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Article: Factors affecting risk of symptomatic temporal lobe necrosis: Significance of fractional dose and treatment time

TitleFactors affecting risk of symptomatic temporal lobe necrosis: Significance of fractional dose and treatment time
Authors
Issue Date2002
PublisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobp
Citation
International Journal of Radiation Oncology - Biology - Physics, 2002, v. 53 n. 1, p. 75-85 How to Cite?
AbstractPurpose: To study the factors affecting the risk of symptomatic temporal lobe necrosis after different fractionation schedules. Methods and Materials: One thousand thirty-two patients with T1-2 nasopharyngeal carcinoma treated with radical radiotherapy in Hong Kong during 1990-1995 were studied. They were treated at four different centers with similar techniques but different fractionation schedules: 984 patients were given 1 fraction daily throughout (q.d.), and 48 patients were irradiated twice daily (b.i.d.) for part of the course. The median total dose was 62.5 Gy (range 50.4-71.2), dose per fraction was 2.5 Gy (range 1.6-4.2), and overall treatment time (OTT) was 44 days (range 29-70). In addition, 500 patients received supplementary doses for parapharyngeal extension, 113 received booster doses by brachytherapy, and 114 received sequential chemotherapy using cisplatin-based regimes. Results: Altogether, 24 patients developed symptomatic temporal lobe necrosis: 18 from the q.d. group and 6 from the b.i.d. group. The 5-year actuarial incidence ranged from 0% (after 66 Gy in 33 fractions within 44 days) to 14% (after 71.2 Gy in 40 fractions within 35 days). Multivariate analyses showed that the risk was significantly affected by the fractional effect of the product of total dose and dose per fraction (hazard ratio [HR] = 1.04, 95% confidence interval [CI] 1.02-1.05), OTT (HR 0.88, 95% CI 0.80-0.97), and b.i.d. scheduling (HR 13, 95% CI 3-54). Repeating the analyses for patients treated with the q.d. schedules confirmed the independent significance of OTT in addition to the product of total dose and dose per fraction. Conclusion: The tentative results suggest that in addition to fractional dose, the OTT also had significant impact on the risk of temporal lobe necrosis, and b.i.d. scheduling increased the hazard further. © 2002 Elsevier Science Inc.
Persistent Identifierhttp://hdl.handle.net/10722/72020
ISSN
2015 Impact Factor: 4.495
2015 SCImago Journal Rankings: 2.274
ISI Accession Number ID
References

 

