Total Mucosal Irradiation with Intensity-modulated Radiotherapy in Patients with Head and Neck Carcinoma of Unknown Primary: A Pooled Analysis of Two Prospective Studies.
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ICR Authors
Authors
Richards, TM
Bhide, SA
Miah, AB
Del Rosario, L
Bodla, S
Thway, K
Gujral, DM
Rooney, KP
Schick, U
McGovern, T
Grove, L
Newbold, KL
Harrington, KJ
Nutting, CM
Bhide, SA
Miah, AB
Del Rosario, L
Bodla, S
Thway, K
Gujral, DM
Rooney, KP
Schick, U
McGovern, T
Grove, L
Newbold, KL
Harrington, KJ
Nutting, CM
Document Type
Journal Article
Date
2016-09-01
Date Accepted
2016-03-03
Abstract
AIMS: To determine the clinical outcomes of an intensity-modulated radiotherapy technique for total mucosal irradiation (TM-IMRT) in patients with head and neck carcinoma of unknown primary (HNCUP). MATERIALS AND METHODS: A single-centre prospective phase II trial design was used in two sequential studies to evaluate TM-IMRT for HNCUP. Patients were investigated for primary tumour site using examination under anaesthetic and biopsies, computed tomography ± magnetic resonance imaging (MRI) or 18-fluorodeoxyglucose positron emission tomography-computed tomography (PET-CT). Patients received IMRT to the potential primary tumour sites and elective cervical nodes. Concomitant chemotherapy was used in patients who received primary radiotherapy or those with nodal extracapsular extension. RESULTS: Thirty-six patients with HNCUP were recruited; 72% male. Twenty-five patients (69.4%) had p16-positive disease. Two year mucosal and local nodal control rates were 97.1% (95% confidence interval 91.4-100) and 89.8% (78.4-100), respectively. One mucosal primary was detected 7.3 months after TM-IMRT and three patients died from recurrent/metastatic squamous cell carcinoma of the head and neck. Twelve patients (33%) developed grade 3 (Late Effects in Normal Tissue-Subjective, Objective, Management and Analytical; LENT-SOMA) dysphagia with a 1 year enteric tube feeding rate of 2.7%. The high-grade subjective xerostomia rate (LENT-SOMA) at 24 months after IMRT was 15%. CONCLUSIONS: At a median follow-up of 36.1 months, the use of TM-IMRT was associated with good local control. Toxicity was comparable with previously reported TM-IMRT regimens encompassing similar mucosal volumes.
Citation
Clinical oncology (Royal College of Radiologists (Great Britain)), 2016, 28 (9), pp. e77 - e84
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Source Title
Publisher
ELSEVIER SCIENCE LONDON
ISSN
0936-6555
eISSN
1433-2981
Research Team
Targeted Therapy