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Regional recurrence of oropharyngeal cancer after definitive radiotherapy: a case control study
Umeå University, Faculty of Medicine, Department of Radiation Sciences, Oncology.
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2015 (English)In: Radiation Oncology, ISSN 1748-717X, E-ISSN 1748-717X, Vol. 10, 117Article in journal (Refereed) Published
Abstract [en]

Background: Elective treatment of lymph nodes in oropharyngeal cancer (OPC) has impact on both regional recurrences (RR) and risk of late side effects. This study was performed to quantify the dose-dependent impact on RR and overall survival (OS) in a prospectively collected cohort of OPC from the ARTSCAN study with emphasis on elective treatment. Methods: ARTSCAN is a previously published prospective, randomized, multicentre study of altered radiotherapy (RT) fractionation in head and neck cancer. In ARTSCAN the elective treatment volume for node positive OPC varied significantly between centres due to local treatment principles. All patients with OPC in complete response after primary treatment were eligible for the present case-control study. Cases were patients with RR during five years follow-up. Patients with no recurrence were eligible as controls. Four controls per case were matched according to T-and N-stage. Mean (D-mean) and median (D-50%) dose for the lymph node level (LNL) of RR in the cases and the corresponding LNL in the controls were analysed with conditional logistic regression. OS was estimated with the Kaplan-Meier method and evaluated by multivariate Cox regression analysis. Results: There was a dose-dependent risk reduction for D-50% in the interval that represented elective treatment (40-50 Gy) (OR = 0.18, p < 0.05) and a trend in the same dose interval for D-mean (OR = 0.19, p = 0.07). OS rates at five years were 0.39 (0.24-0.65) for cases and 0.70 (0.62-0.81) for controls (p < 0.001). The Kaplan-Meier and the Cox regression analysis for cases categorised by delivered dose showed an inverse relationship between dose and survival. The cases with RR in a LNL outside planning target volume (PTV) (D-mean < 40 Gy) had an OS rate comparable to that of all patients, and those with RR in a LNL in PTVelective (D-mean 40-60 Gy) or PTVtumour (D-mean > 60 Gy) did significantly worse (p < 0.05). The same inverse relationship was also shown for a small subset of patient with known HPV-status, defined by over expression of p16 (p < 0.05). Conclusions: There was a significant risk reduction for RR of elective treatment. However the OS for patients with RR outside target volumes was not affected, with similar results for patients with HPV-positive OPC. This could be an argument for a prospective randomized study on limited elective target volumes in OPC.

Place, publisher, year, edition, pages
2015. Vol. 10, 117
National Category
Cancer and Oncology
Identifiers
URN: urn:nbn:se:umu:diva-106606DOI: 10.1186/s13014-015-0422-8ISI: 000357448100001PubMedID: 26014350OAI: oai:DiVA.org:umu-106606DiVA: diva2:843288
Available from: 2015-07-28 Created: 2015-07-24 Last updated: 2017-12-04Bibliographically approved
In thesis
1. Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
Open this publication in new window or tab >>Radiotherapy for head and neck cancer: costs and benefits of time, dose and volume
2017 (English)Doctoral thesis, comprehensive summary (Other academic)
Alternative title[sv]
Radioterapi för huvud-, halscancer : risk och nytta av tid, dos och volym
Abstract [en]

Background In the treatment of head and neck cancers (HNCs), radiotherapy (RT) has the advantage of organ preservation compared to surgery. However, treatment toxicities associated with RT can affect important functions for everyday life, both in the acute and late stage. RT to macroscopic tumour in HNC is commonly combined with elective RT to cervical lymph nodes at risk of microscopic involvement. The resulting risk reduction of the elective treatment based on dose-volume parameters is sparsely evaluated. So is the relationship between the elective treatment and treatment toxicity. The present thesis addresses these aspects.

A strategy aimed at improving the outcome of RT is accelerated fractionation (AF). AF strives to shorten total treatment time to minimise proliferation of the tumour tissue during the RT period. We have investigated the impact of AF on both disease control and toxicity.

Methods In the ARTSCAN study, 750 patients with localised HNC were randomised between AF (68 Gy in 4.5 weeks) and conventional fractionation (CF) (68 Gy in 7 weeks). The elective treatment volume was prescribed 46 Gy with CF in both treatment arms. The thesis is based on four individual papers, investigating the issues above in the whole study population or in sub-populations.

Results No difference in disease control or late toxicity between CF and AF was observed at five years. However, there was an increased acute toxicity with AF. Weight loss was associated with treatment volume, independent of tumour stage. The elective treatment volume was found to be an independent risk factor for late aspiration, as well as mean dose to the pharyngeal constrictor muscles, neck dissection, and age at randomisation. There was a significant risk reduction for node relapses in volumes treated to an elective dose. Only a relapse in volumes treated to >60 Gy affected the survival.

Conclusion The present thesis questions the benefit of AF in definitive RT as well as extensive elective treatment of the cervical nodes.

Place, publisher, year, edition, pages
Umeå: Umeå Universitet, 2017. 29 p.
Series
Umeå University medical dissertations, ISSN 0346-6612 ; 1880
Keyword
radiotherapy, head and neck cancer, adjuvant treatment, accelerated fractionation
National Category
Cancer and Oncology
Research subject
Biomedical Radiation Science
Identifiers
urn:nbn:se:umu:diva-131021 (URN)978-91-7601-646-6 (ISBN)
Public defence
2017-02-24, Sal 933, Norrlands Universitetssjukhus, Umeå, 09:00 (Swedish)
Opponent
Supervisors
Available from: 2017-02-03 Created: 2017-02-02 Last updated: 2017-02-02Bibliographically approved

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