Browsing by Author "Dubinsky, Pavol (7004816422)"

Although conventional fractionated (CF) radiotherapy (RT) became the most common non-surgical approach delivering 66-70 Gy in 33-35 daily fractions (fx) in 6.5-7 weeks several decades ago due to a good local control (LC) with low normal tissue complication rates, recent decades also brought altered fractionated RT regimens based on better understanding of radiobiology. Of these, split course RT is largely abandoned due to inferior results caused by the treatment gap, which led to inferior local control rates and consequently survival. Hyperfractionated (Hfx) RT and various forms of accelerated (Acc) RT had consistently shown improvement in the treatment outcome, given either alone or with concurrent chemotherapy (CHT). Hfx RT was most consistently superior to CF and frequently to Acc RT, while moderate Acc RT also holds promise to be used more often in daily clinical practice. The use of Hfx RT may face the challenge of applicability in busy radiotherapy departments around the world despite unequivocally having been proven as superior regarding both local/regional tumor control and overall survival. With concurrent CHT, although results favor it, risks of accompanying toxicity rise and should be considered when planning such intensified treatment approach. © 2020, Turkish Society for Radiation Oncology.

Meta-analyses of chemotherapy in Head and Neck Cancer (MAC-HNC) showed that adding chemotherapy (CHT) to locoregional treatment improves the treatment outcome. However, it was observed only with concurrent administration of radiotherapy (RT) and CHT. Among many drugs used in this setting, cisplatin (CDDP) has most consistently been used as a single-agent with radical RT. The two most common administrations of CDDP included 100 mg/sqm every three weeks and 40 mg/sqm weekly, both during the course of RT. While a direct comparison of the two modes of CDDP administration in the definitive treatment of locally advanced squamous cell (SQC) HNC is basically lacking, recent summary brought somewhat conflicting results. Questions largely unexplored is the total CDDP dose deemed necessary when administered concurrently with radical RT. Subset analyses from various prospective randomized trials and meta-analyses seem to indicate that one may not need a total CDDP dose of significantly higher than 200 mg/sqm if at all higher than that, irrespective of the type of RT administered and seemingly unnecessary in HPV+ oropharyngeal cancer patients. Due to presumably lower but still effective threshold level of total CDDP given with RT may depend on other factors, such as frequency of CDDP administration or RT fractionation pattern and be closely interrelated with an-ticipated toxicity, researchers continue with their quest to find optimal approach in this setting. Large clinical trials should detect small differences between treatment options in an era when “old” but effective drugs still dominate the research arena of SQC HNC. © 2020, Turkish Society for Radiation Oncology.