Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Locally Advanced Head-and-Neck CancerPage 410
J. J. Caudell, P. E. Schaner, R. F. Meredith, J. L. Locher, L. M. Nabell, W. R. Carroll, J. S. Magnuson, S. A. Spencer, and J. A. Bonner
As organ-preserving strategies in head-and-neck cancer become more aggressive, physicians run the risk of damaging normal structures they seek to spare by opting for nonsurgical treatments. The current analysis utilized a composite endpoint of three measures of severe long-term dysphagia, gastrostomy dependence, aspiration, and pharyngoesophageal stricture, to assess the ramifications of organ-preserving strategies. The use of concurrent chemotherapy with definitive radiotherapy was the strongest predictor of severe dysphagia, as well as primary site and age. Assessments of this nature will be important in the future to help physicians determine whether the desired goals of treatment are being achieved.
Survival Effect of Neoadjuvant Radiotherapy Before Esophagectomy for Patients With Esophageal Cancer: A Surveillance, Epidemiology, and End-Results StudyPage 449
A. L. Schwer, A. Ballonoff, R. McCammon, K. Rusthoven, R. B. D'Agostino, Jr., and T. E. Schefter
The effect of neoadjuvant radiation therapy on outcomes in patients with resectable esophageal cancer was evaluated by a review of the SEER database for the years 1998 to 2004. The authors found that both overall survival and cause-specific survival were significantly improved in patients treated with radiation prior to esophagectomy compared with those in patients who underwent surgery alone. This retrospective analysis supports the use of neoadjuvant radiation therapy in esophageal cancer. However, prospective studies are needed to confirm these results.
Bath and Shower Effect in Spinal Cord: The Effect of Time IntervalPage 514
M. E. P. Philippens, L. A. M. Pop, A. G. Visser, W. J. M. Peeters, and A. J. van der Kogel
These authors investigated the “bath-and-shower” effect, or the effect of a large field with a low dose (bath) followed by irradiation of a small field (shower) in the center of the bath in the rat spinal cord. A 4-Gy bath dose resulted in a higher radiation sensitivity compared to that of a small field alone. If the interval between the bath and shower dose was increased, then the reduced radiation tolerance lasted for 12 hours and disappeared in 24 hours. This time scale deviates from the repair kinetics in spinal cord in response to low-dose-rate and fractionated irradiation.
Can Positron Emission Tomography (PET) or PET/Computed Tomography (CT) Acquired in a Nontreatment Position Be Accurately Registered to a Head-and-Neck Radiotherapy Planning CT?Page 578
A. B. Hwang, S. L. Bacharach, S. S. Yom, V. K. Weinberg, J. M. Quivey, B. L. Franc, and P. Xia
Despite increased interest in using PET to assist with target delineation in head and neck cancer, PET/CT acquisition for radiotherapy planning is not yet standard practice. This article evaluates the accuracy of aligning a PET or PET/CT scan acquired in a nontreatment position with a radiotherapy planning CT using various image registration methods. In this study, PET/CT achieved better accuracy than PET alone. Manual registration was superior to automated methods, and deformable image registration achieved better results than rigid registration methods. Image registration errors were largest in the lower neck, up to 17 mm, due to changes in patient position.
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