RESUMEN
PURPOSE/OBJECTIVE(S): To analyze quality of life (QOL) and performance status (PS) for head and neck cancer (HNC) patients treated on NRG Oncology RTOG 0129 by treatment (secondary outcome) and p16 status, and to examine the association between QOL/PS and survival. METHODS AND MATERIALS: Eligible patients were randomized into either an accelerated-fractionation arm or a standard-fractionation arm, and completed the Performance Status Scale for the Head and Neck (PSS-HN), the Head and Neck Radiotherapy Questionnaire (HNRQ), and the Spitzer Quality of Life Index (SQLI) at 8 time points from before treatment to 5 years after treatment. RESULTS: The results from the analysis of area under the curve showed that QOL/PS was not significantly different between the 2 arms from baseline to year after treatment (P ranged from .39 to .98). The results from general linear mixed models further supported the nonsignificant treatment effects until 5 years after treatment (P=.95, .90, and .84 for PSS-HN Diet, Eating, and Speech, respectively). Before treatment and after 1 year after treatment, p16-positive oropharyngeal cancer (OPC) patients had better QOL than did p16-negative patients (P ranged from .0283 to <.0001 for all questionnaires). However, QOL/PS decreased more significantly from pretreatment to the last 2 weeks of treatment in the p16-positive group than in the p16-negative group (P ranged from .0002 to <.0001). Pretreatment QOL/PS was a significant independent predictor of overall survival, progression-free survival, and local-regional failure but not of distant metastasis (P ranged from .0063 to <.0001). CONCLUSIONS: The results indicated that patients in both arms may have experienced similar QOL/PS. p16-positive patients had better QOL/PS at baseline and after 1 year of follow-up. Patients presenting with better baseline QOL/PS scores had better survival.
Asunto(s)
Quimioradioterapia/mortalidad , Quimioradioterapia/psicología , Neoplasias de Cabeza y Cuello/mortalidad , Neoplasias de Cabeza y Cuello/terapia , Recurrencia Local de Neoplasia/prevención & control , Calidad de Vida/psicología , Adulto , Anciano , Anciano de 80 o más Años , Antineoplásicos/administración & dosificación , Quimioradioterapia/estadística & datos numéricos , Cisplatino/administración & dosificación , Fraccionamiento de la Dosis de Radiación , Femenino , Neoplasias de Cabeza y Cuello/psicología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/mortalidad , Recurrencia Local de Neoplasia/psicología , Prevalencia , Factores de Riesgo , Tasa de Supervivencia , Resultado del Tratamiento , Estados Unidos/epidemiologíaRESUMEN
BACKGROUND: In comparison to sliding-window intensity-modulated radiation therapy (sw-IMRT), we hypothesized that helical tomotherapy (HT) would achieve similar locoregional control and, at the same time, decrease the parotid gland dose, thus leading to a xerostomia reduction. METHODS: The association between radiation techniques, mean parotid dose, and xerostomia incidence, was reviewed in 119 patients with advanced oropharyngeal carcinoma treated with concurrent chemoradiation using sw-IMRT (n = 59) or HT (n = 60). RESULTS: Ipsilateral and contralateral parotid mean doses were significantly lower for patients treated with HT versus sw-IMRT: 24 Gy versus 32 Gy ipsilaterally and 20 Gy versus 25 Gy contralaterally. The incidence of grade ≥2 xerostomia was significantly lower in the HT group than in the sw-IMRT group: 12% versus 78% at 6 months, 3% versus 51% at 12 months, and 0% versus 25% at 24 months. Total parotid mean dose <25 Gy was strongly associated to a lower incidence of grade ≥2 xerostomia at 6, 12, and 24 months. CONCLUSION: This retrospective series suggests that using HT can better spare the parotid glands while respecting quantitative analysis of normal tissue effects in the clinic (QUANTEC)'s criteria.
Asunto(s)
Carcinoma/terapia , Neoplasias Orofaríngeas/terapia , Radioterapia de Intensidad Modulada/métodos , Xerostomía/prevención & control , Antineoplásicos/uso terapéutico , Carcinoma/patología , Terapia Combinada , Relación Dosis-Respuesta en la Radiación , Femenino , Humanos , Incidencia , Masculino , Persona de Mediana Edad , Neoplasias Orofaríngeas/patología , Aceleradores de Partículas , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/efectos adversos , Estudios Retrospectivos , Xerostomía/epidemiologíaRESUMEN
PURPOSE: Current stereotactic ablative radiotherapy (SABR) protocols for lung tumors prescribe a uniform dose regimen irrespective of tumor size. We report the outcomes of a lung tumor volume-adapted SABR dosing strategy. METHODS AND MATERIALS: We retrospectively reviewed the outcomes in 111 patients with a total of 138 primary or metastatic lung tumors treated by SABR, including local control, regional control, distant metastasis, overall survival, and treatment toxicity. We also performed subset analysis on 83 patients with 97 tumors treated with a volume-adapted dosing strategy in which small tumors (gross tumor volume <12 mL) received single-fraction regimens with biologically effective doses (BED) <100 Gy (total dose, 18-25 Gy) (Group 1), and larger tumors (gross tumor volume ≥12 mL) received multifraction regimens with BED ≥100 Gy (total dose, 50-60 Gy in three to four fractions) (Group 2). RESULTS: The median follow-up time was 13.5 months. Local control for Groups 1 and 2 was 91.4% and 92.5%, respectively (p = 0.24) at 12 months. For primary lung tumors only (excluding metastases), local control was 92.6% and 91.7%, respectively (p = 0.58). Regional control, freedom from distant metastasis, and overall survival did not differ significantly between Groups 1 and 2. Rates of radiation pneumonitis, chest wall toxicity, and esophagitis were low in both groups, but all Grade 3 toxicities developed in Group 2 (p = 0.02). CONCLUSION: A volume-adapted dosing approach for SABR of lung tumors seems to provide excellent local control for both small- and large-volume tumors and may reduce toxicity.
