INTENSE THERAPY BEATS HEAD CANCER
Dr. Jai Maharaj
BBC
Saturday, September 20, 2003
The patients all received the same amount of radiotherapy
Short, intense courses of radiotherapy are more effective
in treating head and neck cancer, scientists have found.
Giving patients six sessions a week instead of five
improved the management of their tumours.
In addition, patients with laryngeal cancer were more
likely to conserve their voices if they had the faster
treatment.
The study of almost 1,500 patients was presented to the
European Cancer Conference in Copenhagen.
These findings are unequivocal
Dr Jens Overgaard, Aarhus University Scientists from the
Aarhus University Hospital, Aarhus, Denmark, gave
patients either five or six sessions per week,
administering the same dose overall to each patient.
When patients were examined five years after the
treatment, it was found tumours were better controlled in
those who had received six treatments per week.
Accelerated radiotherapy was also linked to a small
increase in survival rates compared with those given five
treatments per week.
Patients were more likely to be ill if they were given
the more intensive course of treatment, although they
recovered quickly.
'No shades of grey'
Professor Jens Overgaard said: "Although all patients in
the accelerated treatment arm did better, some did better
than others, and we are currently trying to identify
those groups where the benefit is largest. "
But he said there was no doubt about the benefits of the
more intensive treatment: "There are no shades of grey.
"These findings are unequivocal - accelerated treatment
is definitely better in this cancer, both in terms of
disease-specific survival and in quality of life."
Professor Michele Saunders of Cancer Research UK said:
"This accelerated radiotherapy protocol is already being
used in the UK and will be the subject of a randomised
controlled trial to be organised by the National Cancer
Research Institute."
The research is published in The Lancet.
Read the complete news at:
http://news.bbc.co.uk/1/hi/health/3122428.stm
Jai Maharaj
http://www.mantra.com/jai
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o Not for commercial use. Solely to be fairly used for the
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Anth
to validate?
Ant
"Dr. Jai Maharaj" <use...@mantra.com> wrote in message
news:health-075...@news.mantra.com...
Peter Moran
"Anth" <an...@anon.com> wrote in message
news:3f6d8335$0$33799$65c6...@mercury.nildram.net...
> If this beats head cancer then why does it need further randomised
controls
> to validate?
> Ant
The study said ---
> > > Professor Michele Saunders of Cancer Research UK said:
> > "This accelerated radiotherapy protocol is already being
> > used in the UK and will be the subject of a randomised
> > controlled trial to be organised by the National Cancer
> > Research Institute."
It is rare within medicine for the results of a single study to be accepted
as final.
Peter Moran
Rich Andrews
@news.brisbane.pipenetworks.com:
A single study does not a truism make. Remember "Cold Fusion" from the
early 90's?
r
--
"Any sufficiently advanced technology is indistinguishable from
magic."
Arthur C. Clarke (1917 - ), "Technology and the Future"
Orac
"Peter Moran" <mor...@gil.com.au> wrote:
Indeed. It usually takes at least two or three good randomized studies
to convince people or a larger number of less well-designed trials. This
is particularly true when the reported effect is not large.
--
Orac |"A statement of fact cannot be insolent."
|
|"If you cannot listen to the answers, why do you
| inconvenience me with questions?"
Steve Harris sbharris@ROMAN9.netcom.com
> In article <3f6e9...@news.brisbane.pipenetworks.com>,
> "Peter Moran" <mor...@gil.com.au> wrote:
>
> > "Anth" <an...@anon.com> wrote in message
> > news:3f6d8335$0$33799$65c6...@mercury.nildram.net...
> > > If this beats head cancer then why does it need further randomised
> controls
> > > to validate?
> > > Ant
> >
> > The study said ---
> >
> > > > > Professor Michele Saunders of Cancer Research UK said:
> > > > "This accelerated radiotherapy protocol is already being
> > > > used in the UK and will be the subject of a randomised
> > > > controlled trial to be organised by the National Cancer
> > > > Research Institute."
> >
> > It is rare within medicine for the results of a single study to be accepted
> > as final.
>
> Indeed. It usually takes at least two or three good randomized studies
> to convince people or a larger number of less well-designed trials. This
> is particularly true when the reported effect is not large.
COMMENT:
And particularly when the result is not conducive to the comfort of
radiation medicine specialists, who didn't enter the field to work
weekends. Do you know what effort has already gone in to "showing"
that 5 days a week radiotherapy is just as good as 6 and 7 ?? A lot!
So this "accelerated radiotherapy" result, if it holds, is a true
disaster in the field, a mighty smelly brown thingy in the punch bowl.
Things haven't been this bad since they started telling neurologists
they had to come in from Sunday golf in order to see stroke patients
for the new emergency clot-busting. "Say WHAT??" the whole profession
said.
