4 januari 2010: Bron: Arch Otolaryngol Head Neck Surg. 2009 Dec;135(12):1209-17.

IMRT - Intensiteits gemoduleerde radiotherapie blijkt achteraf de kwaliteit van leven en ook de mediane overleving bij patienten met hoofd- halstumoren positief te hebben beïnvloed door toepassing van IMRT = Intensiteitsgemoduleerde bestralingstechniek. De resultaten werden vergeleken bij 104 patienten die in de periode februari 2000 tot maart 2007 zijn behandeld met IMRT i.p.v. gewone bestraling. Hieronder staat nog een andere studie met meer patienten met hoofd- halstumoren die ook significant betere kwaliteit van leven en langere mediane overleving bewerkstelligden met IMRT. Hier het abstract van de meeste recente studie:

RESULTATEN: De meeste patiënten hadden orofarynx-of laryngeal tumoren (87,5%) en vergevorderde stadia van de ziekte (75,0%). Ongeveer de helft had hematologische toxiciteit en de toxiciteit vertraagde in dat verband de behandeling. Ongeveer een kwart had neurotoxicities en / of andere toxicites: verbrandingen, uitdrogingen, longontsteking, ondervoeding, misselijkheid en braken waarvoor ziekenhuisopname was vereist of intraveneuze ingrepen en vele hadden milde of matige koorts. Hoewel patiënten de huidige intensiteit-gemoduleerde radiotherapie ontvingen (IMRT) met behulp van het Pinnacle (3) planning systeem, hadden zij minder toxiciteit en een betere functionele en gezondheid-gerelateerde kwaliteit van leven vergeleken met die van conventionele bestraling of bestraling met het eerste IMRT-protocol met behulp van het Best Nomos PEACOCK planningssysteem.

Adverse events associated with concurrent chemoradiation therapy in patients with head and neck cancer.

Givens DJ, Karnell LH, Gupta AK, Clamon GH, Pagedar NA, Chang KE, Van Daele DJ, Funk GF.

Department of Otolaryngology-Head and Neck Surgery, University of Iowa Hospitals and Clinics, 200 Hawkins Drive, Iowa City, IA 52242, USA.

OBJECTIVE: To assess toxicities, functional outcomes, and health-related quality of life associated with concurrent chemoradiation therapy (CRT) in patients with head and neck cancer.

DESIGN: Prospective and retrospective outcomes study.

SETTING: Tertiary care institution.

PATIENTS: Participants in the longitudinal Outcomes Assessment Project whose head and neck cancer was treated with CRT between February 1, 2000, and March 1, 2007 (n = 104).

INTERVENTIONS: Patients prospectively provided functional and health-related quality of life information, including data from the 1-year and most current follow-up visits. Medical records were reviewed to determine toxicity and survival rates.

MAIN OUTCOME MEASURES: Well-defined acute and late toxicities; functional outcomes (diet, dentition, tracheostomies); head and neck cancer-specific, general health, and depression outcomes; and survival rates.

RESULTS: Most patients had oropharyngeal or laryngeal tumors (87.5%) and advanced-stage disease (75.0%). Approximately one-half had hematologic toxicities and toxicity-related treatment delays. Approximately one-quarter had neurotoxicities and/or ototoxicites, moist desquamation, pneumonia, nausea and vomiting requiring hospitalization or intravenous fluids, dehydration or malnutrition requiring hospitalization, and mild or moderate fever. Although patients receiving the current intensity-modulated radiation therapy (IMRT) protocol using the Pinnacle(3) planning system had more toxicity-related treatment delays, they had fewer toxicities and better functional and health-related quality of life outcomes compared with those receiving conventional lateral opposing-field radiation or the initial IMRT protocol using the Best nomos PEACOCK planning system.

CONCLUSIONS: Patients receiving CRT experience a substantial number of treatment-related adverse events, primarily affecting oropharyngeal and laryngeal function, with improvement noted for the current IMRT protocol. Improving dental prosthetic rehabilitation and including evaluations with speech and swallowing pathologists before and during treatment may enhance patient outcomes.

Een andere studie vorig jaar gepubliceerd gaf ook significant betere resultaten met IMRT te zien bij patienten met hoofd- halstumoren. Hier het studieabstract:

Int J Radiat Oncol Biol Phys. 2009 May 1;74(1):1-8. Epub 2008 Dec 26.

Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life: results of a nonrandomized prospective study using a standardized follow-up program.

Vergeer MR, Doornaert PA, Rietveld DH, Leemans CR, Slotman BJ, Langendijk JA.

Department of Radiation Oncology, VU University Medical Center, Amsterdam, the Netherlands.

PURPOSE: The purpose of this study was to compare intensity-modulated radiation therapy (IMRT) and three-dimensional conventional radiotherapy (3D-CRT) with regard to patient-rated xerostomia, Radiation Therapy Oncology Group (RTOG) acute and late xerostomia and health-related quality of life (HRQoL) among patients with head and neck squamous cell carcinoma (HNSCC).

METHODS AND MATERIALS: Included were 241 patients with HNSCC treated with bilateral irradiation +/- chemotherapy. Since 2000, all patients treated with HNSCC were included in a program, which prospectively assessed acute and late morbidity according to the RTOG and HRQoL on a routine basis at regular intervals. Before October 2004, all patients were treated with 3D-CRT (N = 150). After clinical implementation in October 2004, 91 patients received IMRT. In this study, the differences regarding RTOG toxicity, xerostomia, and other items of HRQoL were analyzed. RESULTS: The use of IMRT resulted in a significant reduction of the mean dose of the parotid glands (27 Gy vs. 43 Gy (p < 0.001). During radiation, Grade 2 RTOG xerostomia was significantly less with IMRT than with 3D-CRT. At 6 months, the prevalence of patient-rated moderate to severe xerostomia and Grade 2 or higher RTOG xerostomia was significantly lower after IMRT versus 3D-CRT. Treatment with IMRT also had a positive effect on several general and head and neck cancer-specific HRQoL dimensions.

CONCLUSIONS: IMRT results in a significant reduction of patient- and observer-rated xerostomia, as well as other head and neck symptoms, compared with standard 3D-CRT. These differences translate into a significant improvement of the more general dimensions of HRQoL.

PMID: 19111400 [PubMed - indexed for MEDLINE]

PMID: 20026818 [PubMed - in process]

tongkanker, hoofd- en halstumoren, mond- en keelkanker