dostęp otwarty

Tom 6, Nr 2 (2021)
Artykuł przeglądowy
Opublikowany online: 2021-04-09
Pobierz cytowanie

Has fractionation in head and neck cancer radiotherapy reached a summit or is there still room for novel therapeutic strategies?

Bogusław Maciejewski1, Leszek Miszczyk2, Krzysztof Składowski3
Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2021;6(2):115-123.
Afiliacje
  1. Div. Research Programmes
  2. Radiotherapy and Chemotherapy Clinic, M. Sklodowska-Curie National Research Institute of Oncology, Gliwice Branch, Poland
  3. Radiotherapy and Chemotherapy Clinic I M. Skłodowska-Curie National Research Institute of Oncology, branch Gliwice, Poland

dostęp otwarty

Tom 6, Nr 2 (2021)
Artykuły przeglądowe / Review articles
Opublikowany online: 2021-04-09

Streszczenie

The aim of this paper is to answer to the question whether various dose fractionation regimens are highly effective up to the summit of normal tissue tolerance. Data from 45 trials on altered fractionation, radio-response of the HPV(+) oropharyngeal cancer (OPC) and concurrent chemoradiation (11 533 data) have been selected from the published papers and re-analysed. Altered fractionation regimens showed an average therapeutic gain (TG) of local tumour control (LTC) of about 2.7% per each 1 izoGy2.0 above 65 Gy. For HPV(+) OPC, TG increased by 3–3.5%/1izoGy2.0. Concurrent chemoradiation for locally advanced H&N cancer produced about 60% LTC using 65 Gy (about 20% more than altered RT). Despite randomization, data sets in the trials remain clinically and biologically heterogeneous. It is not possible to separate the TG rate as the result of change in dose per fraction from that caused by changing the overall treatment time. This is major weakness of the trials. Moreover, the results are presented as an average value of the LTC or survival. The overstepped tolerance summit is very rarely precisely presented. It likely seems that the tolerance summit is not a single value and is only partly related to dose fractionation intensity, it mainly depends on radiosensitivity and the irradiation volume of normal tissue(s) and their potential repair capacity, and an activation of immunological defense. Finally, it is difficult to accept average trial’ results as evidence based guidelines for personalized radiotherapy for individual patients; what is more the individual tolerance summit is not universal and well quantified.

Streszczenie

The aim of this paper is to answer to the question whether various dose fractionation regimens are highly effective up to the summit of normal tissue tolerance. Data from 45 trials on altered fractionation, radio-response of the HPV(+) oropharyngeal cancer (OPC) and concurrent chemoradiation (11 533 data) have been selected from the published papers and re-analysed. Altered fractionation regimens showed an average therapeutic gain (TG) of local tumour control (LTC) of about 2.7% per each 1 izoGy2.0 above 65 Gy. For HPV(+) OPC, TG increased by 3–3.5%/1izoGy2.0. Concurrent chemoradiation for locally advanced H&N cancer produced about 60% LTC using 65 Gy (about 20% more than altered RT). Despite randomization, data sets in the trials remain clinically and biologically heterogeneous. It is not possible to separate the TG rate as the result of change in dose per fraction from that caused by changing the overall treatment time. This is major weakness of the trials. Moreover, the results are presented as an average value of the LTC or survival. The overstepped tolerance summit is very rarely precisely presented. It likely seems that the tolerance summit is not a single value and is only partly related to dose fractionation intensity, it mainly depends on radiosensitivity and the irradiation volume of normal tissue(s) and their potential repair capacity, and an activation of immunological defense. Finally, it is difficult to accept average trial’ results as evidence based guidelines for personalized radiotherapy for individual patients; what is more the individual tolerance summit is not universal and well quantified.

Pobierz cytowanie

Słowa kluczowe

radiotherapy and chemoradiation regimens; weaknesses and benefits; tolerance summits

Informacje o artykule
Tytuł

Has fractionation in head and neck cancer radiotherapy reached a summit or is there still room for novel therapeutic strategies?

Czasopismo

Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory

Numer

Tom 6, Nr 2 (2021)

Typ artykułu

Artykuł przeglądowy

Strony

115-123

Opublikowany online

2021-04-09

Wyświetlenia strony

164

Wyświetlenia/pobrania artykułu

149

Rekord bibliograficzny

Biuletyn Polskiego Towarzystwa Onkologicznego Nowotwory 2021;6(2):115-123.

Słowa kluczowe

radiotherapy and chemoradiation regimens
weaknesses and benefits
tolerance summits

Autorzy

Bogusław Maciejewski
Leszek Miszczyk
Krzysztof Składowski

Referencje (28)
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