Multiple fractions daily for head and neck cancer: Spinal cord effects and other late results
Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have reviewed our experience of head and neck cancers treated thrice daily to examine this problem. Between 1982 and 1990, 65 patients with advanced hea...
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Published in | Clinical oncology (Royal College of Radiologists (Great Britain)) Vol. 5; no. 3; pp. 139 - 142 |
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Main Authors | , , , |
Format | Journal Article |
Language | English |
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England
Elsevier Ltd
1993
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Abstract | Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have reviewed our experience of head and neck cancers treated thrice daily to examine this problem.
Between 1982 and 1990, 65 patients with advanced head and neck cancer were treated by primary radiotherapy using three small fractions delivered on 5 days per week, with an inter-fraction interval of 3–4 hours during normal working hours. In 25 patients, the cervical spinal cord received >39 Gy. In 13 patients, 39.6 Gy was given in 1.1 Gy fractions, and five received 41.8 Gy in 1.1 Gy fractions, two received 45.1 Gy in 1.1 Gy fractions and five received 45 Gy in 1.5 Gy fractions. Eleven of these patients have survived over 2 years, and can be assessed for late spinal cord damage. Ten of these received 1.1 Gy fractions with no cord damage. The only 2-year survivor whose cord received 45 Gy in 1.5 Gy fractions has developed mild, non-progressive long tract signs. Other late side effects were equivalent to those after conventionally fractionated radiotherapy. Tumour control was good, especially for the larynx. We feel that, for radiotherapy given with three small fractions daily and an inter-fraction interval of 3–4 hours, the spinal dose should not exceed 40 Gy. |
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AbstractList | Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have reviewed our experience of head and neck cancers treated thrice daily to examine this problem. Between 1982 and 1990, 65 patients with advanced head and neck cancer were treated by primary radiotherapy using three small fractions delivered on 5 days per week, with an inter-fraction interval of 3-4 hours during normal working hours. In 25 patients, the cervical spinal cord received > 39 Gy. In 13 patients, 39.6 Gy was given in 1.1 Gy fractions, and five received 41.8 Gy in 1.1 Gy fractions, two received 45.1 Gy in 1.1 Gy fractions and five received 45 Gy in 1.5 Gy fractions. Eleven of these patients have survived over 2 years, and can be assessed for late spinal cord damage. Ten of these received 1.1 Gy fractions with no cord damage. The only 2-year survivor whose cord received 45 Gy in 1.5 Gy fractions has developed mild, non-progressive long tract signs. Other late side effects were equivalent to those after conventionally fractionated radiotherapy. Tumour control was good, especially for the larynx. We feel that, for radiotherapy given with three small fractions daily and an inter-fraction interval of 3-4 hours, the spinal dose should not exceed 40 Gy. Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have reviewed our experience of head and neck cancers treated thrice daily to examine this problem. Between 1982 and 1990, 65 patients with advanced head and neck cancer were treated by primary radiotherapy using three small fractions delivered on 5 days per week, with an inter-fraction interval of 3–4 hours during normal working hours. In 25 patients, the cervical spinal cord received >39 Gy. In 13 patients, 39.6 Gy was given in 1.1 Gy fractions, and five received 41.8 Gy in 1.1 Gy fractions, two received 45.1 Gy in 1.1 Gy fractions and five received 45 Gy in 1.5 Gy fractions. Eleven of these patients have survived over 2 years, and can be assessed for late spinal cord damage. Ten of these received 1.1 Gy fractions with no cord damage. The only 2-year survivor whose cord received 45 Gy in 1.5 Gy fractions has developed mild, non-progressive long tract signs. Other late side effects were equivalent to those after conventionally fractionated radiotherapy. Tumour control was good, especially for the larynx. We feel that, for radiotherapy given with three small fractions daily and an inter-fraction interval of 3–4 hours, the spinal dose should not exceed 40 Gy. |
Author | Macmillan, C.H. Berridge, J.K. Morgan, D.A.L. Crellin, R.P. |
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Keywords | Spinal cord Hyperfractionation Radiation damage |
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References | Elkind, Sutton-Gilbert, Moses (bib9) 1965; 25 Hopewell, Morris, Dixon-Brown (bib12) 1987; 60 van der Schueren, Landuyt, Ang (bib15) 1988; 14 Bradley, Morgan (bib1) 1991; 104 Dische (bib14) 1991; 20 Sule-Suso, Brunt, Lindup (bib17) 1991; 3 Lindup (bib16) 1992; 4 van der Kogel (bib3) 1989; 16 Dische, Saunders (bib7) 1990; 19 Morgan, Bradley, Maclennan (bib2) 1987; 26 Lavey, Johnston, McBride (bib13) 1992; 24 Ang, Jiang, Guttenburger (bib10) 1992; 25 Wang (bib8) 1988; 14 (bib6) 1986; 12 Brunt, Sule-Suso, Scoble (bib18) 1992; 4 Dische, Saunders (bib5) 1989; 16 Wong, van Dyk, Simpson (bib4) 1991; 20 van de Bogaert, van der Schueren, Horiot (bib11) 1982; 8 |
