Acute mucosal radiation reactions in patients with head and neck cancer. Patterns of mucosal healing on the basis of daily examinations.

PURPOSE: The goal of this research was to evaluate the healing processes of acute mucosal radiation reactions (AMRR) in patients with head and neck cancer. MATERIALS AND METHODS: In 46 patients with oral and oropharyngeal cancer patients irradiated with conventional (n = 25) and accelerated (n = 21) dose fractionation AMRR was evaluated daily during and after radiotherapy. Complex of morphological and functional symptoms according to the Dische score were collected daily until complete healing. RESULTS: Duration of healing after the end of radiotherapy ranged widely (12-70 days). It was on the average 8 days longer for accelerated than for conventional radiotherapy (p = 0.016). Duration of dysphagia was also longer for accelerated irradiation (11 days, p = 0.027). Three types of morphological symptoms were observed as the last symptom at the end of AMRR healing: spotted and confluent mucositis, erythema, and edema. Only a slight correlation between healing duration and area of irradiation fields (r = 0.23) was noted. In patients with confluent mucositis, two morphological forms of mucosal healing were observed, i.e., marginal and spotted. The spotted form was noted in 71% of patients undergoing conventional radiotherapy and in 38% of patients undergoing accelerated radiotherapy. The symptoms of mucosal healing were observed in 40% patients during radiotherapy. CONCLUSION: The wide range of AMRR healing reflects individual potential of mucosa recovery with longer duration for accelerated radiotherapy. Two morphological forms of confluent mucositis healing were present: marginal and spotted. Healing of AMRR during radiotherapy can be observed in a significant proportion of patients.

[Unconventional accelerated irradiation of advanced pharyngolaryngeal cancer as an alternative treatment compare to surgery. The interim results of randomized clinical trial]. / Przyspieszona niekonwencjonalna radioterapia zaawansowanego raka krtani i gardla dolnego jako alternatywa dla leczenia operacyjnego. Wczesne wyniki kontrolowanego doswiadczenia klinicznego.

The paper presents preliminary results (3 year tumour control and survival) of clinical randomized trial comparing accelerated fractionation (7 fx a week) with conventional (5 fx a week) radiotherapy (RT) for advanced pharyngo-laryngeal cancer. Significant treatment gain (p < 0.001) and good tolerance associated with accelerated RT was noted (82% of disease-free and 79% of overall survival). These results are similar with combined (total laryngectomy + postoperative RT) policy and, additionally, accelerated RT offers a high chance of larynx preservation.

[The effectiveness of combined treatment for laryngeal cancer in Silesia region during the years 1987-1996]. / Ocena wyników skojarzonego leczenia raka krtani w materiale klinicznym Instytutu Onkologii w Gliwicach w latach 1987-1996.

Between 1987-1996, 484 patients with laryngeal cancer were treated by surgery and adjuvant radiotherapy. The 25-30% therapeutic gain was noted when to compare the first period of the study (1987-1992) with the second (1993-1996). The increment of effectiveness of combined treatment for larynx cancer is probably the result of better quality of surgical procedures and individualization of radiation treatment.

[[Radical radiotherapy in patients with laryngeal cancer in clinical material of Institute Oncology in Gliwice treated in year 1990-1996]. / Samodzielna radioterapia chorych na raka krtani w materiale klinicznym Instytutu Onkologii w Gliwicach w latach 1990-1996.

This paper presents influence of selected prognostic factors on results of laryngeal cancer radiotherapy used as the only treatment in 541 patients irradiated in Centre of Oncology-Institute in Gliwice between 1990-1996. The 3-year actuarial disease-free survival was 47.5% for supraglottic cancer and 67% for glottic cancer. Primary tumour localisation in glottis correlates with more favourable prognosis than that in supraglottic. For extralaryngeal involvement the most favourable prognosis was infiltration of cartilages and the worst one for the hypopharyngeal and oropharyngeal involvement. Pretreatment tracheostomy significantly correlates with the worst results.

Randomized clinical trial on 7-day-continuous accelerated irradiation (CAIR) of head and neck cancer - report on 3-year tumour control and normal tissue toxicity.

