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Bossi P.,Head and Neck Medical Oncology | Numico G.,Medical Oncology | De Santis V.,University of Rome La Sapienza | Ruo Redda M.G.,University of Turin | And 9 more authors.
Supportive Care in Cancer

Purpose: There is a limited number of therapies with a high level of recommendations for mucositis, while several strategies are currently employed with a limited evidence for efficacy. A national survey among Italian oncologists who treat head and neck cancer (HNC) was conducted in order to assess the most common preventive and therapeutic protocols (including nutritional support and pain control) for oral mucositis (OM) in patients undergoing chemoradiotherapy. Methods: From September to November 2012, a nationwide electronic survey with 21 focused items was proposed to chemotherapy and radiotherapy centers. Results: We collected 111 answers. Common Terminology Criteria for Adverse Events (CTCAE) scale is employed by 55 % of the physicians in assessing mucosal toxicity. The most relevant predictive factors for OM development are considered smoke, alcohol use, planned radiotherapy, and concurrent use of radiosensitizing chemotherapy. Prophylactic gastrostomy is adopted in <10 % of the patients. Preventive antibiotics or antimycotics are prescribed by 46 % of the responders (mainly local or systemic antimycotic drugs). Alkalinizing mouthwashes or coating agents are frequently adopted (70 % of the cases). Among therapeutic interventions, systemic fluconazole is administered by 80 % of the physicians. Pain is mainly treated by weak followed by strong opioids. Conclusions: A variety of preventive and therapeutic protocols for OM exists among the participating Italian centers, with some uniformity in respect to nutritional support, use of antimycotic and painkillers. There is an urgent need for well-conducted clinical trials aimed at assessing the best choices for OM prevention and treatment in HNC. © 2014 Springer-Verlag. Source

Orlandi E.,Unit of Radiotherapy 2 | Giandini T.,Unit of Medical Physics | Iannacone E.,Unit of Radiotherapy 2 | De Ponti E.,Unit of Medical Physics | And 8 more authors.
Radiotherapy and Oncology

Background and purpose To compare volumetric modulated arc therapy (VMAT) and intensity modulated radiation therapy (IMRT) plans for treatment of unresectable paranasal sinuses cancers (PNSCs) with different clinical presentations. Material and methods Four patients treated for primary target volume only (group 1), four requiring elective nodal irradiation (group 2) and four with positive nodes in macroscopic disease (group 3) were selected. For each patient were generated 7 fields IMRT, coplanar VMAT (c-VMAT) and non-coplanar VMAT (nc-VMAT) treatment plans. Total doses were 70 Gy and 54 Gy to high dose planning target volume (HD-PTV) and low-dose-PTV, respectively. Dose-volume histogram, conformity and homogeneity index (CI and HI), and monitor units (MUs) per Gy were evaluated. Results VMAT provided significantly better target coverage, in terms of V100% (Volume encompassed by the isodose 100%), than IMRT, in particular when nc-VMAT was used. In general, organ at risk sparing is similar with the three approaches, although nc-VMAT can allow a statistically significant reduction of dose to contralateral parotid gland and cochlea for all three groups. Conclusions VMAT can offer significant improvement of treatment for all unresectable PNSCs over existing IMRT techniques. In particular, nc-VMAT may be a further advantage for those patients with sinonasal cancers and involvement of the nodes in whom large volumes and complex/irregular shape have to be irradiated, even if clinical benefits should be established in the future. © 2014 Elsevier Ireland Ltd. Source

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