References_xml | – volume: 8 start-page: 1649 year: 1982 end-page: 1655 ident: bib11 article-title: The feasibility of high dose multiple daily fractionation and its combination with anoxic cell sensitizers in the treatment of head and neck cancer publication-title: Int J Radiat Oncol Biol Phys contributor: fullname: Horiot – volume: 60 start-page: 1099 year: 1987 end-page: 1108 ident: bib12 article-title: The influence of field size on the late tolerance of the rat spinal cord to single doses of X-rays publication-title: Br J Radiol contributor: fullname: Dixon-Brown – volume: 3 start-page: 209 year: 1991 end-page: 213 ident: bib17 article-title: Hyperfractionated accelerated radiotherapy for carcinoma of the oesophagus publication-title: Clin Oncol contributor: fullname: Lindup – volume: 4 start-page: 340 year: 1992 ident: bib18 article-title: Hyperfractionated accelerated radiotherapy for carcinoma of the oesophagus [letter] publication-title: Clin Oncol contributor: fullname: Scoble – volume: 24 start-page: 681 year: 1992 end-page: 686 ident: bib13 article-title: The effect of hyper-fractionation on spinal cord response to radiation publication-title: Int J Radiat Oncol Biol Phys contributor: fullname: McBride – volume: 26 start-page: 437 year: 1987 end-page: 440 ident: bib2 article-title: Early results of radiotherapy for advanced laryngeal cancer using three small fractions per day publication-title: Acta Oncol contributor: fullname: Maclennan – volume: 25 start-page: 287 year: 1992 end-page: 294 ident: bib10 article-title: Impact of spinal cord repair kinetics on the practice of altered fractionation schedules publication-title: Radiother Oncol contributor: fullname: Guttenburger – volume: 104 start-page: 838 year: 1991 end-page: 841 ident: bib1 article-title: Radiotherapy of advanced laryngeal cancer using three small fractions daily publication-title: Otolaryngol Head Neck Surg contributor: fullname: Morgan – volume: 19 start-page: 1317 year: 1990 end-page: 1320 ident: bib7 article-title: The rationale for continuous hyperfractionated accelerated radiotherapy (CHART) publication-title: Int J Radiat Oncol Biol Phys contributor: fullname: Saunders – volume: 14 start-page: 209 year: 1988 end-page: 210 ident: bib8 article-title: The enigma of accelerated hyperfractionated radiation therapy for head and neck cancer publication-title: Int J Radiat Oncol Biol Phys contributor: fullname: Wang – volume: 12 start-page: 587 year: 1986 end-page: 591 ident: bib6 article-title: Early results of the EORTC randomised clinical trial on multiple fractions per day (MFD) and misonidazole in advanced head and neck cancer publication-title: Int J Radiat Oncol Biol Phys – volume: 25 start-page: 359 year: 1965 end-page: 376 ident: bib9 article-title: Radiation response of mammalian cells publication-title: Radiat Res contributor: fullname: Moses – volume: 16 start-page: 75 year: 1989 end-page: 77 ident: bib3 article-title: Continuous, hyperfractionated, accelerated radiotherapy (CHART) [editorial comment] publication-title: Radiother Oncol contributor: fullname: van der Kogel – volume: 16 start-page: 67 year: 1989 end-page: 74 ident: bib5 article-title: Continuous hyperfractionated accelerated radiotherapy (CHART): An interim report upon late morbidity publication-title: Radiother Oncol contributor: fullname: Saunders – volume: 20 start-page: 3 year: 1991 end-page: 9 ident: bib4 article-title: Myelopathy following hyperfractionated accelerated radiotherapy for anaplastic thyroid carcinoma publication-title: Radiother Oncol contributor: fullname: Simpson – volume: 14 start-page: 297 year: 1988 end-page: 300 ident: bib15 article-title: From 2 Gy to 1 Gy per fraction: Sparing effect in rat spinal cord publication-title: Int J Radiat Oncol Biol Phys contributor: fullname: Ang – volume: 20 start-page: 1 year: 1991 end-page: 2 ident: bib14 article-title: Accelerated treatment and radiation myelitis [editorial] publication-title: Radiother Oncol contributor: fullname: Dische – volume: 4 start-page: 280 year: 1992 end-page: 283 ident: bib16 article-title: Multiple fractions in the treatment of head and neck cancer publication-title: Clin Oncol contributor: fullname: Lindup |
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Snippet | Reports of late spinal cord damage after multiple fractions daily radiotherapy regimens for head and neck cancer are infrequent, but increasing. We have... |
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SubjectTerms | Carcinoma, Squamous Cell - radiotherapy Head and Neck Neoplasms - radiotherapy Humans Hyperfractionation Laryngeal Neoplasms - radiotherapy Pharyngeal Neoplasms - radiotherapy Radiation damage Radiotherapy - adverse effects Radiotherapy Dosage Spinal cord Spinal Cord - radiation effects |
Title | Multiple fractions daily for head and neck cancer: Spinal cord effects and other late results |
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