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Stanley Dische - One of the best experts on this subject based on the ideXlab platform.

  • Epidermal Growth Factor Receptor Expression in Pretreatment Biopsies From Head and Neck Squamous Cell Carcinoma As a Predictive Factor for a Benefit From Accelerated Radiation Therapy in a Randomized Controlled Trial
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005
    Co-Authors: Søren M. Bentzen, Stanley Dische, Michele I. Saunders, P I Richman, Beste M. Atasoy, Frances Daley, Klaus R. Trott, George D. Wilson
    Abstract:

    Purpose Accelerated repopulation is a main reason for locoregional failure after fractionated Radiotherapy for head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor (EGFR) is a key controller of cellular proliferation in HNSCC, which stimulated the current study to look for a direct link between EGFR status and a possible clinical advantage of Accelerated Radiotherapy. Patients and Methods Immunohistochemical staining for EGFR was performed in 304 patients with available pretreatment tumor biopsy material among 918 patients randomized to receive continuous Hyperfractionated Accelerated Radiotherapy versus conventionally fractionated Radiotherapy. The EGFR index was estimated as the proportion of tumor cells with EGFR membrane staining. Results Significant benefit in locoregional tumor control from continuous Hyperfractionated Accelerated Radiotherapy was seen in patients with HNSCC with high EGFR expression (2P = .010) but not in those with low EGFR expression (2P = .85). EGFR st...

  • molecular marker profiles predict locoregional control of head and neck squamous cell carcinoma in a randomized trial of continuous Hyperfractionated Accelerated Radiotherapy
    Clinical Cancer Research, 2004
    Co-Authors: Francesca M. Buffa, Stanley Dische, Michele I. Saunders, Søren M. Bentzen, F M Daley, P I Richman, George D. Wilson
    Abstract:

    Purpose: Identification of factors that assist prediction of tumor response to Radiotherapy may aid in refining treatment strategies and improving outcome. Possible association of molecular marker expression profiles with locoregional control of head and neck squamous cell carcinoma was investigated in a randomized trial of conventional versus continuous Hyperfractionated Accelerated Radiotherapy (CHART). Experimental Design: Tumor material was obtained from 402 patients. Immunohistochemistry was used to assess Ki-67, CD31, p53, Bcl-2, and cyclin D1 expression. A hierarchical clustering algorithm with a Bayesian information criterion was used to group tumors with similar marker expression; resulting expression profiles were then compared in terms of their difference in outcome after CHART and conventionally fractionated Radiotherapy. Results: Molecular marker profile was an independent prognostic factor for locoregional control. This was confirmed in multivariate analysis, including clinical variables such as tumor and nodal status, primary site, histological grade, age, and gender ( P P = 0.006 for local and nodal relapse, respectively). In particular, Bcl-2-positive tumors responded significantly better than average in both arms of the trial. Tumors negative for p53- and Bcl-2, with high and randomly patterned Ki-67 expression, responded worse than average with no benefit from CHART. Tumors with similarly negative p53 and Bcl-2, but low Ki-67 staining, with an organized pattern, benefit significantly from CHART schedule. Conclusions: This study demonstrates the potential of molecular profiles to predict Radiotherapy response of head and neck squamous cell carcinoma and for treatment stratification. Distinct expression profiles correlate with three distinct clinical phenotypes, including good locoregional control, poor locoregional control, and an outcome strongly dependent upon fractionation schedule.

