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3-D radiation treatment planning reduces feeding-tube use
November 06, 2006Although current surgical techniques and multi-modality treatment regimens allow organ preservation for a growing number of patients with head and neck cancers, remaining dependent on a feeding tube after treatment is a major problem for these patients. An analysis by Fox Chase Cancer Center researchers sought to identify which treatment-related factors are more likely to avoid feeding-tube dependency.
"Three-dimensional treatment planning appears to have a significant impact on improving quality of life by reducing feeding tube dependency," said medical intern Linna Li, M.D., who presented the results today at the 48th Annual Meeting of the American Society for Therapeutic Radiology and Oncology in Philadelphia.
The retrospective study analyzed treatment records since 1997 for patients receiving definitive radiation therapy-with or without surgery and chemotherapy-for squamous-cell carcinomas of the throat, including oropharynx, hypoharynx and larynx. Definitive radiotherapy is a curative course of radiation treatment designed to eradicate a known cancer.
Eligible patients-a total of 90-had either stage III or IV cancer with no prior surgery or radiation therapy in the head and neck region and remained cancer-free 18 months or more after completing radiation therapy. The majority of patients were men (82 percent) who had oropharyngeal cancer (63 percent) with a T stage (extent of primary tumor, including size, at diagnosis) of either T2 or T3 (71 percent).
Only 44 percent had neck surgery, but 58 percent had concurrent chemotherapy. Only 10 percent had radiation treatments using altered fractionation schemes. Sixty percent had two-dimensional treatment planning for radiation therapy while 40 percent had three-dimensional CT-based treatment planning.
A feeding tube was placed in 56 of these 90 patients (62 percent): 19 before radiation therapy; 26 during radiation therapy; and 11 after radiation therapy. Two-thirds of the men had the feeding tube removed during the follow-up period, with only 15 percent retaining the tube after 18 months.
"In analyzing the factors associated with feeding tube dependency at 18 months, only the higher T stage and 2-D treatment planning were independent predictors," Li said. "Of the 54 patients who had 2-D treatment planning, 20 were feeding-tube dependent at 18 months compared to just five of the 36 who had 3-D treatment planning. Of the three patients who had intensity-modulated radiation therapy instead of conventional radiation, none were feeding-tube dependent.
"Three-dimensional treatment planning can help patients avoid feeding tube dependency," Li concluded. "Possible explanations may be improved tumor targeting with smaller areas receiving high doses or more evenly distributed doses in large radiation fields.\\\
Fox Chase Cancer Center
Eligible patients-a total of 90-had either stage III or IV cancer with no prior surgery or radiation therapy in the head and neck region and remained cancer-free 18 months or more after completing radiation therapy. The majority of patients were men (82 percent) who had oropharyngeal cancer (63 percent) with a T stage (extent of primary tumor, including size, at diagnosis) of either T2 or T3 (71 percent).
Only 44 percent had neck surgery, but 58 percent had concurrent chemotherapy. Only 10 percent had radiation treatments using altered fractionation schemes. Sixty percent had two-dimensional treatment planning for radiation therapy while 40 percent had three-dimensional CT-based treatment planning.
A feeding tube was placed in 56 of these 90 patients (62 percent): 19 before radiation therapy; 26 during radiation therapy; and 11 after radiation therapy. Two-thirds of the men had the feeding tube removed during the follow-up period, with only 15 percent retaining the tube after 18 months.
"In analyzing the factors associated with feeding tube dependency at 18 months, only the higher T stage and 2-D treatment planning were independent predictors," Li said. "Of the 54 patients who had 2-D treatment planning, 20 were feeding-tube dependent at 18 months compared to just five of the 36 who had 3-D treatment planning. Of the three patients who had intensity-modulated radiation therapy instead of conventional radiation, none were feeding-tube dependent.
"Three-dimensional treatment planning can help patients avoid feeding tube dependency," Li concluded. "Possible explanations may be improved tumor targeting with smaller areas receiving high doses or more evenly distributed doses in large radiation fields.\\\
Fox Chase Cancer Center
Radiation Therapy Current Events and Radiation Therapy News RSSASTRO publishes supplement on protecting cancer patients by reducing radiation doses, side effects
The Quantitative Analysis of Normal Tissue Effects in the Clinic (QUANTEC) review has been published in the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO) to update recommendations for the safe irradiation of 16 organs.
Nurses' Research Settles a Common Cancer Concern: Skin Care
Given the complexity of cancer treatment, skin care may seem like a small matter. However, a nurse at the James P. Wilmot Cancer Center knew that skin issues were a constant source of anxiety for many patients receiving radiation therapy, and through research she discovered that routine advice was rooted in myth instead of scientific evidence.
SBRT eliminates tumors with promising survival for early-stage inoperable lung cancer patients
Highly-focused stereotactic body radiation therapy (SBRT) can eliminate the targeted tumor while avoiding treatment-related illness and may ultimately improve survival for patients with inoperable non-small cell lung cancer, according to early findings of a Radiation Therapy Oncology Group study published in the March 17 cancer-themed issue of the Journal of the American Medical Association.
Age, gender can affect risk to radiation treatment
Doctors have a clearer picture than ever before of how much radiation reaches sensitive tissues during routine X-rays and similar imaging, thanks to sophisticated models of the human body being developed at the University of Florida.
Researchers discover brain tumor's 'grow-or-go' switch
Cancer cells in rapidly growing brain tumors must adjust to periods of low energy or die. When energy levels are high, tumor cells grow and proliferate. When levels are low, the cells grow less and migrate more.
Dietary supplements discouraged for prostate cancer patients
Prostate-specific dietary supplements should not be taken during radiation therapy treatments because they have been shown to increase the radiosensitivity of normal prostate cell lines, leading to normal tissue complications, according to a study in the March issue of the International Journal of Radiation Oncology*Biology*Physics, the official journal of the American Society for Radiation Oncology (ASTRO).
Long waits for radiotherapy linked to increased recurrence of breast cancer
The longer women wait for radiotherapy after breast cancer surgery, the more chance there is of local recurrence, concludes a study published on bmj.com today.
Testosterone deficiency affects male cancer survivors' quality of life
A new study has found that many male cancer survivors who develop testosterone deficiency after receiving chemotherapy or radiation therapy have an impaired quality of life and reduced energy levels.
Short-term radiation therapy successful on breast cancer
An intense three-week course of radiation therapy is just as effective as the standard five-week regimen for women with early-stage breast cancer.
Predicting prognosis and treatment response in a subset of pancreatic cancer patients
Specific chemical modifications to proteins called histones, which are found in the nucleus of cells and act as spools around which DNA is wound, can be used to predict prognosis and response to treatment in subsets patients with pancreatic cancer.
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