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Has innovations in radiotherapy for head and neck cancer improved patients curability?


- Div. Research Programmes, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Dept. Radiotherapy, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Dept of Radiology and Diagnostic Imaging, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
- Dept. Radiotherapy Planning, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
open access
Abstract
In the era of distinct technological innovations in radiotherapy, clinically important question arises has the increase of the RT effectiveness been achieved due to these innovations, at least in case of the head and neck (H&N) cancers. To answer to this question 133 studies published in the literature, including 21 058 patients with H&N cancer treated in the period a 1970-2010 years were selected to the present survey. Three end-points, e.g. 5-year local tumour control (LTC), disease-free survival (DFS) and overall survival (OS) and its averages have been evaluated in the consecutive decades of time. For cancer in the early stage, both LTC and DFS were constantly high (80–90%) through the analyzed decades. For locally advanced cancer, average rates of the LTC and an DFS were also constant, but much lower (40-45%) than expected. The OS has an increasing tendency from 45–50% in 1980 to more than 70% in 2010. It may suggest that during the 5-year follow-up some rate (~20%) of advanced tumours gradually progressed from local to chronic disease. Various technical and clinical problems influencing the results of the present review are discussed in details. Some uncertainties and doubts regarding the RT trials may suggest that “evidence based” recommendations are not a good ambassador enough, and in the era of combined treatment modalities it may seem reasonably to replace it by “individually personalized combined therapy”. However, nowadays the only plausible solution to improve H&N curability is to intensify all efforts to detect H&N cancer in a very early stage of disease and to increase various activities to convince people to participate in regular prophylactic examinations.
Abstract
In the era of distinct technological innovations in radiotherapy, clinically important question arises has the increase of the RT effectiveness been achieved due to these innovations, at least in case of the head and neck (H&N) cancers. To answer to this question 133 studies published in the literature, including 21 058 patients with H&N cancer treated in the period a 1970-2010 years were selected to the present survey. Three end-points, e.g. 5-year local tumour control (LTC), disease-free survival (DFS) and overall survival (OS) and its averages have been evaluated in the consecutive decades of time. For cancer in the early stage, both LTC and DFS were constantly high (80–90%) through the analyzed decades. For locally advanced cancer, average rates of the LTC and an DFS were also constant, but much lower (40-45%) than expected. The OS has an increasing tendency from 45–50% in 1980 to more than 70% in 2010. It may suggest that during the 5-year follow-up some rate (~20%) of advanced tumours gradually progressed from local to chronic disease. Various technical and clinical problems influencing the results of the present review are discussed in details. Some uncertainties and doubts regarding the RT trials may suggest that “evidence based” recommendations are not a good ambassador enough, and in the era of combined treatment modalities it may seem reasonably to replace it by “individually personalized combined therapy”. However, nowadays the only plausible solution to improve H&N curability is to intensify all efforts to detect H&N cancer in a very early stage of disease and to increase various activities to convince people to participate in regular prophylactic examinations.
Keywords
H& N cancers; LTC; DFS; OS end-points; early cancer diagnosis; permanent curability


Title
Has innovations in radiotherapy for head and neck cancer improved patients curability?
Journal
Nowotwory. Journal of Oncology
Issue
Article type
Review paper
Published online
2023-08-21
Page views
49
Article views/downloads
27
DOI
Keywords
H&N cancers
LTC
DFS
OS end-points
early cancer diagnosis
permanent curability
Authors
Bogusław Maciejewski
Dorota Gabryś
Justyna Rembak-Szynkiewicz
Aleksandra Napieralska
Małgorzta Stąpór-Fudzińska


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