  • Molecular Marker Profiles Predict Locoregional Control of Head and Neck Squamous Cell Carcinoma in a Randomized Trial of Continuous Hyperfractionated Accelerated Radiotherapy
    Clinical cancer research : an official journal of the American Association for Cancer Research, 2004
    Co-Authors: Francesca M. Buffa, Stanley Dische, Michele I. Saunders, Søren M. Bentzen, F M Daley, P I Richman, George D. Wilson
    Abstract:

    Identification of factors that assist prediction of tumor response to Radiotherapy may aid in refining treatment strategies and improving outcome. Possible association of molecular marker expression profiles with locoregional control of head and neck squamous cell carcinoma was investigated in a randomized trial of conventional versus continuous Hyperfractionated Accelerated Radiotherapy (CHART). Tumor material was obtained from 402 patients. Immunohistochemistry was used to assess Ki-67, CD31, p53, Bcl-2, and cyclin D1 expression. A hierarchical clustering algorithm with a Bayesian information criterion was used to group tumors with similar marker expression; resulting expression profiles were then compared in terms of their difference in outcome after CHART and conventionally fractionated Radiotherapy. Molecular marker profile was an independent prognostic factor for locoregional control. This was confirmed in multivariate analysis, including clinical variables such as tumor and nodal status, primary site, histological grade, age, and gender (P < 0.001 and P = 0.006 for local and nodal relapse, respectively). In particular, Bcl-2-positive tumors responded significantly better than average in both arms of the trial. Tumors negative for p53- and Bcl-2, with high and randomly patterned Ki-67 expression, responded worse than average with no benefit from CHART. Tumors with similarly negative p53 and Bcl-2, but low Ki-67 staining, with an organized pattern, benefit significantly from CHART schedule. This study demonstrates the potential of molecular profiles to predict Radiotherapy response of head and neck squamous cell carcinoma and for treatment stratification. Distinct expression profiles correlate with three distinct clinical phenotypes, including good locoregional control, poor locoregional control, and an outcome strongly dependent upon fractionation schedule.

  • Continuous Hyperfractionated Accelerated Radiotherapy (CHART) versus conventional Radiotherapy in non-small-cell lung cancer: a randomised multicentre trial
    Lancet (London England), 1997
    Co-Authors: Michele I. Saunders, Stanley Dische, Ann Barrett, Angela Harvey, D Gibson, Mahesh K. B. Parmar
    Abstract:

    Summary Background Human tumour cells can proliferate rapidly, and giving Radiotherapy in many small fractions may reduce long-term normal-tissue morbidity. In response to these observations, we developed the CHART (continuous Hyperfractionated Accelerated Radiotherapy) regimen, which uses thirty-six small fractions of 1·5 Gy given three times per day, to give 54 Gy in only 12 consecutive days. We report the long-term follow-up of a trial of CHART versus conventional Radiotherapy in patients with locally advanced non-small-cell lung cancer (NSCLC). Methods 563 patients were entered by thirteen centres between April, 1990, and March, 1995. We included patients with NSCLC localised to the chest with a performance status of 0 or 1 in whom radical Radiotherapy was chosen as the definitive management. Patients were randomly allocated in a 3:2 ratio to CHART or conventional Radiotherapy. The latter was thirty fractions of 2 Gy to a total dose of 60 Gy in 6 weeks. Results The groups were well matched for possible prognostic factors. Overall there was a 24% reduction in the relative risk of death, which is equivalent to an absolute improvement in 2-year survival of 9% from 20% to 29% (p=0·004, 95% CI 0·63–0·92). Subgroup analyses (predefined) suggest that the largest benefit occurred in patients with squamous cell carcinomas (82% of the cases), in whom there was a 34% reduction in the relative risk of death (an absolute improvement at 2 years of 14% from 19% to 33%). During the first 3 months, severe dysphagia occurred more often in the CHART group than in the group on conventional Radiotherapy (19 vs 3%). Otherwise, there were no important differences in short-term or long-term morbidity. Interpretation CHART compared with conventional Radiotherapy gave a significant improvement in survival of patients with NSCLC. Further improvement may be achieved with dose escalation in conformal Radiotherapy, by the addition of cytotoxic chemotherapy, and by hypoxic cell radiosensitisation.

