JAMA Otol Logo Orlando 2013 AHNS Meeting Location
American Head & Neck Society
Annual Meeting, April 10-11, 2013
JW Marriott Grande Lakes
Orlando, Florida

During the
Combined Otolaryngology Spring Meeting
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Presentation: S009
Topic: Clinical - Outcomes Research
Type: Oral Presentation
Date: Wednesday, April 10, 2013
Session: 01:30 PM - 02:30 PM Reconstruction / Oropharynx / HPV
Authors: Shivangi Lohia, BA, Mayuri M Rajapurkar, MD, Anand K Sharma, MD, Terry A Day, MD
Institution(s): Medical University of South Carolina

Background: Head and neck squamous cell carcinoma (SCC) represents approximately 6% of all newly diagnosed cancers in the United States with the majority of patients receiving radiation during the course of their treatment either combined with chemotherapy or following surgery. While innovations in therapy have improved long-term survival rates, treatment related toxicities and side effects from radiation therapy remain high. Approximately 50% of all head and neck cancer survivors suffer from dysphagia and dysphagia-related morbidity. Thus, intensity modulated radiation therapy is being increasingly used in the treatment of oropharyngeal cancers for definitive treatment with excellent oncologic outcomes. However, there are few studies comparing outcomes between IMRT and conventional radiation therapy (CRT).

Methods: We performed a retrospective review of patients who underwent either IMRT or 3D-CRT for definitive treatment of oropharyngeal squamous cell carcinoma at MUSC. Primary endpoints included: gastrostomy (PEG) tube dependence 1 year after radiation start, time to PEG tube removal, weight loss during treatment, disease-free survival, and toxicity profiles at treatment completion.

Results: Of 315 patients identified in the Head and Neck database, 159 had oropharyngeal primaries and underwent definitive radiation therapy. Fifty-six patients were treated with 3D-CRT, and 103 with IMRT. Patients treated with IMRT had significantly lower rates of PEG tube dependence one year after treatment initiation regardless of dose (p=0.0223) or T-stage (p=0.012), and a shorter time to PEG tube removal (p<0.001). Acute grade ≥3 skin and mucous membrane toxicity occurred less frequently in the IMRT group (p= 0.0213 and p< 0.0001 respectively). There were no significant differences in weight loss, treatment failure (hazard ratio=0.82; 95% CI: 0.47 to 1.41), overall survival (p=0.446), or disease free survival (p=0.262) between the two groups.

Conclusion: The use of IMRT techniques significantly improves PEG tube and toxicity related outcomes compared to conventional radiation therapy in the treatment of primary cancers of the oropharynx. Given the association between mucosal toxicity, PEG tube dependence, and dysphagia these findings may be an indication of improved swallowing outcomes with the use of IMRT.

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