Epidermoid Baş-Boyun Kanserlerinin Tedavisinde Hiperfraksiyone Radyoterapi Sonuçları

Öz

Amaç: Çalışmamızda epidermoid başboyun kanserlerinde Hiperfraksiyone Radyoterapi (HFRT)’nin lokal-bölgesel kontrole olan etkilerini, akut ve geç yan etkiler açısından tedavinin hastalar tarafından ne derece tolere edilebileceğinin araştırılması amaçlanmıştır. Gereç ve Yöntem: Mart 1995-Şubat 1996 arasında, baş-boyunun çeşitli bölgelerinden (Nazofarenks, Larenks, Oral kavite, Maksiler sinüs) orjin alan 30 epidermoid karsinomlu hasta HFRT küratif RT protokolüne dahil edildi. 25 hasta değerlendirmeye alındı. Yaşları 15-80 arasındaydı ( ortalama yaş 45.5). Primer tümör ve üst boyun bölgesi 1.2 Gy/fraksiyon (frk) 6 saat ara ile günde iki defa tedavi edildi. Total tedavi dozu 60-74.4 Gy arasında idi. Sonuç: Hastalar minimum ay, maksimum 9 ay takip edildi. 18 hastada servikal lenfatik tutulum vardı (N+). 18 hasta evre IV, 4 hasta evre III, 2 hasta evre II, 1 hastada evre I’di. % 56 (14 hasta) hastada lokal bölgesel tam cevap sağlandı. Primer tümör (lokal) komplet cevap oranı % 56’dır. Tutulmuş servikal lenfatiklerin (bölgesel) komplet cevap oranı % 83’dür. Bölgesel cevap primer cevaba oranla daha yüksek oranda sağlandı. %40 (10 hasta) hastada parsiyel cevap alındı. Hastalarda verilen doz ile lokal kontrol arasında bir ilişki görülmedi. Tedavi hastalar tarafından iyi tolere edildi. Hiçbir hastada grade 4 toksisite görülmedi. Akut reaksiyonlar ile tedaviye ara verilme oranı % 28’dir. Takip süresi içinde % 36 oranında grade 1 geç radyasyon ödemi, hastaların % 24’ünde grade 3 ağız kuruluğu ve tad kaybı, % 8 hastada grade 1 disfaji gözlendi

Anahtar Kelimeler

• Hiperfraksiyone
• Radyoterapi
• Baş-boyun kanserleri

Öz

Purpose: The optimal fractionation schedule for radiotherapy of head and neck cancer has been controversial. The objective of this study was to test the efficacy of hyperfractionation radiotherapy on patients with head and neck cancer. Methods and Materials: Between March 1995- February 1996, 30 patients with head and neck tumors (Nasopharynx, oral cavity, larynx and maksiler sinus) were treated hyperfraction radiotherapy. 25 patients were evaluated. The mean age was 45.5. Fractions used were 1.2 Gy twice-a-day with a curative intent on all patients, to a total mean dose 6074.4 Gy. Results: With a follow-up of min 2 months-9 months. 18 patients had cervical lymphadenopaty (N+). The number of of patients at each clinical stage were as follows: stage IV ,18; stage III, 4; stage II, 2; Stage I, 1. Loca-regional complete response was observed in % 56 (14 patients). Local complet response rate was % 56, regional complete response rate was % 83. Regional response rate was higher than local response rate. %40 (10 patients) had parsiyal response. No relations was observed between dose and local control rate. No patients had grade 4 toxicity. % 28 patients had require treatment interuptions due to acute reactions. Severe late toxicity was not observed ( %36 grade 1 larynx eudema, % 24 grade 3 xerostomia, % 8 grade 1 disphaji). Conclusion: Our data indicates that hyperfractionation radiotherapy for head and neck cancer is both feasible and effective, with acceptable toxicities. Key Words: Hyperfractionation, radiotherapy, head-neck cancer

Anahtar Kelimeler

• Hyperfractionation
• radiotherapy
• head-neck cancer

Kaynakça

1. Ed’s Casciato DA, Lowitz BB: Manual of Clinical Oncology: Head and Cancers. Parker R.G., Casciato D.A. Boston/Toronta, 1992;93-114.
2. Bomford CK, Kunkler IH, Sherriff SB: Textbook of Radiotherapy: New Developments in Radiotherapy and Oncology, Singapore. 1992; 565-572.
3. Dische S: Radiotherapy- New fractionation Schemas. Seminars in Oncology.1994; 21:304-310.
4. Dubben HH, Baumann M, Fassbender Th, Beck-Bornholdt H.: Hyperfraktionierte Strahlentherapie von Tumoren im Kopf-Hals-Bereich. Strahlentherapie und Onkologie. 1992;168:373-382.
5. Marcial VA, Pajak TF, Chang C, Tupchang L and Stezt J. Hyperfractionated Photon Radiation Therapy in the treatment of Advanced Squamous Cell Carcinoma of the Oral Cavity , Pharynx, Larynx and Sinuses, Using Radiation therapy as the only Planned Modality: (preliminary report) by RTOG. Int J Radiat Oncol Biol Phys 1987; 13:41-47.
6. Parsons JT, Mendenhall WM, Cassisi NJ, Isaacs JH, Million RR: Hyperfractionation for Head and Neck .Int J Radiat Oncol Biol Phys 1988;14:649-658.
7. Parsons JT, Mendenhall WM, Stringer SP, Cassisi NJ, and Million RR: Twice a Day Radiotherapy for Squamous Cell Carcinoma of the Head and Neck : The University of Florida Experience. Head and Neck 1993;15:87-96.
8. Fu KK, Pajak TF, Trotti A, ve ark. A Radiation Therapy Oncology Group (RTOG) Phase III Randomized Study to Compare Hyperfractionation and two Variants of Accelerated Fractionation to Standart Fractionation Radiotherapy for Head and Neck Squamous Cell Carcinomas: first report of RTOG 9003. Int J Radiat Oncol Biol Phys 2000;48:1;7-16.

