1 / 22

Adjuvant radiochemotherapy in head and neck tumors H. Christiansen and C. F. Hess

Adjuvant radiochemotherapy in head and neck tumors H. Christiansen and C. F. Hess. Department of Radiotherapy Goettingen University. Adjuvant RT pN+. Local control Cause-specific survival. Surgery + RT. Surgery + RT. Surgery. Surgery. Lundahl et al. Int J Radiat Oncol Biol Phys 1998.

tea
Download Presentation

Adjuvant radiochemotherapy in head and neck tumors H. Christiansen and C. F. Hess

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. Adjuvant radiochemotherapy in head and neck tumorsH. Christiansen and C. F. Hess Department of RadiotherapyGoettingen University

  2. Adjuvant RT pN+ Local control Cause-specific survival Surgery + RT Surgery + RT Surgery Surgery Lundahl et al. Int J Radiat Oncol Biol Phys 1998

  3. Huang et al. Int J Radiat Oncol Biol Phys 1992

  4. Risk factors for locoregional recurrence after radical surgery • Tumor size (>T2) • Lymph node involvement (N+) • Positive margins after surgery

  5. Radio-chemotherapy Radio-chemotherapy Radiotherapy Radiotherapy Progression-free survival Overall survival Bernier et al. N Engl J Med 2004

  6. EPO for correction of anaemia(locoregional progression free survival) 12 24 36 48 60 Henke et. al. Lancet 2003

  7. Toxicity* *Bernier et al. N Engl J Med 2004

  8. Application forms of concomitant cisplatin chemotherapy • 100 mg/m² on days 1, 22, 43(Cooper et al. 2004) • weekly 50 mg/m²(Bachaud et al. 1996) → more intensive chemotherapy leads to increased toxicity

  9. Prophylaxis of side effects Amifostine Patient Benefit Questionnaire (PBQ) locoregional control Brizel et. al. JCO 2000

  10. G-CSF Local control Months Staar et al. Int J Radiat Oncol Biol Phys 2001 • Patients receiving G-CSF showed reduced mucosal toxicities (p=0.066)

  11. Nutrition support BNS = baseline nutrition support before treatment initiationTNS = nutrition support during treatment onlyno NS = no nutrition support Rabinovitch et. al. Head Neck 2006 (in press)

  12. Pilocarpin • Pilocarpine can maintain and protect unstimulated salivary flow • however, there was no positive impact on the QOL outcome for patients taking pilocarpine Fisher et. al. Int J Radiat Oncol Biol Phys 2003

  13. Modern 3–D radiotherapy technique CTV = primary tumour region and cervical and supraclavicular lymph nodes Gregoire et. al. 2004

  14. Adjuvant RT after laser surgery – the University of Goettingen experience(n=208; 40 stage III, 168 stage IV) Pradier, Christiansen et. al. Int J Radiat Oncol Biol Phys 2005

  15. Hb ≥ 13.5 g/dl Survival Hb < 13.5 g/dl Preradiotherapeutic hemoglobin level – significant influence on prognosis (Stage III/IV) Pradier, Christiansen et. al. Int J Radiat Oncol Biol Phys 2005

  16. median Hb-level 14.7 g/dl Hb ≥ 14.7 g/dl Survival Hb < 14.7 g/dl Christiansen, Pradier Unpublished data 2006 Preoperative hemoglobin level – no significant influence on prognosis (Stage III/IV)

  17. RT vs. RCT in the adjuvant situation after laser surgery (n=48) the University of Goettingen experience Christiansen, Pradier Unpublished data 2006

  18. Summary Addition of chemo- to adjuvant radiotherapy • Increased local control (increased survival?) • Main agent: Cisplatinum (different modes of application) • Modestly increased toxicity (prophylaxis by Amifostine?) • Considerable impact of RT technique

  19. Future aspects • New agents e.g. EGFR blocking antibody (Cetuximab) • Patient selection via predictive factors • High precision RT-techniques • Potential impact of laser surgery on treatment efficacy (via better local perfusion) and better QOL

More Related