High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck

Sewit Teckie, Benjamin H. Lok, Shyam Rao, Stanley I. Gutiontov, Yoshiya Yamada, Sean L. Berry, Michael J. Zelefsky, Nancy Y. Lee

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Objectives High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. Materials and methods We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8 Gray per fraction), for HN malignancies. Results A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3 months among five survivors and 6.0 months in the remaining patients. Median RT dose was 30 Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8 Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6 Gray was associated with control (p = 0.04) and previous radiation was associated with inferior control (p = 0.04). Patients who achieved complete response to RT had longer survival than those who did not (p = 0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8 Gray; only re-irradiation increased toxicity rates. Conclusion Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6 Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.

Original languageEnglish (US)
Pages (from-to)74-80
Number of pages7
JournalOral Oncology
Volume60
DOIs
StatePublished - Sep 1 2016
Externally publishedYes

Fingerprint

Neck
Radiotherapy
Head
Neoplasms
Dose Fractionation
Survivors
Multivariate Analysis
Dose Hypofractionation
Radiation
Safety
Survival

Keywords

  • Head-and-neck cancer
  • High-dose radiation therapy
  • Palliation
  • Recurrent head and neck cancer
  • Stereotactic body radiation therapy

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck. / Teckie, Sewit; Lok, Benjamin H.; Rao, Shyam; Gutiontov, Stanley I.; Yamada, Yoshiya; Berry, Sean L.; Zelefsky, Michael J.; Lee, Nancy Y.

In: Oral Oncology, Vol. 60, 01.09.2016, p. 74-80.

Research output: Contribution to journalArticle

Teckie, S, Lok, BH, Rao, S, Gutiontov, SI, Yamada, Y, Berry, SL, Zelefsky, MJ & Lee, NY 2016, 'High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck', Oral Oncology, vol. 60, pp. 74-80. https://doi.org/10.1016/j.oraloncology.2016.06.016
Teckie, Sewit ; Lok, Benjamin H. ; Rao, Shyam ; Gutiontov, Stanley I. ; Yamada, Yoshiya ; Berry, Sean L. ; Zelefsky, Michael J. ; Lee, Nancy Y. / High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck. In: Oral Oncology. 2016 ; Vol. 60. pp. 74-80.
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title = "High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck",
abstract = "Objectives High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. Materials and methods We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8 Gray per fraction), for HN malignancies. Results A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3 months among five survivors and 6.0 months in the remaining patients. Median RT dose was 30 Gray in 5 fractions; 20/62 lesions (32{\%}) received dose-per-fraction of ⩾8 Gray. Overall response rate at first follow-up was 79{\%}. One-year local-progression free rate was 50{\%}. On multivariate analysis for locoregional control, dose-per-fraction ⩾6 Gray was associated with control (p = 0.04) and previous radiation was associated with inferior control (p = 0.04). Patients who achieved complete response to RT had longer survival than those who did not (p = 0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8 Gray; only re-irradiation increased toxicity rates. Conclusion Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6 Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.",
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author = "Sewit Teckie and Lok, {Benjamin H.} and Shyam Rao and Gutiontov, {Stanley I.} and Yoshiya Yamada and Berry, {Sean L.} and Zelefsky, {Michael J.} and Lee, {Nancy Y.}",
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T1 - High-dose hypofractionated radiotherapy is effective and safe for tumors in the head-and-neck

AU - Teckie, Sewit

AU - Lok, Benjamin H.

AU - Rao, Shyam

AU - Gutiontov, Stanley I.

AU - Yamada, Yoshiya

AU - Berry, Sean L.

AU - Zelefsky, Michael J.

AU - Lee, Nancy Y.

PY - 2016/9/1

Y1 - 2016/9/1

N2 - Objectives High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. Materials and methods We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8 Gray per fraction), for HN malignancies. Results A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3 months among five survivors and 6.0 months in the remaining patients. Median RT dose was 30 Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8 Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6 Gray was associated with control (p = 0.04) and previous radiation was associated with inferior control (p = 0.04). Patients who achieved complete response to RT had longer survival than those who did not (p = 0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8 Gray; only re-irradiation increased toxicity rates. Conclusion Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6 Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.

AB - Objectives High-dose, hypofractionated radiotherapy (HFRT) is sometimes used to treat malignancy in the head-and-neck (HN), both in the curative and palliative setting. Its safety and efficacy have been reported in small studies and are still controversial. Materials and methods We retrospectively evaluated the outcomes and toxicities of HFRT, including ultra-high-dose fractionation schemes (⩾8 Gray per fraction), for HN malignancies. Results A total of 62 sites of measurable gross disease in 48 patients were analyzed. The median follow-up was 54.3 months among five survivors and 6.0 months in the remaining patients. Median RT dose was 30 Gray in 5 fractions; 20/62 lesions (32%) received dose-per-fraction of ⩾8 Gray. Overall response rate at first follow-up was 79%. One-year local-progression free rate was 50%. On multivariate analysis for locoregional control, dose-per-fraction ⩾6 Gray was associated with control (p = 0.04) and previous radiation was associated with inferior control (p = 0.04). Patients who achieved complete response to RT had longer survival than those who did not (p = 0.01). Increased toxicity rates were not observed among patients treated with dose-per-fraction ⩾8 Gray; only re-irradiation increased toxicity rates. Conclusion Despite the poor prognostic features noted in this cohort of patients with HN malignancies, HFRT was associated with high response rates, good local control, and acceptable toxicity. Sites that were treated with 6 Gray per fraction or higher and had not been previously irradiated had the best disease control. A prospective trial is warranted to further refine the use and indications of HFRT in this setting.

KW - Head-and-neck cancer

KW - High-dose radiation therapy

KW - Palliation

KW - Recurrent head and neck cancer

KW - Stereotactic body radiation therapy

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