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The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters.

Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K - Biomed Res Int (2013)

Bottom Line: The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001).The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis).In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT.

View Article: PubMed Central - PubMed

Affiliation: Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece.

ABSTRACT
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.

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Related in: MedlinePlus

Linear curve estimation for grading ≥ II xerostomia related to the mean dose of parotid gland (rho = 0.5013, P < 0.001). The analysis was performed from 20 published trials with relevant available data.
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fig1: Linear curve estimation for grading ≥ II xerostomia related to the mean dose of parotid gland (rho = 0.5013, P < 0.001). The analysis was performed from 20 published trials with relevant available data.

Mentions: Published results on tumor control outcomes in terms of local control (LC), regional control (RC), and locoregional control (LRC) and also on survival outcomes in terms of overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) are presented in Table 1. Relevant data are shown according to the patient sample, primary tumor site and stage, treatment intention, median followup, and the percentage of patients that received radiotherapy combined with chemotherapy. The treatment outcomes referred to head and neck cancer patients underwent radiotherapy either with conventional radiotherapy techniques or IMRT. Twenty five trials with available data were analysed in terms of overall survival and locoregional control rate. The mean 3-year overall survival for either IMRT or 2-3D RT was 89.5% (range: 64–100%) and 82.7% (71–88%), respectively. The mean 3-year locoregional control rate 83.6% (range: 70–97%) and 74.4 (range: 61–82%), respectively. The Kruskal-Wallis test revealed a significant (P = 0.026) correlation of overall survival with RT technique (IMRT either 2-3DRT), while there was also a significant impact of IMRT technique to locoregional rate (P = 0.025). However, according to the bonferroni correction, neither of the above correlations was finally significant. In Table 2, the reported acute and late toxicity rates for mucositis and xerostomia are listed according to the median followup, radiation therapy technique (IMRT or 2-3D RT), and the percentage of patients that received chemotherapy combined with radiotherapy. Few data were available for late mucositis and acute xerostomia concerning the evaluated relevant publications. In the same table, the mean parotid-gland dose is also presented in order to depict the correlation with patient-rated xerostomia. Relevant data with xerostomia grading score and dose deposited at the parotid gland were available in twenty published trials. As shown in Figure 1, the spearman-rho test showed that there was a significant correlation of late xerostomia and mean dose at the parotid gland (rho = 0.5013, P < 0.001). According to Figure 2, the mean score of xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The mean dose deposited in the parotid gland for IMRT versus 2-3DRT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). By analysing thirty five relevant publications with available data with acute mucositis, after comparing the mean values of acute mucositis stratified by IMRT versus 2-3DRT, we found a mean score of 0.71 ± 0.23 versus 0.89 ± 0.07 (Mann-Whitney test, P = 0.022), respectively. However, according to bonferroni correction the difference was not significant.


The treatment outcome and radiation-induced toxicity for patients with head and neck carcinoma in the IMRT era: a systematic review with dosimetric and clinical parameters.

Kouloulias V, Thalassinou S, Platoni K, Zygogianni A, Kouvaris J, Antypas C, Efstathopoulos E, Nikolaos K - Biomed Res Int (2013)

Linear curve estimation for grading ≥ II xerostomia related to the mean dose of parotid gland (rho = 0.5013, P < 0.001). The analysis was performed from 20 published trials with relevant available data.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC3818806&req=5

fig1: Linear curve estimation for grading ≥ II xerostomia related to the mean dose of parotid gland (rho = 0.5013, P < 0.001). The analysis was performed from 20 published trials with relevant available data.
Mentions: Published results on tumor control outcomes in terms of local control (LC), regional control (RC), and locoregional control (LRC) and also on survival outcomes in terms of overall survival (OS), distant metastasis-free survival (DMFS), and disease-free survival (DFS) are presented in Table 1. Relevant data are shown according to the patient sample, primary tumor site and stage, treatment intention, median followup, and the percentage of patients that received radiotherapy combined with chemotherapy. The treatment outcomes referred to head and neck cancer patients underwent radiotherapy either with conventional radiotherapy techniques or IMRT. Twenty five trials with available data were analysed in terms of overall survival and locoregional control rate. The mean 3-year overall survival for either IMRT or 2-3D RT was 89.5% (range: 64–100%) and 82.7% (71–88%), respectively. The mean 3-year locoregional control rate 83.6% (range: 70–97%) and 74.4 (range: 61–82%), respectively. The Kruskal-Wallis test revealed a significant (P = 0.026) correlation of overall survival with RT technique (IMRT either 2-3DRT), while there was also a significant impact of IMRT technique to locoregional rate (P = 0.025). However, according to the bonferroni correction, neither of the above correlations was finally significant. In Table 2, the reported acute and late toxicity rates for mucositis and xerostomia are listed according to the median followup, radiation therapy technique (IMRT or 2-3D RT), and the percentage of patients that received chemotherapy combined with radiotherapy. Few data were available for late mucositis and acute xerostomia concerning the evaluated relevant publications. In the same table, the mean parotid-gland dose is also presented in order to depict the correlation with patient-rated xerostomia. Relevant data with xerostomia grading score and dose deposited at the parotid gland were available in twenty published trials. As shown in Figure 1, the spearman-rho test showed that there was a significant correlation of late xerostomia and mean dose at the parotid gland (rho = 0.5013, P < 0.001). According to Figure 2, the mean score of xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The mean dose deposited in the parotid gland for IMRT versus 2-3DRT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). By analysing thirty five relevant publications with available data with acute mucositis, after comparing the mean values of acute mucositis stratified by IMRT versus 2-3DRT, we found a mean score of 0.71 ± 0.23 versus 0.89 ± 0.07 (Mann-Whitney test, P = 0.022), respectively. However, according to bonferroni correction the difference was not significant.

Bottom Line: The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001).The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis).In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT.

View Article: PubMed Central - PubMed

Affiliation: Second Department of Radiology, Radiotherapy Unit, Attikon University Hospital, Medical School, Rimini 1, Xaidari, 12462 Athens, Greece.

ABSTRACT
A descriptive analysis was made in terms of the related radiation induced acute and late mucositis and xerostomia along with survival and tumor control rates (significance level at 0.016, bonferroni correction), for irradiation in head and neck carcinomas with either 2D Radiation Therapy (2DRT) and 3D conformal (3DCRT) or Intensity Modulated Radiation Therapy (IMRT). The mean score of grade > II xerostomia for IMRT versus 2-3D RT was 0.31 ± 0.23 and 0.56 ± 0.23, respectively (Mann Whitney, P < 0.001). The parotid-dose for IMRT versus 2-3D RT was 29.56 ± 5.45 and 50.73 ± 6.79, respectively (Mann Whitney, P = 0.016). The reported mean parotid-gland doses were significantly correlated with late xerostomia (spearman test, rho = 0.5013, P < 0.001). A trend was noted for the superiority of IMRT concerning the acute oral mucositis. The 3-year overall survival for either IMRT or 2-3DRT was 89.5% and 82.7%, respectively (P = 0.026, Kruskal-Wallis test). The mean 3-year locoregional control rate was 83.6% (range: 70-97%) and 74.4 (range: 61-82%), respectively (P = 0.025, Kruskal-Wallis). In conclusion, no significant differences in terms of locoregional control, overall survival and acute mucositis could be noted, while late xerostomia is definitely higher in 2-3D RT versus IMRT. Patients with head and neck carcinoma should be referred preferably to IMRT techniques.

Show MeSH
Related in: MedlinePlus