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Altered fractionation: limited by mucosal reactions?
J H Kaanders1, A J van der Kogel, K K Ang
1The Institute of Radiotherapy, University of Nijmegen, The Netherlands.
Summary
Accelerated radiotherapy for head and neck cancer increases early side effects like mucositis. Mucosa limits treatment intensification, suggesting new strategies are needed to improve outcomes.
Area of Science:
- Radiation oncology
- Head and neck cancer treatment
- Tissue response to radiation
Background:
- Accelerated and hyperfractionation radiotherapy improve head and neck cancer outcomes.
- These strategies often increase early normal tissue reactions, particularly mucosal reactions.
Purpose of the Study:
- To assess the limiting role of upper aerodigestive tract mucosa in intensified radiotherapy schedules.
- To review experimental and clinical data on radiation-induced mucositis.
Main Methods:
- Survey of available experimental and clinical mucositis data.
- Analysis of the relationship between dose delivery rate and early radiation reactions.
Main Results:
- The rate of dose delivery is the primary factor in early radiation reactions.
- Mucosa is the limiting tissue for accelerated radiotherapy, capping treatment time gains at approximately 2 weeks.
- Further acceleration necessitates dose reduction.
- Hyperfractionation dose escalation is not directly limited by early mucosal reactions, but by late-reacting tissues.
Conclusions:
- Significant further intensification of accelerated radiotherapy is unlikely without dose reduction.
- Strategies to improve outcomes include agents to ameliorate mucositis, combination with hypoxic modifiers, and personalized treatment tailoring.