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Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy.
Int J Radiat Oncol Biol Phys. 2008 Mar 15; 70(4):1100-7.IJ

Abstract

PURPOSE

Unknown primary head and neck cancers often require comprehensive mucosal and bilateral neck irradiation. With conventional techniques, significant toxicity can develop. Intensity-modulated radiotherapy (IMRT) has the potential to minimize the toxicity.

METHODS AND MATERIALS

Between 2000 and 2005, 21 patients underwent IMRT for unknown primary head and neck cancer at our center. Of the 21 patients, 5 received IMRT with definitive intent and 16 as postoperative therapy; 14 received concurrent chemotherapy and 7 IMRT alone. The target volumes included the bilateral neck and mucosal surface. The median dose was 66 Gy. Acute and chronic toxicities, esophageal strictures, and percutaneous endoscopic gastrostomy tube dependence were evaluated. Progression-free survival, regional progression-free survival, distant metastasis-free survival, and overall survival were estimated with Kaplan-Meier curves.

RESULTS

With a median follow-up of 24 months, the 2-year regional progression-free survival, distant metastasis-free survival, and overall survival rate was 90%, 90%, and 85%, respectively. Acute grade 1 and 2 xerostomia was seen in 57% and 43% of patients, respectively. Salivary function improved with time. Percutaneous endoscopic gastrostomy tube placement was required in 72% with combined modality treatment and 43% with IMRT alone. Only 1 patient required percutaneous endoscopic gastrostomy support at the last follow-up visit. Two patients treated with combined modality and one treated with IMRT alone developed esophageal strictures, but all had improvement or resolution with dilation.

CONCLUSION

The preliminary analysis of IMRT for unknown primary head and neck cancer has shown acceptable toxicity and encouraging efficacy. The analysis of the dosimetric variables showed excellent tumor coverage and acceptable doses to critical normal structures. Esophageal strictures developed but were effectively treated with dilation. Techniques to limit the esophageal dose could help further minimize this complication.

Authors+Show Affiliations

Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY 10022, USA. mlklem@yahoo.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Evaluation Study
Journal Article

Language

eng

PubMed ID

17980501

Citation

Klem, Michelle L., et al. "Intensity-modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy." International Journal of Radiation Oncology, Biology, Physics, vol. 70, no. 4, 2008, pp. 1100-7.
Klem ML, Mechalakos JG, Wolden SL, et al. Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy. Int J Radiat Oncol Biol Phys. 2008;70(4):1100-7.
Klem, M. L., Mechalakos, J. G., Wolden, S. L., Zelefsky, M. J., Singh, B., Kraus, D., Shaha, A., Shah, J., Pfister, D. G., & Lee, N. Y. (2008). Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy. International Journal of Radiation Oncology, Biology, Physics, 70(4), 1100-7.
Klem ML, et al. Intensity-modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy. Int J Radiat Oncol Biol Phys. 2008 Mar 15;70(4):1100-7. PubMed PMID: 17980501.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Intensity-modulated radiotherapy for head and neck cancer of unknown primary: toxicity and preliminary efficacy. AU - Klem,Michelle L, AU - Mechalakos,James G, AU - Wolden,Suzanne L, AU - Zelefsky,Michael J, AU - Singh,Bhuvanesh, AU - Kraus,Dennis, AU - Shaha,Ashok, AU - Shah,Jatin, AU - Pfister,David G, AU - Lee,Nancy Y, Y1 - 2007/11/05/ PY - 2007/02/26/received PY - 2007/06/25/revised PY - 2007/07/25/accepted PY - 2007/11/6/pubmed PY - 2008/5/7/medline PY - 2007/11/6/entrez SP - 1100 EP - 7 JF - International journal of radiation oncology, biology, physics JO - Int J Radiat Oncol Biol Phys VL - 70 IS - 4 N2 - PURPOSE: Unknown primary head and neck cancers often require comprehensive mucosal and bilateral neck irradiation. With conventional techniques, significant toxicity can develop. Intensity-modulated radiotherapy (IMRT) has the potential to minimize the toxicity. METHODS AND MATERIALS: Between 2000 and 2005, 21 patients underwent IMRT for unknown primary head and neck cancer at our center. Of the 21 patients, 5 received IMRT with definitive intent and 16 as postoperative therapy; 14 received concurrent chemotherapy and 7 IMRT alone. The target volumes included the bilateral neck and mucosal surface. The median dose was 66 Gy. Acute and chronic toxicities, esophageal strictures, and percutaneous endoscopic gastrostomy tube dependence were evaluated. Progression-free survival, regional progression-free survival, distant metastasis-free survival, and overall survival were estimated with Kaplan-Meier curves. RESULTS: With a median follow-up of 24 months, the 2-year regional progression-free survival, distant metastasis-free survival, and overall survival rate was 90%, 90%, and 85%, respectively. Acute grade 1 and 2 xerostomia was seen in 57% and 43% of patients, respectively. Salivary function improved with time. Percutaneous endoscopic gastrostomy tube placement was required in 72% with combined modality treatment and 43% with IMRT alone. Only 1 patient required percutaneous endoscopic gastrostomy support at the last follow-up visit. Two patients treated with combined modality and one treated with IMRT alone developed esophageal strictures, but all had improvement or resolution with dilation. CONCLUSION: The preliminary analysis of IMRT for unknown primary head and neck cancer has shown acceptable toxicity and encouraging efficacy. The analysis of the dosimetric variables showed excellent tumor coverage and acceptable doses to critical normal structures. Esophageal strictures developed but were effectively treated with dilation. Techniques to limit the esophageal dose could help further minimize this complication. SN - 0360-3016 UR - https://www.unboundmedicine.com/medline/citation/17980501/Intensity_modulated_radiotherapy_for_head_and_neck_cancer_of_unknown_primary:_toxicity_and_preliminary_efficacy_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0360-3016(07)03702-9 DB - PRIME DP - Unbound Medicine ER -