  • CONTINUOUS Hyperfractionated Accelerated Radiotherapy (CHART) IN LOCALIZED CANCER OF THE ESOPHAGUS
    International journal of radiation oncology biology physics, 1997
    Co-Authors: Melanie E Powell, Michele I. Saunders, Peter Hoskin, Christopher Foy, Stanley Dische
    Abstract:

    To assess the efficacy and toxicity of continuous Hyperfractionated Accelerated Radiotherapy (CHART) in locoregional control compared with a historical group of patients treated with conventionally fractionated radical Radiotherapy. Between 1985 and 1994, 54 patients with localized esophageal cancer were treated with CHART. Twenty-eight patients received CHART alone (54 Gy in 36 fractions over 12 consecutive days) and 15 were given intravenous mitomycin C and cisplatin on days 10 and 13, respectively. Eleven patients received 40.5 Gy in 27 fractions over 9 days, followed by a single high-dose-rate intraluminal brachytherapy insertion of 15 Gy at 1 cm. Acute toxicity was well tolerated and dysphagia was improved in 35 patients (65%), with 28 (52%) eating a normal diet by week 12. This compares with an improvement in dysphagia score in 72% of the conventionally treated group. The median duration of relief of dysphagia was 7.8 months (range 0-41.4) in the CHART group compared with 5.5 months (range 0-48) in the controls. Strictures developed in 29 patients (61%) and 18 were confirmed on biopsy to be due to recurrent disease. Median survival was 12 months (range 0.5-112) in the CHART group and 15 months (range 3.6-56) in the control patients. CHART is well tolerated and achieves a high rate of local control. Palliation in the short overall treatment time of esophageal cancer is an advantage in these patients whose median survival is only 12 months.

Kate Newbold - One of the best experts on this subject based on the ideXlab platform.

  • Hyperfractionated Accelerated Radiotherapy hart for anaplastic thyroid carcinoma toxicity and survival analysis
    International Journal of Radiation Oncology Biology Physics, 2009
    Co-Authors: Prasad Dandekar, Yolanda Barbachano, Kevin J. Harrington, Christopher M. Nutting, C L Harmer, P Rhysevans, Kate Newbold
    Abstract:

    Purpose Anaplastic thyroid carcinoma (ATC) is one of the most aggressive cancers, and the current protocol of Hyperfractionated Accelerated Radiotherapy was initiated to improve survival while limiting toxicities. Methods and Materials All patients with ATC from 1991 to 2002 were accrued and received megavoltage Radiotherapy from the mastoid processes to the carina up to 60 Gy in twice-daily fractions of 1.8 and 2 Gy, 6 hours apart. Results Thirty-one patients were accrued with a median age of 69 years, and 55% were women. Debulking was performed in 26%, and total thyroidectomy, in 6%, whereas 68% received radical Radiotherapy alone. Local control data were available for 27 patients: 22% had a complete response, 26% had a partial response, 15% showed progressive disease, and 37% showed static disease. Median overall survival for all 31 patients was 70 days (95% confidence interval, 40–99). There was no significant difference in median survival between patients younger (70 days) and older than 70 years (42 days), between men (70 days) and women (49days), and between patients receiving postoperative Radiotherapy (77 days) and radical Radiotherapy alone (35 days). Grade III or higher skin erythema was seen in 56% patients; desquamation in 21%; dysphagia in 74%; and esophagitis in 79%. Conclusion The current protocol failed to offer a significant survival benefit, was associated with severe toxicities, and thus was discontinued. There is a suggestion that younger patients with operable disease have longer survival, but this would require a larger study to confirm it.

