OUTCOME MEASURES: Percentage of cases in which recommendations were given on diagnostic and/or therapeutic plans during video-conferenced MDT. RESULTS: In eight of the 336 patient cases presented (2%), specialists offered recommendations to the collaborating team (three given from centre to partner and five from partner to centre). Recommendations mainly consisted of alternative diagnostic modalities or treatment plans for a specific patient. Interviews revealed that specialists perceive added value in discussing complex cases because the other team offered a fre

Multicenter validation of recursive partitioning analysis classification for patients with squamous cell head and neck carcinoma treated with surgery and postoperative radiotherapy.

Contains fulltext : 52824.pdf (publisher's version ) (Closed access)PURPOSE: To validate the recursive partitioning analysis (RPA) classification system for squamous cell head and neck cancer as recently reported by the VU University Medical Center. METHODS AND MATERIALS: In eight Dutch head and neck cancer centers, data necessary to classify patients according to the RPA system were retrospectively collected from the charts of a group of 780 patients treated between 1989 and 2003. The patients in this validation group were classified according to the RPA classification system. For each endpoint, the 5-year values and hazard ratios were calculated and compared with the results of the VU University Medical Center. The RPA classification system was considered valid if the hazard ratio of the validation population was within the 95% confidence interval of the VU University Medical Center study population. RESULTS: The locoregional control rate was 82%, 75%, and 63% at 5 years for those with class I, II, and III, respectively (p < 0.0001). The hazard ratio for the locoregional control rate relative to class I was 1.44 (95% confidence interval, 0.97-2.16) for class II and 2.37 (95% confidence interval, 1.57-3.57) for class III. Similar results were found for the distant metastasis, overall survival, and disease-free survival rates. CONCLUSION: The RPA classification system for head and neck squamous cell carcinoma in the postoperative setting, which was originally designed at one center, proved to be valid in a multicenter setting among patients included in a national multicenter study. This validated RPA classification scheme can be used to assess standard treatment strategies for head and neck squamous cell carcinoma in the postoperative setting, as well as in the design of future prospective studies

Late follow-up of the randomized radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) trial for advanced head and neck cancer

Background. The radiation and concomitant high-dose intra-arterial or intravenous cisplatin (RADPLAT) phase III trial compared intra-arterial (IA) to intravenous (IV) cisplatin-based chemoradiation for head and neck cancer. Long-term efficacy and toxicity are reported after a median follow-up of 7.5 years.Methods. Patients with inoperable squamous cell carcinoma (SCC) of the oropharynx, oral cavity, or hypopharynx, were randomized between radiotherapy (RT) + IA cisplatin 150 mg/m(2), followed by systemic rescue or RT + I. V. cisplatin 100 mg/m(2). RT consisted of 46 Gy to the affected and elective areas, followed by a boost of 24 Gy.Results. Among 237 patients, 57 recurred locally, 35 regionally, and 80 locoregionally. There were 32 second primary tumors, 65 distant metastases, and 154 deaths. Locoregional control and overall survival were not different between the treatment arms. Late dysphagia was worse in the I.V. arm (log-rank p=.014).Conclusion. IA cisplatin did not improve tumor control compared to I.V. administered cisplatin, despite the higher dose in IA delivery of the drug. (C) 2015 Wiley Periodicals, Inc.Biological, physical and clinical aspects of cancer treatment with ionising radiatio