Nancy Lee, MD - ASTRO

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Wh What t is i th the bbest t RT FFractionation ti ti in i setting tti of f chemotherapy? h h ?
Concurrent Chemoradiation with Altered Fx • Rationale springs from RTOG 90-03 where altered fx improves loco- regional control control, disease disease-free free survival when compared to standard fractionation • Bourhis et al. (Lancent 2006): Meta-Analyses of 15 altered fx RT alone trials improves 5 year overall LC by 6.7% and survival by 3.4% (More pronouced with HFX than ACC FX • Trials of CT combined with QD RT are positive • C bi i CT i h l df i i h ldl d f h • Combining CT with altered fractionation should lead to further improvement of results
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Head and Neck II: Oropharynx, Laryn
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OROPHARYNX-Sites Base of tongue Sof
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INCIDENCE OF LYMPH NODE METASTASES
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CA. OF THE OROPHARYNX INCIDENCE OF
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Oropharyngeal CA: Treatment Volume
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RTOG 73-03 Oral Cavity And Orophary
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Surgery and Adjuvant RT vs. CCRT in
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Stage III/IV Head and Neck CA: Rand
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CA. OF THE TONSILLAR REGION LOCAL C
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CARCINOMA OF THE TONSIL LOCAL CONTR
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BASE OF TONGUE IMPLANTS Patient Sel
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BASE OF TONGUE IMPLANTS Dose to the
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Trans-Tasman Radiation Oncology PPo
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RTOG 90-03 PHASE III STUDY OF ALTER
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CB: 33% Late Grade 3-4 Toxicity
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• N=77 • IV=83% RTOG 99-14 Ang
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Gortec French Study DDenis i et t a
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French Trial: Oropharyngeal CA (D (
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There is also site-specific orophar
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Why shouldn’t we just treat all a
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Chemoradiotherapy: Late FT Dependen
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Chemoradiotherapy: Late FT Dependen
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An example of patient with late eff
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Historical RT Dose Escalation • I
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IMRT in the Treatment of Oropharyng
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Patients Population From 9/1998 to
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Local Control 3-year 94.4% 5-year 9
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Local Failure versus T-stage • T1
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Toxicities : Acute • Mucositis gr
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IMRT for oropharynx: available data
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Mean Doses Right Parotid 19.80 Gy R
Page 70 and 71: % >G2 LENT SOM Subjective Xerostomi
Page 72 and 73: Conclusions • RT preferred f d ov
Page 74 and 75: Conclusions • Careful selection o
Page 76 and 77: T1 T1-2NO 2NO Gl Glottic tti Cancer
Page 78 and 79: T1 Carcinoma of the Glottis Local C
Page 80 and 81: LOCAL CONTROL OF T1 LESIONS Locall
Page 82 and 83: T2 Carcinoma of the Glottis Local o
Page 84 and 85: LOCAL CONTROL OF T2 LESIONS Control
Page 86 and 87: LOCAL CONTROL FOR T2 LESIONS Local
Page 88 and 89: Randomized trial on RT fraction siz
Page 90 and 91: Meta-analysis of Impaired VC Mobili
Page 92 and 93: RTOG 91-11 Phase III Trial to Prese
Page 94 and 95: T4 T4a: Thyroid Th id Cartilage C i
Page 96 and 97: Induction Chemotherapy Followed By
Page 98 and 99: Stage T3 Carcinoma of the Glottis R
Page 100 and 101: Carcinoma of the Supraglottis % LLo
Page 102 and 103: VA LARYNGEAL CA. STUDY Surgery Radi
Page 104 and 105: VA LARYNX PRESERVATON STUDY Surgery
Page 106 and 107: R A N D O M GETTEC Trial - T3 Laryn
Page 108 and 109: Does Vocal Cord Fixation Preclude N
Page 110 and 111: RTOG 91-11 Ph Phase III TTrial i l
Page 112 and 113: RTOG 91-11 Induction CCRT RT 2 year
Page 114 and 115: Squamous Cell Head and Neck Cancer
Page 116 and 117: Functional Organ Preservation with
Page 120 and 121: Stage III or IV of f sq cell ll ca
Page 122 and 123: HHypopharynx h
Page 124 and 125: EORTC 24891 LARYNX PRESERVATION FOR
Page 126: CConcurrent Ch Chemoradiotherapy di
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Nancy Lee, MD - ASTRO

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