  • Hyperfractionated Accelerated Radiotherapy (HART) for anaplastic thyroid carcinoma: toxicity and survival analysis.
    International journal of radiation oncology biology physics, 2009
    Co-Authors: Prasad Dandekar, Clive Harmer, Yolanda Barbachano, Peter Rhys-evans, Kevin J. Harrington, Christopher M. Nutting, Kate Newbold
    Abstract:

    Anaplastic thyroid carcinoma (ATC) is one of the most aggressive cancers, and the current protocol of Hyperfractionated Accelerated Radiotherapy was initiated to improve survival while limiting toxicities. All patients with ATC from 1991 to 2002 were accrued and received megavoltage Radiotherapy from the mastoid processes to the carina up to 60 Gy in twice-daily fractions of 1.8 and 2 Gy, 6 hours apart. Thirty-one patients were accrued with a median age of 69 years, and 55% were women. Debulking was performed in 26%, and total thyroidectomy, in 6%, whereas 68% received radical Radiotherapy alone. Local control data were available for 27 patients: 22% had a complete response, 26% had a partial response, 15% showed progressive disease, and 37% showed static disease. Median overall survival for all 31 patients was 70 days (95% confidence interval, 40-99). There was no significant difference in median survival between patients younger (70 days) and older than 70 years (42 days), between men (70 days) and women (49 days), and between patients receiving postoperative Radiotherapy (77 days) and radical Radiotherapy alone (35 days). Grade III or higher skin erythema was seen in 56% patients; desquamation in 21%; dysphagia in 74%; and esophagitis in 79%. The current protocol failed to offer a significant survival benefit, was associated with severe toxicities, and thus was discontinued. There is a suggestion that younger patients with operable disease have longer survival, but this would require a larger study to confirm it.

Michele I. Saunders - One of the best experts on this subject based on the ideXlab platform.

  • Epidermal Growth Factor Receptor Expression in Pretreatment Biopsies From Head and Neck Squamous Cell Carcinoma As a Predictive Factor for a Benefit From Accelerated Radiation Therapy in a Randomized Controlled Trial
    Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 2005
    Co-Authors: Søren M. Bentzen, Stanley Dische, Michele I. Saunders, P I Richman, Beste M. Atasoy, Frances Daley, Klaus R. Trott, George D. Wilson
    Abstract:

    Purpose Accelerated repopulation is a main reason for locoregional failure after fractionated Radiotherapy for head and neck squamous cell carcinoma (HNSCC). Epidermal growth factor receptor (EGFR) is a key controller of cellular proliferation in HNSCC, which stimulated the current study to look for a direct link between EGFR status and a possible clinical advantage of Accelerated Radiotherapy. Patients and Methods Immunohistochemical staining for EGFR was performed in 304 patients with available pretreatment tumor biopsy material among 918 patients randomized to receive continuous Hyperfractionated Accelerated Radiotherapy versus conventionally fractionated Radiotherapy. The EGFR index was estimated as the proportion of tumor cells with EGFR membrane staining. Results Significant benefit in locoregional tumor control from continuous Hyperfractionated Accelerated Radiotherapy was seen in patients with HNSCC with high EGFR expression (2P = .010) but not in those with low EGFR expression (2P = .85). EGFR st...

  • Molecular Marker Profiles Predict Locoregional Control of Head and Neck Squamous Cell Carcinoma in a Randomized Trial of Continuous Hyperfractionated Accelerated Radiotherapy
    Clinical cancer research : an official journal of the American Association for Cancer Research, 2004
    Co-Authors: Francesca M. Buffa, Stanley Dische, Michele I. Saunders, Søren M. Bentzen, F M Daley, P I Richman, George D. Wilson
    Abstract:

