Radiation induced brachial plexopathy in head and neck cancer patients treated with definitive radiotherapy and correlation with disease characteristics and dosimetric parameters.

Background: Definitive concurrent chemoradiotherapy (CRT) is the standard of care in advanced stages of head and neck cancer (HNC). With evident increase in survival rate there is also simultaneous increase in toxicity affecting the quality of life. One of the less researched late toxicity is radiation induced brachial plexopathy (RIBP). In this dosimetric study we intent to contour the brachial plexus (BP) as an organ at risk (OAR) and determine the factors that contribute to dose variations to BP, and clinically evaluate the patients for RIBP during follow-up using a questionnaire. Materials and methods: 30 patients with HNC planned for CRT from September 2020 to June 2022 were accrued. Patients were treated to a dose of 6600 cGy with intensity modulated radiotherapy using the simultaneous integrated boost technique. From the dose-volume histogram (DVH) statistics the BP volume, Dmax and other parameters like V66, V60 were assessed and was correlated with respect to primary tumour and nodal stage. Results: On corelation, more than the T stage, the N stage and the primary location had a significant impact on the Dmax. With a median follow-up of 17.9 months, the incidence of RIBP was 6.67%. The 2-year disease free survival and the 2-year overall survival were 53.7% and 59.4%, respectively. Conclusions: In oropharyngeal/hypopharyngeal primaries and in advanced nodal disease, BP receives higher doses contributing to RIBP. Primary tumor and nodal stage also impacted V60 and V66 of BP. Hence, contouring of BP as an OAR becomes imperative, and respecting the DVH parameters is essential.

Hospital factors determining overall survival in cancer patients undergoing curative treatment.

BACKGROUND: In oncology, overall survival (OS) and quality of life (QoL) are key indicators. The factors that affect OS and QoL include tumor-related characteristics (stage and grade), patient-related factors (performance status and comorbidities), and cancer-directed therapy (CDT)-related aspects. In addition, external factors such as governance or policy (e.g., inaccessibility to CDT, increased distance to service, poor socioeconomic status, lack of insurance), and hospital-related factors (e.g., facility volume and surgeon volume) can influence OS and QoL. MATERIALS AND METHODS: The primary objective of this narrative review was to identify hospital-related factors that affect OS and QoL in patients receiving curative CDT. The authors defined extrinsic factors that can be modified at the hospital level as "hospital-related" factors. Only factors supported by randomized controlled trials (RCT), systematic reviews (SR) and/or meta-analyses (MA), and population database (PDB) analyses that address the relationship between OS and hospital factors were considered. RESULTS: The literature review found that high hospital or oncologist volume, adherence to evidence-based medicine (EBM), optimal time-to-treatment initiation (TTI), and decreased overall treatment time (OTT) increase OS in patients undergoing curative CDT. The use of case management strategies was associated with better symptom management and treatment compliance, but had a mixed effect on QoL. The practice of enhanced recovery after surgery (ERAS) in cancer patients did not result in an increase in OS. There was insufficient evidence to support the impact of factors such as teaching or academic centers, hospital infrastructure, and treatment compliance on OS and QoL. CONCLUSION: The authors conclude that hospital policies should focus on increasing hospital and oncologist volume, adhering to EBM, optimizing TTI, and reducing OTT for cancer patients receiving curative treatment.

A comparison of conventional and accelerated hypofractionated radiotherapy in definitive chemoradiation for locally advanced head and neck carcinoma: a retrospective cohort study.

PURPOSE: The study evaluates accelerated hypofractionated radiotherapy (AHRT) compared to conventional fractionation radiotherapy (CFRT) in patients with locally advanced head and neck cancer (LAHNC) receiving definitive chemoradiation therapy. MATERIALS AND METHODS: The study includes a retrospective cohort analysis of 120 patients. CFRT arm (n = 65) received 2 Gy per fraction to a dose of 70 Gy over 7 weeks in a three-volume approach, whereas the AHRT arm (n = 55) received 2.2 Gy per fraction to a dose of 66 Gy in 6 weeks with a two-volume approach. The primary outcome was overall survival (OS). RESULTS: With a median follow-up of 18.9 months, 23 patients died in the AHRT arm, and 45 deaths in the CFRT arm. The median OS was 23.4 and 37.63 months in the CFRT and AHRT arms, respectively (hazard ratio [HR] = 0.709; 95% confidence interval [CI], 0.425-1.18; p = 0.189). The median time to loco-regional control was 33.3 months in the CFRT arm and was not reached in the patient group receiving AHRT (HR = 0.558; 95% CI, 0.30-1.03; p = 0.065). The median progression-free survival was 15.9 months in the CFRT arm and 26.9 months in the AFRT arm (HR = 0.801; 95% CI, 0.49-1.28; p = 0.357). Out of 11 acute toxic deaths, eight were in the CFRT arm. CONCLUSION: The study showed a trend towards benefit in terms of locoregional control in the AHRT arm and similar OS. A longer follow-up of patients receiving AHRT is required to assess the benefit.