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Carcinoma de Pulmón de Células no Pequeñas/patología , Carcinoma de Pulmón de Células no Pequeñas/cirugía , Neoplasias Pulmonares/patología , Neoplasias Pulmonares/cirugía , Radiocirugia/métodos , Carga Tumoral , Adenocarcinoma/mortalidad , Adenocarcinoma/patología , Adenocarcinoma/cirugía , Anciano , Carcinoma de Pulmón de Células no Pequeñas/mortalidad , Carcinoma de Células Escamosas/mortalidad , Carcinoma de Células Escamosas/patología , Carcinoma de Células Escamosas/cirugía , Fraccionamiento de la Dosis de Radiación , Esofagitis/epidemiología , Esofagitis/etiología , Femenino , Marcadores Fiduciales , Humanos , Neoplasias Pulmonares/mortalidad , Masculino , Neumonitis por Radiación/epidemiología , Dosificación Radioterapéutica , Efectividad Biológica Relativa , Estudios RetrospectivosRESUMEN
PURPOSE: To determine the impact of (18)F-fluorodeoxyglucose positron emission tomography (PET) in radiotherapy target delineation and patient management for head and neck squamous cell carcinoma (HNSCC) compared to computed tomography (CT) alone. MATERIALS AND METHODS: Twenty-nine patients with HNSCC were included. CT and PET/CT obtained for treatment planning purposes were reviewed respectively by a neuroradiologist and a nuclear medicine specialist who were blinded to the findings from each other. The attending radiation oncologist together with the neuroradiologist initially defined all gross tumor volume of the primary (GTVp) and the suspicious lymph nodes (GTVn) on CT. Subsequently, the same radiation oncologist and the nuclear medicine specialist defined the GTVp and GTVn on (18)F-FDG-PET/CT. Upon disagreement between CT and (18)F-FDG-PET on the status of a particular lymph node, an ultrasound-guided fine needle aspiration was performed. Volumes based on CT and (18)F-FDG-PET were compared with a paired Student's t-test. RESULTS: For the primary disease, four patients had previous diagnostic tonsillectomy and therefore, FDG uptake occurred in 25 patients. For these patients, GTVp contoured on (18)F-FDG-PET (GTVp-PET) were smaller than the GTVp contoured on CT (GTVp-CT) in 80% of the cases, leading to a statistically significant volume difference (p=0.001). Of the 60 lymph nodes suspicious on PET, 55 were also detected on CT. No volume change was observed (p=0.08). Ten biopsies were performed for lymph nodes that were discordant between modalities and all were of benign histology. Distant metastases were found in two patients and one had a newly diagnosed lung adenocarcinoma. CONCLUSIONS: GTVp-CT was significantly larger when compared to GTVp-PET. No such change was observed for the lymph nodes. (18)F-FDG-PET modified treatment management in three patients, including two for which no curative radiotherapy was attempted. Larger multicenter studies are needed to ascertain whether combined (18)F-FDG-PET/CT in target delineation can influence the main clinical outcomes.
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Carcinoma de Células Escamosas/radioterapia , Fluorodesoxiglucosa F18 , Neoplasias de Cabeza y Cuello/radioterapia , Imagen Multimodal/métodos , Tomografía de Emisión de Positrones , Radiofármacos , Carcinoma de Células Escamosas/diagnóstico por imagen , Carcinoma de Células Escamosas/patología , Femenino , Neoplasias de Cabeza y Cuello/diagnóstico por imagen , Neoplasias de Cabeza y Cuello/patología , Humanos , Metástasis Linfática , Masculino , Persona de Mediana Edad , Radioterapia Guiada por Imagen , Estudios Retrospectivos , Carcinoma de Células Escamosas de Cabeza y Cuello , Tomografía Computarizada por Rayos XRESUMEN
PURPOSE: A comparative treatment planning study was conducted to analyze combined intensity-modulated radiation therapy (IMRT) vs. three-dimensional highly conformal radiotherapy (3D-hCRT) after (125)I permanent seed brachytherapy in patients with localized prostate cancer. METHODS AND MATERIALS: We optimized an IMRT and a 3D-hCRT treatment plan to 45Gy in 9 patients 2 months after (125)I seed brachytherapy (110Gy) implant. IMRT and 3D-hCRT were planned using eight and seven nonopposed coplanar fields of 6- and 23-MV. Dose-volume histograms for target volume and organs at risk were compared for both techniques. RESULTS: IMRT provided similar conformality but better homogeneity (p=0.021) than 3D-hCRT plans, despite slightly higher maximal point dose rates (101.9% vs. 100.9%, p=0.050). 3D-hCRT plans required fewer monitor units than did IMRT (289 vs. 607, p=0.008). Dose to bladder, penile bulb, and femoral heads were lower with IMRT than with 3D-hCRT (p=0.008-0.028). No differences were observed for dose to urethra and the entire rectum. Mean dose to rectal wall was lower with IMRT than with 3D-hCRT (25.1 vs. 26.5Gy, p=0.028). CONCLUSION: IMRT plans result in more homogeneous dose distribution and in reduced doses to most organs at risk at the expense of needing more than twice the monitor units compared with 3D-hCRT.