    Identification of factors that assist prediction of tumor response to Radiotherapy may aid in refining treatment strategies and improving outcome. Possible association of molecular marker expression profiles with locoregional control of head and neck squamous cell carcinoma was investigated in a randomized trial of conventional versus continuous Hyperfractionated Accelerated Radiotherapy (CHART). Tumor material was obtained from 402 patients. Immunohistochemistry was used to assess Ki-67, CD31, p53, Bcl-2, and cyclin D1 expression. A hierarchical clustering algorithm with a Bayesian information criterion was used to group tumors with similar marker expression; resulting expression profiles were then compared in terms of their difference in outcome after CHART and conventionally fractionated Radiotherapy. Molecular marker profile was an independent prognostic factor for locoregional control. This was confirmed in multivariate analysis, including clinical variables such as tumor and nodal status, primary site, histological grade, age, and gender (P < 0.001 and P = 0.006 for local and nodal relapse, respectively). In particular, Bcl-2-positive tumors responded significantly better than average in both arms of the trial. Tumors negative for p53- and Bcl-2, with high and randomly patterned Ki-67 expression, responded worse than average with no benefit from CHART. Tumors with similarly negative p53 and Bcl-2, but low Ki-67 staining, with an organized pattern, benefit significantly from CHART schedule. This study demonstrates the potential of molecular profiles to predict Radiotherapy response of head and neck squamous cell carcinoma and for treatment stratification. Distinct expression profiles correlate with three distinct clinical phenotypes, including good locoregional control, poor locoregional control, and an outcome strongly dependent upon fractionation schedule.

  • molecular marker profiles predict locoregional control of head and neck squamous cell carcinoma in a randomized trial of continuous Hyperfractionated Accelerated Radiotherapy
    Clinical Cancer Research, 2004
    Co-Authors: Francesca M. Buffa, Stanley Dische, Michele I. Saunders, Søren M. Bentzen, F M Daley, P I Richman, George D. Wilson
    Abstract:

    Purpose: Identification of factors that assist prediction of tumor response to Radiotherapy may aid in refining treatment strategies and improving outcome. Possible association of molecular marker expression profiles with locoregional control of head and neck squamous cell carcinoma was investigated in a randomized trial of conventional versus continuous Hyperfractionated Accelerated Radiotherapy (CHART). Experimental Design: Tumor material was obtained from 402 patients. Immunohistochemistry was used to assess Ki-67, CD31, p53, Bcl-2, and cyclin D1 expression. A hierarchical clustering algorithm with a Bayesian information criterion was used to group tumors with similar marker expression; resulting expression profiles were then compared in terms of their difference in outcome after CHART and conventionally fractionated Radiotherapy. Results: Molecular marker profile was an independent prognostic factor for locoregional control. This was confirmed in multivariate analysis, including clinical variables such as tumor and nodal status, primary site, histological grade, age, and gender ( P P = 0.006 for local and nodal relapse, respectively). In particular, Bcl-2-positive tumors responded significantly better than average in both arms of the trial. Tumors negative for p53- and Bcl-2, with high and randomly patterned Ki-67 expression, responded worse than average with no benefit from CHART. Tumors with similarly negative p53 and Bcl-2, but low Ki-67 staining, with an organized pattern, benefit significantly from CHART schedule. Conclusions: This study demonstrates the potential of molecular profiles to predict Radiotherapy response of head and neck squamous cell carcinoma and for treatment stratification. Distinct expression profiles correlate with three distinct clinical phenotypes, including good locoregional control, poor locoregional control, and an outcome strongly dependent upon fractionation schedule.

  • Continuous Hyperfractionated Accelerated Radiotherapy (CHART) versus conventional Radiotherapy in non-small-cell lung cancer: a randomised multicentre trial
    Lancet (London England), 1997
    Co-Authors: Michele I. Saunders, Stanley Dische, Ann Barrett, Angela Harvey, D Gibson, Mahesh K. B. Parmar
    Abstract:

