Comparison of Toxicity Associated With Early Morning Versus Late Afternoon Radiotherapy in Patients With Head-and-Neck Cancer: A Prospective Randomized Trial of the National Cancer Institute of Canada Clinical Trials Group (HN3)
- Department of Radiation Oncology, Sunnybrook Odette Cancer Centre, Toronto, ON (Canada)
- Department of Radiation Oncology, Centre Hosp Universitaire de Sherbrooke-Hop Fleurimont, Sherbrooke, QC (Canada)
- Department of Radiation Oncology, Juravinski Cancer Centre, Hamilton, ON (Canada)
- Department of Radiation Oncology, Ottawa Hospital Cancer Centre, Ottawa, ON (Canada)
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON (Canada)
- Department of Radiation Oncology, British Columbia Cancer Agency, Vancouver, BC (Canada)
- Department of Radiation Oncology, Dr. H. Bliss Murphy Cancer Centre, St. John's, NL (Canada)
- Department of Radiation Oncology, Fraser Valley Cancer Centre, Surrey, BC (Canada)
- Department of Radiation Oncology, Cancer Centre for Southern Interior, Kelowna, BC (Canada)
- Oral Pathology and Pathology, University of California, San Francisco, San Francisco, CA (United States)
- National Cancer Institute of Canada Clinical Trials Group, Kingston, ON (Canada)
Purpose: Based on our demonstration of a circadian rhythm in the human oral mucosa cell cycle, with most cells in the G{sub 1} phase in the morning and M phase at night, we hypothesized that morning radiotherapy (RT) would lead to less oral mucositis than afternoon RT. Methods and Materials: A total of 216 patients were randomized to morning (8-10 AM) vs. afternoon (4-6 PM) RT and stratified by radiation dose, smoking status, and center. Patients receiving primary or postoperative RT alone were eligible. Oral mucositis was scored using the Radiation Therapy Oncology Group (RTOG) criteria and a validated scoring system. Results: Of 205 evaluable patients, 52.9% vs. 62.4% developed RTOG Grade 3 or greater mucositis after morning vs. afternoon RT, respectively (p = 0.17). Morning RT was also associated with significantly less weight loss after 5 months (p = 0.024). In a subgroup of 111 patients treated to a dose of 66-70 Gy in 33-35 fractions, exploratory analyses revealed a significant reduction in Grade 3 or greater mucositis with morning RT (44.6% vs. 67.3%, p = 0.022) and a longer interval to the development of Grade 3 or greater mucositis (median, >7.9 vs. 5.6 weeks, p = 0.033). In 53 patients, who smoked during therapy, a significant reduction was found in Grade 3 or greater mucositis with morning RT (42.9% vs. 76%, p = 0.025). Conclusion: In this proof of principle study, morning RT was associated with significantly less weight loss after 5 months and an apparent reduction in oral mucositis in a subset of patients receiving {>=}66 Gy and in patients who smoked during therapy.
- OSTI ID:
- 21172549
- Journal Information:
- International Journal of Radiation Oncology, Biology and Physics, Vol. 73, Issue 1; Other Information: DOI: 10.1016/j.ijrobp.2008.07.009; PII: S0360-3016(08)03035-6; Copyright (c) 2009 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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