News | May 12, 2010

Highly Conformal IMRT Reduces Side Effects in Head and Neck

May 12, 2010 - This year, 35,720 Americans will be diagnosed with head and neck cancer, and 7,600 will die from the disease, according to the American Cancer Society.

To better manage the disease, researchers at the University of Michigan (U-M) Comprehensive Cancer Center have applied advanced radiation techniques for head and neck cancer to avoid treating critical structures that affect swallowing and eating. These principles and techniques treated the cancer effectively while greatly reducing long-term swallowing complications, according to the study published in Journal of Clinical Oncology.

The researchers applied highly conformal, intensity-modulated radiation therapy (IMRT) and knowledge of the anatomy and physiology of the structures involved to carefully craft a novel treatment plan that avoids certain muscles in the mouth and throat that are most involved in swallowing. Generally, head and neck tumors do not spread to these structures.

Of the 73 patients treated with this technique, all but four were eating a normal diet after their treatment ended and only one was dependent on a feeding tube. Typically up to 20 percent of head and neck cancer patients remain dependent on a feeding tube after finishing an intensive course of radiation treatment concurrent with chemotherapy.

"More aggressive treatments for head and neck cancer have improved cancer control, but at the expense of quality of life. In this study, we did not compromise tumor control and we were able to improve this important quality of life measure," said study author Avraham Eisbruch, M.D., professor of radiation oncology at the U-M Medical School.

Scar tissue from radiation treatments to the head and neck often creates long-term problems with swallowing and eating solid foods, which does not improve over time. In this study, 29 percent of the patients required a temporary feeding tube during treatment because of pain while swallowing. But by one year after treatment, only one of the 73 patients on the study still required a feeding tube. Questionnaires to assess eating and swallowing function showed that on average, patients had only slight difficulties up to two years after treatment.

No patients had a spread of their cancer to the untreated structures and few cancers recurred overall, suggesting it was not harmful to avoid treating these areas. After three years, 88 percent of patients were cancer-free.

Eisbruch and his colleagues were also leaders in pioneering head and neck radiation treatments that avoid the salivary glands, reducing significantly the severity of permanently dry mouth, which has previously been a major complication of radiotherapy for head and neck cancer.

"We seek a cure for these patients, but we also seek quality of life. As cure rates have improved in recent years, quality of life issues become more and more important. Our next steps are to identify which patients are likely to do well with treatment and reduce the intensity of treatment to limit the burden of these side effects," Eisbruch said.

Methodology: The study looked at 73 patients with stage III or stage IV oropharyngeal cancer, including cancer of the tonsils or the base of the tongue. Patients were treated with seven weeks of daily intensity-modulated radiation therapy to the neck, designed to avoid the swallowing structures. Chemotherapy was administered weekly during this time. Patients were assessed with videofluoroscopy, an imaging procedure, periodically during treatment and up to two years after to assess swallowing. Swallowing was also assessed by doctors and through patient report using standard questionnaires.

Additional U-M authors: Felix Y. Feng, M.D.; Hyungjin M. Kim, Sc.D.; Teresa H. Lyden, M.A.; Marc J. Haxer, M.A.; Francis P. Worden, M.D.; Mary Feng, M.D.; Jeffrey S. Moyer, M.D.; Mark E. Prince, M.D.; Thomas E. Carey, Ph.D.; Gregory T. Wolf, M.D.; Carol R. Bradford, M.D.; Douglas B. Chepeha, M.D.
Funding: National Institutes of Health, Newman Family Foundation

For more information: jco.ascopubs.org

Related Content

First Hospitals Achieve Inter-System Connectivity Across Accuray Radiation Therapy Platforms
News | Radiation Therapy | January 19, 2018
Accuray Inc. announced recently that the Heidelberg University Hospital in Heidelberg, Germany, and Oscar Lambret...
RayStation Selected for New Carbon Ion Therapy Center in Japan
News | Treatment Planning | January 18, 2018
January 18, 2018 – RayStation has been chosen as the treatment planning system for a new carbon-ion therapy facility
Raysearch Receives First Order for the Raycare Oncology Information System
News | Oncology Information Management Systems (OIMS) | January 18, 2018
January 18, 2018 – Anderson Regional Cancer Center (ARCC) in Meridian, Mississippi, has placed the first order for...
Mevion Receives 510(k) Clearance for Hyperscan Pencil Beam Scanning Proton Therapy
Technology | Proton Therapy | January 04, 2018
Mevion Medical Systems has received U.S. Food and Drug Administration (FDA) 510(k) clearance for the Mevion S250i...
Study Compares Radiosurgery and Whole-Brain Radiation in Lung Cancer Patients With Multiple Brain Metastases
News | Radiation Therapy | January 03, 2018
Although targeted therapies have produced dramatic advances in the ability to control some types of advanced lung...
MEDraysintell Downgrades Proton Therapy Market Projection for 2030
News | Proton Therapy | January 02, 2018
MEDraysintell recently downgraded its projection for proton therapy rooms expected to be operational in 2030 from 1,200...
California US Oncology Network Centers Adopt Xoft Electronic Brachytherapy System for Early-Stage Non-Melanoma Skin Cancer
News | Brachytherapy Systems | January 02, 2018
iCAD Inc. announced that its Xoft Axxent Electronic Brachytherapy (eBx) System is now available at two California-based...
Blue Phantom System Used for Acceptance of First European Varian Halcyon Machine
News | Radiation Therapy | January 02, 2018
IBA (Ion Beam Applications S.A.) announced in November the acceptance and beam model validation of the first Varian...
Study Finds Link Between Breast Cancer Treatments and Cellular Aging Markers
News | Women's Health | January 02, 2018
January 2, 2018 — A new study found women who had received chemotherapy and/or...
ACR Appropriateness Criteria Adds and Revises Topics for December 2017
News | Clinical Decision Support | December 29, 2017
December 29, 2017 — Radiologists can enhance the quality and effectiveness of care with the newest release of the ACR
Overlay Init