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Braquiterapia/métodos , Neoplasias de la Próstata/radioterapia , Radioterapia Conformacional/métodos , Humanos , Radioisótopos de Yodo/uso terapéutico , Masculino , Dosificación Radioterapéutica , Radioterapia de Intensidad Modulada/métodosRESUMEN
BACKGROUND: Our aim was to determine the incidence rates of head and neck cancer in Vietnamese Californians compared with other Asian and non-Asian Californians. METHODS: Age-adjusted incidence rates of head and neck cancer between 1988 and 2004 were computed for Vietnamese Californians compared with other racial/ethnic groups by time period, ethnicity, neighborhood-level socioeconomic status (SES), and sex using data from the population-based California Cancer Registry (CCR). Data by smoking and alcohol status were tabulated from the California Health Interview Survey. RESULTS: Vietnamese men had a higher incidence rate of head and neck cancer than other Asian men. Specifically, the laryngeal cancer rate was significantly higher for Vietnamese men (6.5/100,000; 95% confidence interval [CI], 5.0-8.2) than all other Asian men (range, 2.6-3.8/100,000), except Korean men (5.1/100,000; 95% CI, 3.9-6.4). Both Vietnamese and Korean men had the highest percentage of current smokers. Neighborhood SES was inversely related to head and neck cancer rates among Vietnamese men and women. CONCLUSION: The higher incidence rate of head and neck cancer in Vietnamese men may correspond to the higher smoking prevalence in this group. Individual-level data are needed to establish the link of tobacco, alcohol, and other risk factors with head and neck cancer in these patients.
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Asiático/estadística & datos numéricos , Neoplasias de Cabeza y Cuello/epidemiología , Consumo de Bebidas Alcohólicas/epidemiología , California/epidemiología , Encuestas Epidemiológicas , Humanos , Incidencia , Masculino , Sistema de Registros , Fumar/epidemiología , Clase Social , Vietnam/etnologíaAsunto(s)
Carcinoma de Células Escamosas/radioterapia , Infecciones por VIH/tratamiento farmacológico , Inhibidores de la Proteasa del VIH/uso terapéutico , VIH-1/patogenicidad , Hemoptisis/etiología , Neoplasias Pulmonares/radioterapia , Nelfinavir/uso terapéutico , Carcinoma de Células Escamosas/etiología , Resultado Fatal , Seropositividad para VIH , Hemoptisis/patología , Humanos , Neoplasias Pulmonares/etiología , MasculinoRESUMEN
PURPOSE: To evaluate the prognostic value of metabolic tumor volume measured on 18F-fluorodeoxyglucose positron emission tomography (FDG-PET) imaging and other clinical factors in patients treated for locally advanced head-and-neck cancer (HNC) at a single institution. MATERIALS AND METHODS: Between March 2003 and August 2007, 85 patients received positron emission tomography (PET)/computed tomography-guided chemoradiotherapy for HNC. Metabolically active tumor regions were delineated on pretreatment PET scans semiautomatically using custom software. We evaluated the relationship of (18)F-fluorodeoxyglucose-PET maximum standardized uptake value (SUV) and total metabolic tumor volume (MTV) with disease-free survival (DFS) and overall survival (OS). RESULTS: Mean follow-up for surviving patients was 20.4 months. The estimated 2-year locoregional control, DFS, and OS for the group were 88.0%, 69.5%, and 78.4%, respectively. The median time to first failure was 9.8 months among the 16 patients with relapse. An increase in MTV of 17.4 mL (difference between the 75th and 25th percentiles) was significantly associated with an increased hazard of first event (recurrence or death) (1.9-fold, p < 0.001), even after controlling for Karnofsky performance status (KPS) (1.8-fold, p = 0.001), and of death (2.1-fold, p < 0.001). We did not find a significant relationship of maximum SUV, stage, or other clinical factors with DFS or OS. CONCLUSIONS: Metabolic tumor volume is an adverse prognostic factor for disease recurrence and death in HNC. MTV retained significance after controlling for KPS, the only other significant adverse prognostic factor found in this cohort. MTV is a direct measure of tumor burden and is a potentially valuable tool for risk stratification and guiding treatment in future studies.