9. Million RR, Parsons JT and Cassisi NJ. Twice a Day Irradiation Technique for Squamous Cell Carcinomas of the Head and Neck. Cancer 1985;55:2096-2099.
10. Horiot JC, Le-Fur R, NG, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: Final analysis of a randomized trial of the EORTC cooperative group of Radiotherapy. Radiother Oncol 1992; 25:231-241.
11. Wang CC: Accelerared Hyperfractionation Radiation Therapy for Carcinoma of the Nasopharynx. Cancer 1989;63:2461-2467.
12. Teo PML, Leung SF, Chan ATC, ve ark. Final report of a randomized trial on altered-fractionated radiotherapy in nasopharyngeal carcinoma prematurely terminated by significant increase in neurological complication . Int J Radiat Oncol Biol Phys 2000; 48:1311-1322.
13. Lee AWM, Sze WM, Yau TK, ve ark. Retrospective analysis on treating nasopharyngeal carcinoma with accelerated fractionation ( 6 fraction per weeks ) in comparison with conventional fractionation (5 fraction per week): report on 3 year tumor control and normal tissiue toxicity. Radiother Oncol 2001;58:121-130.
14. Toita T, Ogawa K, Kamata M, ve ark. Hyperfractionated radiotherapy followed by adjuvant chemotherapy for nasopharyngeal carcinoma : report of seven cases. Jpn J Clin Oncol 1999; 29:160-163.
15. Jian JJ, Cheng SH, Tsai S,Y, et al. Improvement of local control of T3 and T4 Nasopharyngeal Carcinoma by Hyperfractionated radiotherapy and concomitant chemotherapy. Int J Radiat Oncol Biol Phys 2002;53:344-352.
16. Jen YM, Lın YS, Su W, et al. Dose escalation using twice-daily radiotherapy for nasopharyngeal carcinoma: Does heavier dosing result in a happier ending? Int J Radiat Oncol Biol Phys 2002;54:14-22.
17. Wendt CD, Peters LJ, Ang KK, et al. Hyperfractionated radiotherapy in the treatment of squamous cell carcinomas of the supraglottik larynx. Int J Radiat Oncol Biol Phys 1989;17:1057-1062.
18. Wang CC, Suit HD, Phil D, et al. Twice a day radiation therapy for supraglottic larynx carcinoma. Int J Radiat Oncol Biol Phys 1986;12:3-7.
19. Horiot JC, LeFur R, Guyen TN, et al. Hyperfractionation versus conventional fractionation in oropharyngeal carcinoma: Final analysis of a randomized trial of the EORTC Cooperative group of radiotherapy. Radiotherapy Oncology 1992;25:23241.
20. van den Bogaert W, van der Schueren E, Horiot JC. The EORTC randomized trial on three fractions per day and misonidazole (trial 22811) in advanced head and neck cancer: Long term results and side effects. Radiother Oncol 1995;35:231-241.
21. Hehr T, Classen J, Schreck U, et al. Hyperfractionated accelerated radiotherapy alone and with concomitant chemotherapy to the head and neck: Treated within and outside of randomized clinical trials. Int J Radiat Oncol Biol Phys 2004;58:1424-1430.
22. Kaanders JH, van-daalWA, Hoogenraad WJ,van-der-Kogel, et al. Accelerated fractionation radiotherapy for laryngeal cancer, acute and late toxicity. Int J Radiat Oncol Biol Phys 1992;24:497-503.
23. Brizel DM. Radiotherapy and concurrent chemotherapy for the treatment of locally advanced head and neck squamous cell carcinoma. Semin Radiat Oncol 1998;8:237-246.
24. Trotti A. Toxicity antagonist in cancer therapy. Curr Opin Oncol 1997;9:569-578.
25. Eisbruch A, Marsh LH, Martel MK, et al. Comprehensive irradiation of head and neck cancer using conformal multisegmental fields: Assessment of target coverage and noninvolved tissue sparing. Int J Radiat Oncol Biol Phys 1998;41:559-568.
26. Eisbruch A, Ten Haken RK, Kim HM, et al. Dose, volume and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999;45:577-587.
27. Wu Q, Manning M, Schmidt-Ullrich R, Mohan R. The potential for sparing of parotids and escalation of biologically effective dose with intensity-modulated radiations treatments of head and neck cancer: A treatment design study. Int J Radiat Oncol Biol Phys 2000;46:195-205.
28. Fu KK. Combined modality therapy for head and neck cancer. Oncology 1997;11:1781-1796.
29. Wendt TG, Grabenbauer GG, Reodal CM, et al. Simultaneous radiochemotherapy versus radiotherapy alone in advanced head and neck cancer: A randomized multicentre study. J Clin Oncol 1998;16:1318-1324.
30. Calais G, Alfonsi M, Bardet E, et al. Randomized trial of radiation therapy versus concomitant chemotherapy and radiation therapy for advanced-stage oropharynx carcinoma(see comments). J Natl Cancer Inst 1999;91:2081-2086.