IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

Anna W. LaVigne; Danielle N. Margalit; Bhupendra Rawal; Maria Puzanov; Donald J. Annino; Laura A. Goguen; David J. Sher; Jonathan D. Schoenfeld; Nicole G. Chau; Jochen H. Lorch; Guilherme Rabinowits; Robert I. Haddad; Roy B. Tishler

doi:10.1002/hed.25531

IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

Anna W. LaVigne, Danielle N. Margalit, Bhupendra Rawal, Maria Puzanov, Donald J. Annino, Laura A. Goguen, David J. Sher, Jonathan D. Schoenfeld, Nicole G. Chau, Jochen H. Lorch, Guilherme Rabinowits, Robert I. Haddad, Roy B. Tishler

Research output: Contribution to journal › Article › peer-review

8 Scopus citations

Abstract

Background: Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods: Retrospective analysis of 58 patients with head and neck CUP treated with intensity-modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results: There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx-sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion: In this single institution study, a 56 Gy IMRT-based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx-sparing IMRT.

Original language	English (US)
Pages (from-to)	959-966
Number of pages	8
Journal	Head and Neck
Volume	41
Issue number	4
DOIs	https://doi.org/10.1002/hed.25531
State	Published - Apr 2019

Keywords

head and neck cancer
radiation therapy
squamous cell carcinoma
swallowing toxicity
unknown primary

ASJC Scopus subject areas

Otorhinolaryngology

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10.1002/hed.25531

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LaVigne, A. W., Margalit, D. N., Rawal, B., Puzanov, M., Annino, D. J., Goguen, L. A., Sher, D. J., Schoenfeld, J. D., Chau, N. G., Lorch, J. H., Rabinowits, G., Haddad, R. I., & Tishler, R. B. (2019). IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing. Head and Neck, 41(4), 959-966. https://doi.org/10.1002/hed.25531

LaVigne, AW, Margalit, DN, Rawal, B, Puzanov, M, Annino, DJ, Goguen, LA, Sher, DJ, Schoenfeld, JD, Chau, NG, Lorch, JH, Rabinowits, G, Haddad, RI & Tishler, RB 2019, 'IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing', Head and Neck, vol. 41, no. 4, pp. 959-966. https://doi.org/10.1002/hed.25531

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title = "IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing",

abstract = "Background: Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods: Retrospective analysis of 58 patients with head and neck CUP treated with intensity-modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results: There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx-sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion: In this single institution study, a 56 Gy IMRT-based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx-sparing IMRT.",

keywords = "head and neck cancer, radiation therapy, squamous cell carcinoma, swallowing toxicity, unknown primary",

author = "LaVigne, {Anna W.} and Margalit, {Danielle N.} and Bhupendra Rawal and Maria Puzanov and Annino, {Donald J.} and Goguen, {Laura A.} and Sher, {David J.} and Schoenfeld, {Jonathan D.} and Chau, {Nicole G.} and Lorch, {Jochen H.} and Guilherme Rabinowits and Haddad, {Robert I.} and Tishler, {Roy B.}",

note = "Publisher Copyright: {\textcopyright} 2019 Wiley Periodicals, Inc.",

year = "2019",

month = apr,

doi = "10.1002/hed.25531",

language = "English (US)",

volume = "41",

pages = "959--966",

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T1 - IMRT-based treatment of unknown primary malignancy of the head and neck

T2 - Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

AU - LaVigne, Anna W.

AU - Margalit, Danielle N.

AU - Rawal, Bhupendra

AU - Puzanov, Maria

AU - Annino, Donald J.

AU - Goguen, Laura A.

AU - Sher, David J.

AU - Schoenfeld, Jonathan D.

AU - Chau, Nicole G.

AU - Lorch, Jochen H.

AU - Rabinowits, Guilherme

AU - Haddad, Robert I.

AU - Tishler, Roy B.

PY - 2019/4

Y1 - 2019/4

N2 - Background: Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods: Retrospective analysis of 58 patients with head and neck CUP treated with intensity-modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results: There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx-sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion: In this single institution study, a 56 Gy IMRT-based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx-sparing IMRT.

AB - Background: Radiation therapy for squamous cell cancer of the head and neck with unknown primary (head and neck CUP) has been associated with significant levels of swallowing toxicity. We examined the effect of changes in mucosal dose on development of laryngeal strictures and percutaneous endoscopic gastrostomy (PEG) dependence. Methods: Retrospective analysis of 58 patients with head and neck CUP treated with intensity-modulated radiation therapy (IMRT) at the Dana Farber Cancer Institute from August 2004 through July 2013. Results: There were no significant differences between any recurrences for groups treated to 56 versus ≥60 Gy to the mucosal surfaces. However, mucosal dose and chemotherapy type were associated with stricture on multivariable analysis; median PEG dependence was decreased for patients treated to 56 Gy. A larynx-sparing approach was associated with improved outcomes for strictures and PEG use. Conclusion: In this single institution study, a 56 Gy IMRT-based mucosal dose demonstrated significant improvements in swallowing toxicity. Additional benefit was seen with larynx-sparing IMRT.

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IMRT-based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing

Abstract

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