Altered Fractionation Schemes in Radiotherapy

2009 ◽  
pp. 150-156 ◽  
Author(s):  
Martin Stuschke ◽  
Christoph Pöttgen
Keyword(s):  
Altered Fractionation

scholarly journals Critical Appraisal of Experimental Radiation Modalities for Malignant Astrocytomas

1990 ◽  
Vol 17 (2) ◽  
pp. 199-208 ◽  
Author(s):  
N.J. Laperriere
Keyword(s):  
Critical Appraisal ◽  
Clinical Results ◽  
Particle Therapy ◽  
Postoperative Radiation ◽  
Postoperative Radiation Therapy ◽  
Initial Management ◽  
Altered Fractionation ◽  
Malignant Astrocytomas ◽  
Prospective Trials ◽  
Radiation Sensitizers

ABSTRACT:The management of patients with supratentorial malignant astrocytomas has remained a major problem. Patients continue to die from a lack of local control in 90% of cases despite an improvement of median survival seen with the use of postoperative radiation therapy. Because of this, there has been considerable interest in exploring novel ways of possibly improving results. This paper reviews the rationale and clinical results with the use of altered fractionation schemes, brachytherapy, radiation sensitizers, hyperthermia, particle therapy, and radiosurgery in the treatment of these patients. Currently, there is no demonstrated advantage with the use of these experimental modalities in the initial management of patients. There would appear to be some benefit for selected patients who are treated with brachytherapy at recurrence, but its efficacy as part of initial management remains to be determined in ongoing randomized prospective trials.

Randomized Trials on Altered Fractionation in Head and Neck Cancer Radiotherapy with Conventional Fractionation as Control Arm: Another Lap to Go

1998 ◽  
Vol 84 (2) ◽  
pp. 160-166 ◽  
Author(s):  
Patrizia Olmi ◽  
Carlo Fallai
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Randomized Trials ◽  
Local Control Rate ◽  
Cancer Radiotherapy ◽  
Conventional Radiotherapy ◽  
Conventional Fractionation ◽  
Altered Fractionation ◽  
Accelerated Fractionation

The Authors present a review of randomized trials on non conventional fractionation in head and neck cancer radiotherapy with conventional fractionation as control arm. Hyperfractionation was studied in 5 trials, accelerated hyperfractionation in 4 trials and accelerated fractionation in 3 trials. Furthermore, the reviews of eminent Authors dealing with the above mentioned trials are summarized. In spite of improved local control rate reported with hyperfractionation, non conventional radiotherapy schedules are not yet recommended as routine clinical practice, but all the radiation oncologists are invited to join trials on this subject.

Can Protons or Altered Fractionation Decrease Neurotoxicity after Chemoradiation in Head and Neck Cancer?

2014 ◽  
Vol 26 (12) ◽  
pp. 762-764 ◽  
Author(s):  
H. Benghiat ◽  
J. Cashmore ◽  
T. Williams ◽  
S. Green ◽  
A. Hartley ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Altered Fractionation

Altered Fractionation Schedules in Radiotherapy of Head and Neck Cancer. A Review

1992 ◽  
Vol 78 (5) ◽  
pp. 311-325 ◽  
Author(s):  
Carlo Fallai ◽  
Patrizia Olmi
Keyword(s):  
Total Dose ◽  
Head And Neck ◽  
Local Control ◽  
Randomized Trials ◽  
Treatment Time ◽  
Dose Intensity ◽  
Field Size ◽  
Overall Treatment Time ◽  
Altered Fractionation ◽  
Improvement In Survival

The authors review the main contributions of international literature to show the current status in clinical trials on unconventional fractionations of the dose in radiotherapy of head and neck cancers. Several clinical (but only a few randomized) trials have been conducted over the last 15 years using hyperfractionated (HF), accelerated (AF) or mixed (HF-AF) schedules. HF schedules have obtained promising results in terms of local control in comparison with conventional fractionation (CF) of the dose. Improvement in survival was also obtained by the random trials of Pinto and Sanchiz, whereas in EORTC trial no. 22791, the improvement in survival rate was only marginal. A significant increase in local control and, less frequently, in survival has been claimed in several studies using HF-AF. Such data still need to be confirmed by a random study, since EORTC trial 22811 showed superimposable results in comparison with CF. Selection of the most suitable cases for altered fractionation schemes is also being studied in ongoing trials of the EORTC (22851) and RTOG (90-03). As regards acute reactions during and after altered fractionation, they are more severe than after CF. Only pure HF with a dose intensity approximately comparable to CF seems to produce similar acute reactions. Several factors have been found to influence the severity of acute mucosal reactions: interfraction interval, overall treatment time, total dose, and field size. As regards late damage, genuine HF schemes seem to cause roughly equivalent late damage in comparison to CF, whereas high-dose intensity schedules have a higher rate of complications. Interfraction interval, overall treatment time, total dose, fraction size and field size can influence the risk of late sequelae. Before altered fractionations can be considered standard therapy, more data are needed, which should be provided by multicentric randomized trials, some of which are already in progress.

scholarly journals Comparison of altered fractionation schedule with concurrent chemo-radiation for squamous cell carcinoma of head and neck

2020 ◽  
Vol 8 (8) ◽  
pp. 2834
Author(s):  
Mathew Varghese K. ◽  
Geeta S. Narayanan ◽  
Bhaskar Vishwanathan ◽  
Shashidhar V. Karpurmath ◽  
Soumya Narayanan
Keyword(s):  
Squamous Cell Carcinoma ◽  
Cell Carcinoma ◽  
Head And Neck ◽  
Squamous Cell ◽  
Performance Status ◽  
Locally Advanced ◽  
Complete Response ◽  
Altered Fractionation ◽  
Fractionation Schedule ◽  
Nodal Burden

Background: Aim of the study was to compare the response of altered fractionation schedule with concurrent chemo-radiation in patients with primary and the nodal disease.Methods: Total of 40 patients (20 in each arm) with stage 1- 4 squamous cell carcinoma of the head and neck with a performance status of 0-2 (ECOG) were included in the study. Arm A was altered fractionation schedule where in patients received 6 fractions per week to a total dose of 6600 cGy in 33 fractions. In Arm B, patients received conventional radiotherapy with concurrent chemotherapy three weekly Inj. of cisplatin (100 mg/m2). Patients were evaluated for acute toxicity every week using the Acute Radiation Morbidity Scoring Criteria. The response was assessed after 6 weeks and 12 weeks post treatment using the RECIST criteria. Data was statistically analyzed.Results: Seventeen patients in Arm A and 18 patients in Arm B completed the treatment. At the end of three months, In Arm A, 7 patients had complete response and in Arm B, 9 patients had complete response of the primary (p>0.05).  When the complete nodal response was compared in both the arms, there was no difference (2 vs 4 in Arm A vs Arm B resp.). But there were more partial nodal responders in Arm B (p = 0.016). The acute toxicities were comparable in both the arms.Conclusions: Altered fraction radiotherapy can be used in early lesions with minimal nodal burden but with locally advanced disease or large nodal burden addition of chemotherapy should not be avoided.

scholarly journals Concomitant weekly cisplatin and altered fractionation radiotherapy in locally advanced head and neck cancer

Cancer ◽  
2010 ◽  
Vol 116 (19) ◽  
pp. 4533-4540 ◽  
Author(s):  
Heather E. Newlin ◽  
Robert J. Amdur ◽  
Charles E. Riggs ◽  
Christopher G. Morris ◽  
Jessica M. Kirwan ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Locally Advanced ◽  
Advanced Head ◽  
Altered Fractionation ◽  
Weekly Cisplatin
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