When a patient's cancer comes back, he or she is often left with limited treatment options and higher odds of debilitating side effects. But a University of Pittsburgh Cancer Institute (UPCI) study presented at the American Society for Radiation Oncology (ASTRO) 2016 Annual Meeting in Boston offers positive news for people with recurrent head and neck cancer.
Stereotactic body radiation therapy (SBRT), a technique for delivering pinpoint radiation to kill cancer cells and shrink tumors, resulted in only half as many patients with recurrent head and neck cancer suffering severe, long-term side effects as compared to previously reported studies using more traditional treatment techniques. This discovery by UPCI scientists was made in the largest and longest follow-up analysis to date of patients with recurrent head and neck cancer treated with SBRT. The findings make SBRT a more attractive possibility for patients with few options left.
"We're hoping that data like this will help physicians and patients understand and weigh their individual risks and benefits when deciding whether to pursue SBRT," said Diane Ling, M.D., a resident in in UPCI's Radiation Oncology Residency Program.
Dr. Ling and her colleagues reviewed the outcomes of 291 patients treated by UPMC CancerCenter who had recurrent, previously irradiated head and neck cancer between April 2002 and March 2013.
In particular, they were looking for acute toxicity, such as severe difficulty swallowing or painful irritation of the mucosal lining while undergoing SBRT, or late toxicity, such as long-term difficulty swallowing or deterioration of the jaw bone that begins anywhere from three months to more than five years after radiation.
Overall, 11.3 percent of patients experienced acute toxicity and 18.9 percent late toxicity. Previous studies using older treatment techniques put those rates at closer to 40 percent.
The analysis also revealed that the location of the cancer recurrence was an important factor in the severity of the patient's side-effects. When it is on the larynx (voice box) or hypopharynx (beside and behind the voice box), the rate of long-term, severe side-effects is typically worse, at about 50 percent.
"Toxicity, particularly late toxicity, can significantly affect the quality of life in patients who survive cancer," said Dr. Ling. "We can treat somebody's cancer and possibly cure them, but if they are left with severely debilitating quality-of-life issues, what did we accomplish? It's very encouraging to know that we can offer a treatment option with a relatively low rate of severe toxicity for most patients."
Additional authors on this research are John Vargo, M.D., Robert L. Ferris, M.D., Ph.D., James Ohr, D.O., David A. Clump, M.D., Ph.D., Wai-ying Wendy Yau, B.S., Umamaheswar Duvvuri, M.D., Ph.D., Seungwon Kim, M.D., Jonas T. Johnson, M.D., Julie E. Bauman, M.D., M.P.H., Barton Branstetter, M.D., and Dwight E. Heron, M.D., all of UPCI or its clinical partner UPMC CancerCenter or both.