    Summary Background Human tumour cells can proliferate rapidly, and giving Radiotherapy in many small fractions may reduce long-term normal-tissue morbidity. In response to these observations, we developed the CHART (continuous Hyperfractionated Accelerated Radiotherapy) regimen, which uses thirty-six small fractions of 1·5 Gy given three times per day, to give 54 Gy in only 12 consecutive days. We report the long-term follow-up of a trial of CHART versus conventional Radiotherapy in patients with locally advanced non-small-cell lung cancer (NSCLC). Methods 563 patients were entered by thirteen centres between April, 1990, and March, 1995. We included patients with NSCLC localised to the chest with a performance status of 0 or 1 in whom radical Radiotherapy was chosen as the definitive management. Patients were randomly allocated in a 3:2 ratio to CHART or conventional Radiotherapy. The latter was thirty fractions of 2 Gy to a total dose of 60 Gy in 6 weeks. Results The groups were well matched for possible prognostic factors. Overall there was a 24% reduction in the relative risk of death, which is equivalent to an absolute improvement in 2-year survival of 9% from 20% to 29% (p=0·004, 95% CI 0·63–0·92). Subgroup analyses (predefined) suggest that the largest benefit occurred in patients with squamous cell carcinomas (82% of the cases), in whom there was a 34% reduction in the relative risk of death (an absolute improvement at 2 years of 14% from 19% to 33%). During the first 3 months, severe dysphagia occurred more often in the CHART group than in the group on conventional Radiotherapy (19 vs 3%). Otherwise, there were no important differences in short-term or long-term morbidity. Interpretation CHART compared with conventional Radiotherapy gave a significant improvement in survival of patients with NSCLC. Further improvement may be achieved with dose escalation in conformal Radiotherapy, by the addition of cytotoxic chemotherapy, and by hypoxic cell radiosensitisation.

  • CONTINUOUS Hyperfractionated Accelerated Radiotherapy (CHART) IN LOCALIZED CANCER OF THE ESOPHAGUS
    International journal of radiation oncology biology physics, 1997
    Co-Authors: Melanie E Powell, Michele I. Saunders, Peter Hoskin, Christopher Foy, Stanley Dische
    Abstract:

    To assess the efficacy and toxicity of continuous Hyperfractionated Accelerated Radiotherapy (CHART) in locoregional control compared with a historical group of patients treated with conventionally fractionated radical Radiotherapy. Between 1985 and 1994, 54 patients with localized esophageal cancer were treated with CHART. Twenty-eight patients received CHART alone (54 Gy in 36 fractions over 12 consecutive days) and 15 were given intravenous mitomycin C and cisplatin on days 10 and 13, respectively. Eleven patients received 40.5 Gy in 27 fractions over 9 days, followed by a single high-dose-rate intraluminal brachytherapy insertion of 15 Gy at 1 cm. Acute toxicity was well tolerated and dysphagia was improved in 35 patients (65%), with 28 (52%) eating a normal diet by week 12. This compares with an improvement in dysphagia score in 72% of the conventionally treated group. The median duration of relief of dysphagia was 7.8 months (range 0-41.4) in the CHART group compared with 5.5 months (range 0-48) in the controls. Strictures developed in 29 patients (61%) and 18 were confirmed on biopsy to be due to recurrent disease. Median survival was 12 months (range 0.5-112) in the CHART group and 15 months (range 3.6-56) in the control patients. CHART is well tolerated and achieves a high rate of local control. Palliation in the short overall treatment time of esophageal cancer is an advantage in these patients whose median survival is only 12 months.

Masato Hareyama - One of the best experts on this subject based on the ideXlab platform.

  • Hyperfractionated Accelerated Radiotherapy for T1,2 Glottic Carcinoma
    Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al], 2008
    Co-Authors: Koh-ichi Sakata, Masanori Someya, Masakazu Hori, Kensei Nakata, Masaru Takagi, Masato Hareyama
    Abstract:

    Hyperfractionated Accelerated Radiotherapy without a split (AF) has been performed to improve the local control probability of early glottic carcinomas since 1990 in the authors' institution. Here, they report their experience treating early glottic cancer patients with AF in a single institution who have a long follow-up period. 131 T1 N0 M0 glottic cancers and 65 T2 N0 M0 glottic cancers were treated with conventional fractionation (CF) from 1984 to 1989 and with AF since 1990. CF consisted of five daily fractions of 2 Gy per week, to a total dose of 64 Gy. AF consisted of 1.72 Gy per fraction, two fractions per day, 5 days a week, to a total dose of 55 or 58.5 Gy. The 5-year local control probability for T1 tumors was 94% with 58.5 Gy and 87% with 55 Gy of AF, whereas it amounted to 80% with CF. For T2 tumors, it was 56% with 58.5 Gy and 68% with 55 Gy of AF, whereas it amounted to 64% with CF. The data of T2 should be evaluated with caution due to the small number of patients. Patients with AF had more severe mucosal reactions but no severe late reactions. AF significantly improved the local control rates for T1 glottic cancer.