DC FieldValueLanguage
dc.contributor.authorLee, AWMen_HK
dc.contributor.authorKwong, DLWen_HK
dc.contributor.authorLeung, SFen_HK
dc.contributor.authorTung, SYen_HK
dc.contributor.authorSze, WMen_HK
dc.contributor.authorSham, JSTen_HK
dc.contributor.authorTeo, PMLen_HK
dc.contributor.authorLeung, TWen_HK
dc.contributor.authorWu, PMen_HK
dc.contributor.authorChappell, Ren_HK
dc.contributor.authorPeters, LJen_HK
dc.contributor.authorFowler, JFen_HK
dc.date.accessioned2010-09-06T06:37:33Z-
dc.date.available2010-09-06T06:37:33Z-
dc.date.issued2002en_HK
dc.identifier.citationInternational Journal of Radiation Oncology - Biology - Physics, 2002, v. 53 n. 1, p. 75-85en_HK
dc.identifier.issn0360-3016en_HK
dc.identifier.urihttp://hdl.handle.net/10722/72020-
dc.description.abstractPurpose: To study the factors affecting the risk of symptomatic temporal lobe necrosis after different fractionation schedules. Methods and Materials: One thousand thirty-two patients with T1-2 nasopharyngeal carcinoma treated with radical radiotherapy in Hong Kong during 1990-1995 were studied. They were treated at four different centers with similar techniques but different fractionation schedules: 984 patients were given 1 fraction daily throughout (q.d.), and 48 patients were irradiated twice daily (b.i.d.) for part of the course. The median total dose was 62.5 Gy (range 50.4-71.2), dose per fraction was 2.5 Gy (range 1.6-4.2), and overall treatment time (OTT) was 44 days (range 29-70). In addition, 500 patients received supplementary doses for parapharyngeal extension, 113 received booster doses by brachytherapy, and 114 received sequential chemotherapy using cisplatin-based regimes. Results: Altogether, 24 patients developed symptomatic temporal lobe necrosis: 18 from the q.d. group and 6 from the b.i.d. group. The 5-year actuarial incidence ranged from 0% (after 66 Gy in 33 fractions within 44 days) to 14% (after 71.2 Gy in 40 fractions within 35 days). Multivariate analyses showed that the risk was significantly affected by the fractional effect of the product of total dose and dose per fraction (hazard ratio [HR] = 1.04, 95% confidence interval [CI] 1.02-1.05), OTT (HR 0.88, 95% CI 0.80-0.97), and b.i.d. scheduling (HR 13, 95% CI 3-54). Repeating the analyses for patients treated with the q.d. schedules confirmed the independent significance of OTT in addition to the product of total dose and dose per fraction. Conclusion: The tentative results suggest that in addition to fractional dose, the OTT also had significant impact on the risk of temporal lobe necrosis, and b.i.d. scheduling increased the hazard further. © 2002 Elsevier Science Inc.en_HK
dc.languageengen_HK
dc.publisherElsevier Inc. The Journal's web site is located at http://www.elsevier.com/locate/ijrobpen_HK
dc.relation.ispartofInternational Journal of Radiation Oncology - Biology - Physicsen_HK
dc.rightsInternational Journal of Radiation: Oncology - Biology - Physics. Copyright © Elsevier Inc.en_HK
dc.subject.meshAdolescenten_HK
dc.subject.meshAdulten_HK
dc.subject.meshAgeden_HK
dc.subject.meshAged, 80 and overen_HK
dc.subject.meshAnalysis of Varianceen_HK
dc.subject.meshCarcinoma - radiotherapyen_HK
dc.subject.meshDose Fractionationen_HK
dc.subject.meshFemaleen_HK
dc.subject.meshHumansen_HK
dc.subject.meshMaleen_HK
dc.subject.meshMiddle Ageden_HK
dc.subject.meshNasopharyngeal Neoplasms - radiotherapyen_HK
dc.subject.meshRadiation Injuries - pathologyen_HK
dc.subject.meshRadiotherapy Dosageen_HK
dc.subject.meshRadiotherapy Planning, Computer-Assisteden_HK
dc.subject.meshRisken_HK
dc.subject.meshTemporal Lobe - pathology - radiation effectsen_HK
dc.titleFactors affecting risk of symptomatic temporal lobe necrosis: Significance of fractional dose and treatment timeen_HK
dc.typeArticleen_HK
dc.identifier.openurlhttp://library.hku.hk:4550/resserv?sid=HKU:IR&issn=0360-3016&volume=53&issue=1&spage=75&epage=85&date=2002&atitle=Factors+Affecting+Risk+Of+Symptomatic+Temporal+Lobe+Necrosis:+Significance+Of+Fractional+Dose+And+Treatment+Timeen_HK
dc.identifier.emailKwong, DLW:dlwkwong@hku.hken_HK
dc.identifier.authorityKwong, DLW=rp00414en_HK
dc.description.naturelink_to_subscribed_fulltext-
dc.identifier.doi10.1016/S0360-3016(02)02711-6en_HK
dc.identifier.pmid12007944-
dc.identifier.scopuseid_2-s2.0-0036570252en_HK
dc.identifier.hkuros71813en_HK
dc.relation.referenceshttp://www.scopus.com/mlt/select.url?eid=2-s2.0-0036570252&selection=ref&src=s&origin=recordpageen_HK
dc.identifier.volume53en_HK
dc.identifier.issue1en_HK
dc.identifier.spage75en_HK
dc.identifier.epage85en_HK
dc.identifier.isiWOS:000175400500011-
dc.publisher.placeUnited Statesen_HK
dc.identifier.scopusauthoridLee, AWM=17035384900en_HK
dc.identifier.scopusauthoridKwong, DLW=15744231600en_HK
dc.identifier.scopusauthoridLeung, SF=7202044876en_HK
dc.identifier.scopusauthoridTung, SY=7102858954en_HK
dc.identifier.scopusauthoridSze, WM=7003795941en_HK
dc.identifier.scopusauthoridSham, JST=24472255400en_HK
dc.identifier.scopusauthoridTeo, PML=7006685066en_HK
dc.identifier.scopusauthoridLeung, TW=7202110934en_HK
dc.identifier.scopusauthoridWu, PM=8663653900en_HK
dc.identifier.scopusauthoridChappell, R=7005397670en_HK
dc.identifier.scopusauthoridPeters, LJ=7202838411en_HK
dc.identifier.scopusauthoridFowler, JF=35498510200en_HK

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