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Title: Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck

Abstract

Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control ratemore » was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.« less

Authors:
 [1];  [1];  [2];  [3];  [4];  [2];  [3];  [5]; ;  [4];  [1]
  1. Department of Radiation Oncology, Dana-Farber Cancer Institute and Brigham and Women's Hospital, Boston, MA (United States)
  2. Department of Medical Oncology, Dana-Farber Cancer Institute, Boston, MA (United States)
  3. (United States)
  4. Department of Surgery, Division of Otolaryngology, Brigham and Women's Hospital, Boston, MA (United States)
  5. Department of Medical Oncology, Massachusetts General Hospital, Boston, MA (United States)
Publication Date:
OSTI Identifier:
21587646
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 80; Journal Issue: 5; Other Information: DOI: 10.1016/j.ijrobp.2010.04.029; PII: S0360-3016(10)00606-1; Copyright (c) 2011 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved.; Country of input: International Atomic Energy Agency (IAEA); Journal ID: ISSN 0360-3016
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; BIOPSY; CARCINOMAS; CHEMOTHERAPY; COMBINED THERAPY; ESOPHAGUS; HEAD; IRRADIATION; NECK; POSITRON COMPUTED TOMOGRAPHY; RADIATION DOSES; RADIOTHERAPY; SURGERY; BODY; COMPUTERIZED TOMOGRAPHY; DIAGNOSTIC TECHNIQUES; DIGESTIVE SYSTEM; DISEASES; DOSES; EMISSION COMPUTED TOMOGRAPHY; MEDICINE; NEOPLASMS; NUCLEAR MEDICINE; ORGANS; RADIOLOGY; THERAPY; TOMOGRAPHY

Citation Formats

Sher, David J., E-mail: dsher@lroc.harvard.edu, Balboni, Tracy A., Haddad, Robert I., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Norris, Charles M., Posner, Marshall R., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Wirth, Lori J., Goguen, Laura A., Annino, Donald, and Tishler, Roy B.. Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck. United States: N. p., 2011. Web. doi:10.1016/j.ijrobp.2010.04.029.
Sher, David J., E-mail: dsher@lroc.harvard.edu, Balboni, Tracy A., Haddad, Robert I., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Norris, Charles M., Posner, Marshall R., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Wirth, Lori J., Goguen, Laura A., Annino, Donald, & Tishler, Roy B.. Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck. United States. doi:10.1016/j.ijrobp.2010.04.029.
Sher, David J., E-mail: dsher@lroc.harvard.edu, Balboni, Tracy A., Haddad, Robert I., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Norris, Charles M., Posner, Marshall R., Department of Medicine, Brigham and Women's Hospital, Boston, MA, Wirth, Lori J., Goguen, Laura A., Annino, Donald, and Tishler, Roy B.. Mon . "Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck". United States. doi:10.1016/j.ijrobp.2010.04.029.
@article{osti_21587646,
title = {Efficacy and Toxicity of Chemoradiotherapy Using Intensity-Modulated Radiotherapy for Unknown Primary of Head and Neck},
author = {Sher, David J., E-mail: dsher@lroc.harvard.edu and Balboni, Tracy A. and Haddad, Robert I. and Department of Medicine, Brigham and Women's Hospital, Boston, MA and Norris, Charles M. and Posner, Marshall R. and Department of Medicine, Brigham and Women's Hospital, Boston, MA and Wirth, Lori J. and Goguen, Laura A. and Annino, Donald and Tishler, Roy B.},
abstractNote = {Purpose: No single standard treatment paradigm is available for head-and-neck squamous cell carcinoma of an unknown primary (HNCUP). Bilateral neck radiotherapy with mucosal axis irradiation is widely used, with or without chemotherapy and/or surgical resection. Intensity-modulated radiotherapy (IMRT) is a highly conformal method for delivering radiation that is becoming the standard of care and might reduce the long-term treatment-related sequelae. We report the Dana-Farber Cancer Institute experience with IMRT-based treatment for HNCUP. Patients and Materials: A retrospective study of all patients treated at the Dana-Farber Cancer Institute for HNCUP with IMRT between August 2004 and January 2009. The primary endpoint was overall survival; the secondary endpoints were locoregional and distant control, and acute and chronic toxicity. Results: A total of 24 patients with HNCUP were included. Of these patients, 22 had Stage N2 disease or greater. All patients underwent neck computed tomography, positron emission tomography-computed tomography, and examination under anesthesia with directed biopsies. Of the 24 patients, 22 received concurrent chemotherapy, and 7 (29%) also underwent induction chemotherapy. The median involved nodal dose was 70 Gy, and the median mucosal dose was 60 Gy. With a median follow-up of 2.1 years, the 2-year actuarial overall survival and locoregional control rate was 92% and 100%, respectively. Only 25% of the patients had Grade 2 xerostomia, although 11 patients (46%) required esophageal dilation for stricture. Conclusion: In a single-institution series, IMRT-based chemoradiotherapy for HNCUP was associated with superb overall survival and locoregional control. The xerostomia rates were promising, but the aggressive therapy was associated with significant rates of esophageal stenosis.},
doi = {10.1016/j.ijrobp.2010.04.029},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 5,
volume = 80,
place = {United States},
year = {2011},
month = {8}
}