  • Hyperfractionated Accelerated Radiotherapy for T1,2 Glottic Carcinoma
    Strahlentherapie und Onkologie, 2008
    Co-Authors: Koh-ichi Sakata, Masanori Someya, Masakazu Hori, Kensei Nakata, Masaru Takagi, Masato Hareyama
    Abstract:

    Background and Purpose: Hyperfractionated Accelerated Radiotherapy without a split (AF) has been performed to improve the local control probability of early glottic carcinomas since 1990 in the authors’ institution. Here, they report their experience treating early glottic cancer patients with AF in a single institution who have a long follow-up period. Patients and Methods: 131 T1 N0 M0 glottic cancers and 65 T2 N0 M0 glottic cancers were treated with conventional fractionation (CF) from 1984 to 1989 and with AF since 1990. CF consisted of five daily fractions of 2 Gy per week, to a total dose of 64 Gy. AF consisted of 1.72 Gy per fraction, two fractions per day, 5 days a week, to a total dose of 55 or 58.5 Gy. Results: The 5-year local control probability for T1 tumors was 94% with 58.5 Gy and 87% with 55 Gy of AF, whereas it amounted to 80% with CF. For T2 tumors, it was 56% with 58.5 Gy and 68% with 55 Gy of AF, whereas it amounted to 64% with CF. The data of T2 should be evaluated with caution due to the small number of patients. Patients with AF had more severe mucosal reactions but no severe late reactions. Conclusion: AF significantly improved the local control rates for T1 glottic cancer. Hintergrund und Ziel: Die hyperfraktionierte akzelerierte Strahlentherapie ohne Bestrahlungspause (AF) wird durchgeführt, um die lokale Kontrolle früher Glottiskarzinome zu verbessern. In diesem Beitrag geht es um die Erfahrung bei der AF-Behandlung von Patienten mit frühen Glottiskarzinomen in einer einzelnen Institution mit langen Nachuntersuchungszeiträumen. Patienten und Methodik: 196 Glottiskarzinome (131 T1 N0 M0 und 65 T2 N0 M0) wurden zwischen 1984 und 1989 mit konventioneller Fraktionierung (CF) und seit 1990 mit AF behandelt. Die CF bestand aus fünf täglichen Fraktionen von 2 Gy pro Woche an 5 Tagen pro Woche bis zu einer Gesamtdosis von 64 Gy. Die AF bestand aus 1,72 Gy pro Fraktion, zwei Fraktionen pro Tag, 5 Tage pro Woche, bis zu einer Gesamtdosis von 55 oder 58 Gy. Ergebnisse: Die lokale 5-Jahres-Kontrollrate für T1-Tumoren betrug mit 58,5 Gy AF 94% und mit 55 Gy AF 87%, während sie mit CF bei 80% lag. Für T2-Tumoren betrug sie mit 58,5 Gy AF 56% und mit 55 Gy AF 68%, während sie mit CF bei 64% lag. Die T2-Daten sollten wegen der geringen Patientenzahl mit Vorsicht beurteilt werden. Patienten mit AF wiesen schwerere mukosale Reaktionen, jedoch keine schweren Spätkomplikationen auf. Schlussfolgerung: Die AF stellt eine signifikante Verbesserung der lokalen Kontrollrate für T1-Glottiskarzinome dar.

Horst Sack - One of the best experts on this subject based on the ideXlab platform.