Aims: To document the use of adjuvant regional irradiation after breast-conserving therapy for early stage breast cancer by Canadian radiation oncologists and to identify the factors influencing their clinical decisions.Materials and methods: We conducted a survey to assess the above aims. In April 2008, a questionnaire was sent to 167 members of the Canadian and Quebec Associations of Radiation Oncologists with interest in breast cancer management. The answers were obtained through a dedicated website, which collected the raw data collected for analysis.Results: In total, 67 radiation oncologists completed the survey, corresponding to a 40% response rate. Most respondents were experienced and high-volume providers. We identified several areas of variation in the decision-making regarding regional lymph node irradiation after breast-conserving therapy. Regarding the decision to combine regional nodal irradiation with irradiation of the breast, the number of positive nodes after axillary dissection (1-3 vs >= 4) was a crucial determinant. For patients with between one and three positive nodes and a nodal ratio of 50%, most respondents added regional irradiation. Similarly, the same nodal ratio of 50% was the main factor for inclusion of the axillary nodal region in the radiation field. However, few radiation oncologists have chosen to include the internal mammary chain in their treatment plan. The number of positive lymph nodes, the nodal ratio, the number of lymph nodes removed and the presence of extracapsular extension were the primary self-reported factors that directed the decision to offer regional radiotherapy.Conclusions: This survey showed that there is a wide variation of practices among radiation oncologists in Canada. These results support the need for treatment guidelines and provide guidance on which factors should be included in a decision-making algorithm. (C) 2009 The Royal College of Radiologists. Published by Elsevier Ltd. All rights reserved.

Ageing is still a frequent limiting factor for aggressive treatments in patients with advanced head and neck squamous cell carcinoma (HNSCC). Some studies reported poor or no benefits from concurrent chemotherapy and radiotherapy (CTRT) in such patients, probably because of increased co-morbidities. To assess outcome and toxicities in patients older than 70 years with HNC undergoing curative CTRT. Materials/Methods Retrospective study including 25 patients ≥70 years with Stage III–IV HNSCC, treated with curative CTRT. Toxicities, local control, and survival were analyzed. Toxicity was assessed according to the RTOG acute toxicity grading system. Overall co-morbidity scores were estimated using Adult Co-morbidity Evaluation-27 (ACE-27). Mean age was 72.3 (70–78) years old, 21 males and 4 females. Median follow-up was 32 months. Tumors originated from oropharynx (21.84%), hypopharynx (2.8%), oral cavity (1.4%), and unknown primary site (1.4%). Most of cancers were T3–T4 (68%) and/or N2–N3 (84%). Mean KPS was 90.9±2.9, and the median ACE-27 score was 1 (0–3). Overall survival and loco-regional control at 3 years follow-up were 53.7% and 81%, respectively. Five deaths (50%) resulted from the initial HNC, three (30%) from other cancers, and two (25%) from undetermined causes during the follow-up. No treatment related deaths were observed. Four patients had local relapse. Six patients, including those with local relapse, developed distant metastases. Febrile neutropenia occurred in two patients, and transfusion was required in two patients because of anemia. Eleven patients (44%) required hospitalization, with a median of 11 (3–41) days. Fourteen patients (56%) required temporary gastric tube (GT) because of important weight loss, with a median duration of 48.5 days. GT dependency was observed in one patient at 1 year. In selected elderly patients with highly advanced HNC, concurrent CTRT can be given safely, resulting in good local control and survival that might not have been achieved otherwise.

Purpose/Objective(s)The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concurrent chemotherapy for locally advanced oropharyngeal cancer.Materials/MethodsBetween January 2000 and December 2007, 249 patients with Stage III–IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for 4 days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered 5 times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log–rank test.ResultsMedian follow-up was 33 months. Three year actuarial rates for OS, DFS and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT, respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization, and death during treatment. There was significantly less xerostomia at 12, 24, and 36 months (p < 0.001) following the end of treatment with IMRT. Interestingly, this better salivary function was associated with an increased long-term weight regain in patients treated with IMRT.ConclusionsIn this retrospective study, a simultaneously integrated boost using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long-term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis. Purpose/Objective(s)The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concurrent chemotherapy for locally advanced oropharyngeal cancer. The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concurrent chemotherapy for locally advanced oropharyngeal cancer. Materials/MethodsBetween January 2000 and December 2007, 249 patients with Stage III–IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for 4 days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered 5 times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log–rank test. Between January 2000 and December 2007, 249 patients with Stage III–IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for 4 days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered 5 times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log–rank test. ResultsMedian follow-up was 33 months. Three year actuarial rates for OS, DFS and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT, respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization, and death during treatment. There was significantly less xerostomia at 12, 24, and 36 months (p < 0.001) following the end of treatment with IMRT. Interestingly, this better salivary function was associated with an increased long-term weight regain in patients treated with IMRT. Median follow-up was 33 months. Three year actuarial rates for OS, DFS and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT, respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization, and death during treatment. There was significantly less xerostomia at 12, 24, and 36 months (p < 0.001) following the end of treatment with IMRT. Interestingly, this better salivary function was associated with an increased long-term weight regain in patients treated with IMRT. ConclusionsIn this retrospective study, a simultaneously integrated boost using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long-term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis. In this retrospective study, a simultaneously integrated boost using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long-term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis.

6038 Background: The aim of this retrospective study was to compare toxicity and efficacy of two different radiotherapy regimens, the first one using intensity-modulated radiation therapy (IMRT) to that of conventional radiotherapy (CRT) in patients treated with concomitant chemotherapy for locally advanced oropharyngeal cancer. Methods: Between January 2000 and December 2007, 249 patients with stage III-IV squamous cell oropharyngeal carcinoma were treated at our institution with definitive concurrent chemoradiation using carboplatin 70 mg/m2/day for four days and 5-fluorouracil 600 mg/m2/day as a continuous infusion every 3 weeks. One hundred patients had 70 Gy in 33 fractions using IMRT (2.12 Gy per day) and 149 received CRT at 70 gy in 35 fractions (2 Gy per day), both administered five times a week. Toxicities were compared using Fisher's exact test. Overall survival (OS), disease-free survival (DFS), and locoregional control (LRC) were estimated using the Kaplan-Meier method and compared with the log-rank test. Results: Median follow-up was 33 months. Three year actuarial rates for OS, DFS, and LRC were 95.4 vs. 75.8% (p < 0.001), 89.3 vs. 71.6% (p < 0.001), and 92.4 vs. 85.3% (p = 0.050) for IMRT and CRT respectively. To minimize the effect of changes in treatment paradigm over time, analyses were performed for patients treated after January 2004 and still showed OS, DFS, and LRC differences. Comparison of toxicities demonstrated that IMRT was associated with fewer dermatitis than CRT (p < 0.01), but caused the same rates of mucositis, weight loss, enteral feeding, hospitalization and death during treatment. There was significantly less xerostomia at 24 and 36 months (p < 0.001) following the end of treatment with IMRT. Conclusions: In this retrospective study, higher dose per fraction and shorter overall treatment time using IMRT given concurrently with chemotherapy when compared to CRT is a safe regimen with better OS, DFS, LRC, and less long term xerostomia. Altered fractionation RT with chemotherapy seems to result in better outcome and future prospective trials are needed to confirm this hypothesis. No significant financial relationships to disclose.