Improving functional outcomes for patients with head and neck cancer
Mené au Royaume-Uni entre 2016 et 2018 sur 112 patients atteints d'un cancer oropharyngé ou hypopharyngé de stade T1-4 N0-3 M0 (durée médiane de suivi : 39,5 mois ; 80 % d'hommes ; âge médian : 57 ans), cet essai randomisé multicentrique de phase III évalue l'intérêt, du point de vue de la réduction de la dose de rayonnement reçue par les structures impliquée dans la dysphagie, l'aspiration et la déglutition, d'une radiothérapie avec modulation d'intensité optimisée pour la dysphagie par rapport à une radiothérapie avec modulation d'intensité standard
Radiotherapy is one of the main treatments for solid tumours, with more than 50% of patients receiving radiotherapy as part of their treatment. Radiotherapy for head and neck cancer has undergone immense technological advancements, resulting in targeted delivery of radiation to tumour tissues while minimising toxicity to normal tissue. With the use of advanced imaging techniques, such as CT and MRI, radiation oncologists can create detailed three-dimensional models of the tumour and surrounding structures. This allows for precise delineation of tumour boundaries and critical organs, aiding in the development of optimal treatment plans. With the use of intensity-modulated radiotherapy (IMRT), radiation beams of varying intensities can be delivered from multiple angles, allowing for precise dose modulation. This technique helps spare healthy tissues while delivering higher radiation doses to the tumour, improving treatment outcomes and minimising side-effects. In previous work, the UK group led by Christopher Nutting provided evidence that parotid-sparing IMRT was successful in reducing the incidence and severity of xerostomia. Xerostomia is now a much less common complaint, but has been replaced by another toxicity that severely affects quality of life: dysphagia.
The Lancet Oncology , commentaire, 2022