RADIATION & RISK
Bulletin of the National Radiation and Epidemiological Registry
since 1992
About the Journal : 2010 : vol. 19, No. 4 : Local radiation-induced injuries after radiation therapy and combined treatment of head and neck cancer

Local radiation-induced injuries after radiation therapy and combined treatment of head and neck cancer

«Radiation and Risk», 2010, vol. 19, no. 4, pp.30-44

Authors

Isaev P.A. – Lead. Researcher, C.Sc., Med. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk. Contacts: 4 Korolyov str., Obninsk, Kaluga region, Russia, 249036. Tel.: (903) 8174194; (48439) 93201, fax: (48439) 9-33-58; e-mail: This email address is being protected from spambots. You need JavaScript enabled to view it. .
Medvedev V.S. – Head of Department, MD. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk, Russia.
Pasov V.V. – Head of Department, MD. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk, Russia.
Siomin D.Y. – Physician, C.Sc., Med. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk, Russia.
Derbugov D.N. – Physician. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk, Russia.
Polkin V.V. – Postgraduate Student. Medical Radiological Research Center of the Russian Ministry of Health and Social Development, Obninsk, Russia.

Abstract

Causes of local radiation-induced injuries after radiation therapy and combined treatment of head and neck cancer in 1192 patients are reported. The cohort of study subjects was divided in 4 groups in accordance with the used plan of treatment of a disease. Patients of group 1 (486; 40.8%) were treated with external beam radiation therapy (EBRT) using conventional fractionation of 1.8-2.3 Gy, 5 times a week, total focal dose was 60 Gy. Patients of group 2 (244; 20.5%) underwent combined treatment: RF hyperthermia, chemotherapy and hyperglycemia. Patients of group 3 (204; 17.1 %) underwent accelerated fractionation radiation therapy, altered regimen, one-time focal dose 1+1.5/2 Gy to total focal dose 60 Gy in combination with non-adjuvant  polychemotherapy: cisplatin  (100 mg/m2  of a body surface), 5 Fluorouracil (5-FU, 72 hour continuous infusion of 3000 mg). Neutron beam therapy combined with radiation therapy was delivered to 258 (21.6 %) patients of the group 4; 36 (3.0%) patients underwent neutron beam therapy and 222 (18.6%) underwent combined gamma-neutron therapy with 252Cf. In 285 (23.9%) cases with detected residual tumors and in 184 (15.4%) patients with incomplete regression of regional metastases surgery interventions were made. The main factors of risk of delayed complications are tumor site, radiation dose, surgery as a part of combined treatment. Delayed radiation-induced injuries were detected in 252 (21.1%) cases. The most part of complications was detected in patients (115; 23.7%) undergone conventional EBRT. The least frequency of complications (35; 15.7%, р=0.00963) was found in patients undergone brachytherapy with 252Cf. So, brachytherapy is the sparing treatment with homogeneous irradiation of a target. This modality causes the least damage to surrounding normal tissue and allows to escalate a total focal dose to maximum dose to a primary tumor site.

Key words
Head & neck cancer, local radiation-induced injures.

References

1. Gulidov I.A., Mardynsky Yu.S., Tsyb A.F., Sysoev A.S. Nuclear reactors neutrons in the treatment of malignant neoplasms. Obninsk. MRRC RAMS, 2001. pp. 31-45.

2. Pavlov A.S., Fadeeva M.A., Kostromina K.N. and others. Time-dose-fractionation factors and their use in radiation therapy of malignant tumors: a method. recommendations. Moscow, 1990, 36 p.

3. Semin D.Yu. Combined treatment of cancer of the oral mucosa and oropharynx (intra-tissue neutron therapy, remote radiation therapy, polychemotherapy): dis. ... cand. honey. med. Obninsk, 2003. 135 p.

4. Hoseva E.N. Clinical variants, flow peculiarities and differential therapy of early radiation reactions and skin lesions: author's abstract. dis. ... cand. med. sciences. Ekaterinburg, 2006. 21 p.

5. Bhandare N., Monroe A.T., Morris C.G. et al. Does altered fractionation influence the risk of radiation-induced optic neuropathy? Int. J. Radiat. Oncol. Biol. Phys. 2005. Vol. 62. PP.1070-1077.

6. Cox J.D., Stetz J., Pajak T.F. Toxicity criteria of the Radiation Therapy Oncology Group (RTOG) and the European Organization for Research and Treatment of Cancer (EORTC) [Editorial]. Int. J. Radiat. Oncol. Biol. Phys. 1995. Vol. 31. PP. 1341-1346.

7. Mendenhall W.M., Riggs C.E., Amdur R.J. et al. Altered fractionation and/or adjuvant chemotherapy in definitive irradiation of squamous cell carcinoma of the head and neck. Laryngoscope. 2003. Vol. 113.P. 546-551.

8. Scully С., Epstein J., Sonis S. Oral mucositis: a challenging complication of radiotherapy, chemotherapy and radiochemotherapy. Part 2: Diagnosis and management of mucositis. Head & Neck. 2004. Vol. 1. PP. 77-84.

9. Trotti A., Bellm L.A., Epstein J.B. et al. Mucositis incidence, severity and associated outcomes in patients with head and neck cancer receiving radiotherapy with or without chemotherapy: a systemic literature review. RT&O. 2003. Vol. 66. PP. 253-263.

Full-text article (in Russian)