PURPOSE: To evaluate tumour and normal tissues 3-year response to 7-day-a-week continuous accelerated irradiation (CAIR) compared to a conventional treatment (5 days per week) in a randomized trial. MATERIALS AND METHODS: One hundred patients with squamous cell carcinoma of the head and neck in stage T(2-4)N(0-1)M(0) were entered into the trial between December 1, 1993 and June 30, 1996. Dose per fraction of 2.0 Gy (to the end of 1994), and 1.8 Gy (since January 1, 1995) was the same in both arms and delivered once a day at regular 24-h intervals to total dose in the range of 66-72 Gy (depending on tumour stage). The only difference was overall treatment time being 5 weeks in the CAIR and 7 weeks in control arm. RESULTS: Actuarial 3-year local tumour control was 82% in the CAIR and 37% in the control group (P<0.0001) with reduction in local recurrence rate of 83%. Actuarial 3-year overall survival was 78 and 32% (P<0.0001), respectively. Confluent mucositis was significantly more severe and lasted longer in the CAIR than in control arm. After 2.0 Gy fractions five of 23 patients (22%) in the CAIR developed early necroses over a period of 2-4 months of follow-up which can be considered as a consequential to severe protracted acute mucosal reactions (CLE). For this reason dose per fraction was lowered to 1. 8 Gy and the CLE was not observed again until now. Thus the overall rate of CLE decreased to 10%. CONCLUSIONS: The gain in tumour control is likely the effect of shortening of overall treatment time by 14 days and regular continuous dose delivery during the whole course of radiation therapy including weekends. A 7-day schedule produces more severe acute mucosal reactions lasting longer than in conventional fractionation, however tolerable by patients. Relatively high rate (22%) of CLE in the 7-day arm observed during the first year of the study was eliminated by decreasing dose per fraction from 2.0 Gy to 1.8 Gy.

[Evaluation of severity and clinical course of acute mucosal reaction during postop radiotherapy of laryngeal cancer]. / Ocena nasilenia i przebiegu ostrego odczynu popromiennego blony sluzowej w trakcie pooperacyjnej radioterapii raka krtani.

In the group of 110 epiglottic and glottic cancer patients treated with postoperative radiotherapy, relationships between the severity of acute mucosal reaction and time of treatment for different types of surgery and for different intervals between surgery and postoperative radiotherapy were analysed. The dependence between the total dose and the radiation reaction was assigned. The maximal radiation reaction appeared in the fourth week of irradiation independently of operation type. The highest grade of reaction in the last week of irradiation appeared in the group after limited operations and the lowest one in the group after total laryngectomy. There was a statistically significant difference between distribution of acute radiation injury grade in a group after limited operation and a group after hemilaryngectomy compared by Wilcoxon matched pairs test. For the interval between operation and radiotherapy shorter than 6 weeks the highest reaction was in the fourth, for the interval 6 to 12 weeks in the third and for the interval longer than 22 weeks in the fifth week of irradiation. The highest reaction in the last irradiation week appeared in the first group, the lowest one in the second group. However, generally the time-interval between surgery and radiotherapy does not influence the severity of acute mucosal reaction (there was no statistically significant difference between reaction grade distribution compared by Wilcoxon matched pairs test). There was also no correlation between the total dose and intensity of radiation injury in last irradiation week. The interrelationships and other factors which could influence the obtained results were considered. The main final conclusions were formed: maximal intensity of mucous membrane radiation injury and the intensity in the last week of treatment depend on the character of previous operation (smaller operation--bigger postradiation reaction) and do not depend on total dose or on the interval between operation and beginning of radiotherapy.

[Primary non-Hodgkin's lymphoma of the maxillary sinus]. / Pierwotny nieziarniczy chloniak zlosliwy zatoki szczekowej.

The head and neck region is one of the most common sites of extranodal non-Hodgkin's lymphoma, but it is an infrequent tumor at the paranasal sinuses site, representing no more than 5.8-8 percent of the entire malignant tumours in this localization and 0.3-2 percent of all extranodal lymphomas. These rare tumors are characterized by bulky local disease, and a propensity for central nervous system spread. Most of patients with paranasal sinus lymphoma have stage I or IIE disease, but according to the TNM system, more than half have T3-4 disease. Most of these tumors are asymptomatic in the early stages and are diagnosed only after invasion of adjacent structures with local bone destruction. Treatment is basically radiotherapy in combination with aggressive multidrug chemotherapy, also in elderly patients, even at the beginning of the illness. A case of primary extranodal non-Hodgkin's lymphoma arising in maxillary sinus, in 64 year-old man is reported. He was staged IAE by the Ann-Arbor system, and according to the TNM staging T4N0M0. He was treated with irradiation and polychemotherapy and responded complete local regression, but during chemotherapy has been developed extranodal dissemination to central nervous system.

Sequential combination of radio-chemotherapy (5-fluorouracil, cis-platinum and irradiation) in the management of locally advanced head and neck cancers.

Thirty-seven previously untreated patients with advanced, inoperable head and neck were treated with a sequential courses combining hypofractionated irradiation with chemotherapy (5-fluorouracil and cis-platinum). Each course was repeated every 4 weeks. Tumor response was evaluated and for 15 patients (41%) with a partial or complete regression after 3 radio-chemotherapy courses conventional radiotherapy was added. Eleven percent of all patients were in complete remission at the end of a treatment. This tumor response rate and the 50% rate of pain subside after first course for symptomatic patients contributed for a good palliative effect in the present study. However, the median survival of 7.2 months was considered unsatisfactory.