skip to main content
OSTI.GOV title logo U.S. Department of Energy
Office of Scientific and Technical Information

Title: Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis

Abstract

Purpose: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods and Materials: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube {>=}2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. Results: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had amore » severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving {<=}60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.« less

Authors:
 [1];  [2];  [3];  [4];  [2];  [2];  [4]; ;  [5];  [6];  [7];  [5]
  1. University Hospitals Seidman Cancer Center and Case Western Reserve University School of Medicine, Cleveland, Ohio (United States)
  2. Radiation Therapy Oncology Group Headquarters and Statistical Center, Philadelphia, Pennsylvania (United States)
  3. Thomas Jefferson University, Philadelphia, Pennsylvania (United States)
  4. (United States)
  5. MD Anderson Cancer Center, Houston, Texas (United States)
  6. Maimonides Medical Center, New York, New York (United States)
  7. Johns Hopkins University Medical Center, Baltimore, Maryland (United States)
Publication Date:
OSTI Identifier:
22149641
Resource Type:
Journal Article
Journal Name:
International Journal of Radiation Oncology, Biology and Physics
Additional Journal Information:
Journal Volume: 84; Journal Issue: 4; Other Information: Copyright (c) 2012 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; CARCINOMAS; DEATH; DOSIMETRY; FEEDING; HEAD; MULTIVARIATE ANALYSIS; NECK; PATIENTS; PNEUMONIA; RADIATION DOSES; RADIOTHERAPY; TOXICITY

Citation Formats

Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org, Moughan, Jennifer, Farach, Andrew, University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas, Martin-O'Meara, Elizabeth, Galvin, James, Thomas Jefferson University, Philadelphia, Pennsylvania, Garden, Adam S., Weber, Randal S., Cooper, Jay S., Forastiere, Arlene, and Ang, K. Kian. Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis. United States: N. p., 2012. Web. doi:10.1016/J.IJROBP.2012.03.005.
Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org, Moughan, Jennifer, Farach, Andrew, University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas, Martin-O'Meara, Elizabeth, Galvin, James, Thomas Jefferson University, Philadelphia, Pennsylvania, Garden, Adam S., Weber, Randal S., Cooper, Jay S., Forastiere, Arlene, & Ang, K. Kian. Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis. United States. doi:10.1016/J.IJROBP.2012.03.005.
Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org, Moughan, Jennifer, Farach, Andrew, University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas, Martin-O'Meara, Elizabeth, Galvin, James, Thomas Jefferson University, Philadelphia, Pennsylvania, Garden, Adam S., Weber, Randal S., Cooper, Jay S., Forastiere, Arlene, and Ang, K. Kian. Thu . "Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis". United States. doi:10.1016/J.IJROBP.2012.03.005.
@article{osti_22149641,
title = {Hypopharyngeal Dose Is Associated With Severe Late Toxicity in Locally Advanced Head-and-Neck Cancer: An RTOG Analysis},
author = {Machtay, Mitchell, E-mail: mitchell.machtay@uhhospitals.org and Moughan, Jennifer and Farach, Andrew and University of Texas Health Science Center/Baylor College of Medicine, Houston, Texas and Martin-O'Meara, Elizabeth and Galvin, James and Thomas Jefferson University, Philadelphia, Pennsylvania and Garden, Adam S. and Weber, Randal S. and Cooper, Jay S. and Forastiere, Arlene and Ang, K. Kian},
abstractNote = {Purpose: Concurrent chemoradiation therapy (CCRT) for squamous cell carcinoma of the head and neck (SCCHN) increases local tumor control but at the expense of increased toxicity. We recently showed that several clinical/pretreatment factors were associated with the occurrence of severe late toxicity. This study evaluated the potential relationship between radiation dose delivered to the pharyngeal wall and toxicity. Methods and Materials: This was an analysis of long-term survivors from 3 previously reported Radiation Therapy Oncology Group (RTOG) trials of CCRT for locally advanced SCCHN (RTOG trials 91-11, 97-03, and 99-14). Severe late toxicity was defined in this secondary analysis as chronic grade 3-4 pharyngeal/laryngeal toxicity and/or requirement for a feeding tube {>=}2 years after registration and/or potential treatment-related death (eg, pneumonia) within 3 years. Radiation dosimetry (2-dimensional) analysis was performed centrally at RTOG headquarters to estimate doses to 4 regions of interest along the pharyngeal wall (superior oropharynx, inferior oropharynx, superior hypopharynx, and inferior hypopharynx). Case-control analysis was performed with a multivariate logistic regression model that included pretreatment and treatment potential factors. Results: A total of 154 patients were evaluable for this analysis, 71 cases (patients with severe late toxicities) and 83 controls; thus, 46% of evaluable patients had a severe late toxicity. On multivariate analysis, significant variables correlated with the development of severe late toxicity, including older age (odds ratio, 1.062 per year; P=.0021) and radiation dose received by the inferior hypopharynx (odds ratio, 1.023 per Gy; P=.016). The subgroup of patients receiving {<=}60 Gy to the inferior hypopharynx had a 40% rate of severe late toxicity compared with 56% for patients receiving >60 Gy. Oropharyngeal dose was not associated with this outcome. Conclusions: Severe late toxicity following CCRT is common in long-term survivors. Age is the most significant factor, but hypopharyngeal dose also was associated.},
doi = {10.1016/J.IJROBP.2012.03.005},
journal = {International Journal of Radiation Oncology, Biology and Physics},
issn = {0360-3016},
number = 4,
volume = 84,
place = {United States},
year = {2012},
month = {11}
}