• Ensure that the scope and remit have been appropriately defined;
  
• Discuss the main issues raised by consultees and commentators in their written comments on the draft remit and draft scope;
  
• Ensure that relevant issues are highlighted to the Assessment Group, who will be carrying out a systematic review for the proposed appraisal, should it proceed.

quote:

This trial is comparing a new method of radiotherapy treatment with the standard radiotherapy treatment for head and neck cancers. It will look at the outcome and side effects of each treatment.

The new method is called Intensity Modulated Radiotherapy, or IMRT for short. IMRT alters the radiotherapy dose depending on the thickness of the body tissue. So the same dose is given across the treatment area. It also allows the radiotherapy beams to be shaped more accurately. It is directed at the cancer, while avoiding the surrounding normal tissue. So, the patient may have fewer side effects. But there is a small risk that this shaped radiotherapy will miss some of the cancer and so may not work so well.

Recruitment
Starts 01/06/2003
Ends 31/12/2007

Trial design
This trial is recruiting 100 patients. There are 2 treatment groups. It is a randomised trial. This means that the people taking part will be put into the groups by a computer.

• Group 1 will have standard radiotherapy treatment.
• Group 2 will have IMRT.

Location of trials:

• Cambridge
• Ipswich
• London
• Manchester
• Sheffield
• Stoke-on-Trent
• Sutton

Click for more info

quote:

Originally posted by Dr Vinod K Joshi:
Intensity modulated radiotherapy for treatment of specific cancers
There is one Hi-Art System (delivering helical tomotherapy) in use in the UK at present. Currently there are no helical tomotherapy systems available in the NHS. The availability of other IMRT systems is not known.


Best wishes

Dr Vinod K Joshi
Founder and Chief Executive
Mouth Cancer Foundation

quote:

• PURPOSE: To assess the prevalence and dosimetric and clinical predictors of mandibular osteoradionecrosis (ORN) in patients with head and neck cancer who underwent a pretherapy dental evaluation and prophylactic treatment according to a uniform policy and were treated with intensity-modulated radiotherapy (IMRT).
• METHODS AND MATERIALS: Between 1996 and 2005, all patients with head-and-neck cancer treated with parotid gland-sparing IMRT in prospective studies underwent a dental examination and prophylactic treatment according to a uniform policy that included extractions of high-risk, periodontally involved, and nonrestorable teeth in parts of the mandible expected to receive high radiation doses, fluoride supplements, and the placement of guards aiming to reduce electron backscatter off metal teeth restorations. The IMRT plans included dose constraints for the maximal mandibular doses and reduced mean parotid gland and noninvolved oral cavity doses. A retrospective analysis of Grade 2 or worse (clinical) ORN was performed.
• RESULTS: A total of 176 patients had a minimal follow-up of 6 months. Of these, 31 (17%) had undergone teeth extractions before RT and 13 (7%) after RT. Of the 176 patients, 75% and 50% had received >or=65 Gy and >or=70 Gy to >or=1% of the mandibular volume, respectively. Falloff across the mandible characterized the dose distributions: the average gradient (in the axial plane containing the maximal mandibular dose) was 11 Gy (range, 1-27 Gy; median, 8 Gy). At a median follow-up of 34 months, no cases of ORN had developed (95% confidence interval, 0-2%).
• CONCLUSION: The use of a strict prophylactic dental care policy and IMRT resulted in no case of clinical ORN. In addition to the dosimetric advantages offered by IMRT, meticulous dental prophylactic care is likely an essential factor in reducing ORN risk.

quote:

Results from a University of Pittsburgh study evaluating intensity modulated radiation therapy (IMRT) for head and neck cancer determined the ideal doses for lessening treatment side effects. The findings were presented today at the 47th Annual Meeting of the American Society for Therapeutic Radiology and Oncology (ASTRO) in Denver.

"Despite major advances in chemotherapy and radiation for the treatment of head and neck cancers, many patients continue to suffer debilitating side effects that greatly impact their quality of life," said Dwight E. Heron, M.D., study co-author and associate professor of radiation oncology, University of Pittsburgh School of Medicine and director of radiation oncology, University of Pittsburgh Medical Center. "While these high-energy beams are targeted to the tumor site as precisely as possible, they often inadvertently injure healthy tissue that surrounds the tumor site, limiting the doses of radiation that can be used to effectively destroy cancer cells. With this study, we sought to discover whether tightly focused radiation beams, such as those provided by IMRT, would make a difference in the severity of side effects associated with treatment and found a distinct dose-response relationship in the oral cavity of patients treated with IMRT in addition to chemotherapy."

"We found that if we constrain the dose of IMRT, we reduce the toxic effects of treatment," said Dr. Heron. "These results are encouraging evidence that head and neck cancer patients can benefit from IMRT at specific doses. With more homogenous and conformal treatment, head and neck cancer patients may be spared side effects from standard radiotherapy that can be significant."