SBH
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
Heh heh. Or since radiologists working at some trauma centers were told
that they had to take in-house call to read trauma films at night and on
weekends and couldn't just leave the initial "wet" readings to
residents. Or since AIDS turned infectious disease specialists (who,
back before the mid-1980's usually had a very cushy consultant role)
into de facto primary care doctors for AIDS patients, with all the
attendant headaches that come with being primary care doctors to a group
of sick patients. Now if we could only find a treatment that would
require dermatologists to come in on nights or weekends. ;-)
But all joking aside, radiation oncologists have always had to deal with
the occasional emergency that required night or weekend treatment, such
as spinal cord compression by tumor with neurologic deficit or superior
vena cava syndrome from obstruction of the superior vena cava with
tumor. There is also a a fairly large developing literature on
hyperfractionated radiation therapy, which requires even more frequent
small doses seven days a week; so it's not as if they haven't been
studying treatments that might disturb their weekends...
Steve Harris sbharris@ROMAN9.netcom.com
> But all joking aside, radiation oncologists have always had to deal with
> the occasional emergency that required night or weekend treatment, such
> as spinal cord compression by tumor with neurologic deficit or superior
> vena cava syndrome from obstruction of the superior vena cava with
> tumor. There is also a a fairly large developing literature on
> hyperfractionated radiation therapy, which requires even more frequent
> small doses seven days a week; so it's not as if they haven't been
> studying treatments that might disturb their weekends...
COMMENT:
My god, don't radiation oncologists get a lot of mileage out of cord
compression by tumor and superior vena cava syndrome. These are rare
enough to be good trivia quiv for student docs (what are the only true
radiation oncology emergencies..). But ask a rad onc guy to honestly
tell you if he personally has ever had to come in on a weekend to
treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
my training." They saw it because as a *fellow* or whatever, they had
to come in and do it <G>.
As for hyperfractionated dose therapy, don't tout it until you see how
it's done. Some is 7 days a week, but a good fraction of the studies
are twice a day for 5 days a week. Guess which 5?
SBH
Steph
"Steve Harris sbha...@ROMAN9.netcom.com" <sbha...@ix.netcom.com> wrote in
message news:79cf0a8.03092...@posting.google.com...
> Orac <or...@wlsfanmail.com> wrote in message
news:<orac-4E8D07.0...@host9.newsfeeds.com>...
> > But all joking aside, radiation oncologists have always had to deal with
> > the occasional emergency that required night or weekend treatment, such
> > as spinal cord compression by tumor with neurologic deficit or superior
> > vena cava syndrome from obstruction of the superior vena cava with
> > tumor. There is also a a fairly large developing literature on
> > hyperfractionated radiation therapy, which requires even more frequent
> > small doses seven days a week; so it's not as if they haven't been
> > studying treatments that might disturb their weekends...
>
>
> COMMENT:
>
> My god, don't radiation oncologists get a lot of mileage out of cord
> compression by tumor and superior vena cava syndrome. These are rare
> enough to be good trivia quiv for student docs (what are the only true
> radiation oncology emergencies..).
About 10% of the common cancer get spinal cord compression, or threatened
compression at some time..
> But ask a rad onc guy to honestly
> tell you if he personally has ever had to come in on a weekend to
> treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> my training." They saw it because as a *fellow* or whatever, they had
> to come in and do it <G>.
>
Happens to me 5-6 times per year
> As for hyperfractionated dose therapy, don't tout it until you see how
> it's done. Some is 7 days a week, but a good fraction of the studies
> are twice a day for 5 days a week. Guess which 5?
>
> SBH
I think you have an attitude, based on very few facts..
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> Orac <or...@wlsfanmail.com> wrote in message
> news:<orac-4E8D07.0...@host9.newsfeeds.com>...
Man, you seem to have a bug up your butt about radiation oncologists.
You seem to be downright hostile here. I actually did some of my lab
research in a very prestigious radiation oncology department; so I know
a few radiation oncologists. I count the Chairman of the particular
department where I did my research as a friend and someone who has
helped my career greatly. Those guys worked hard, although admittedly
they were in an academic medical center and had to do research along
with patient care.
Steve Harris sbharris@ROMAN9.netcom.com
> > My god, don't radiation oncologists get a lot of mileage out of cord
> > compression by tumor and superior vena cava syndrome. These are rare
> > enough to be good trivia quiv for student docs (what are the only true
> > radiation oncology emergencies..).
>
> About 10% of the common cancer get spinal cord compression, or threatened
> compression at some time..
Irrelevent, since the "threatened" are by far the largest fraction of
this group, and treating them doesn't consitute weekend emergency
care.
>
> > But ask a rad onc guy to honestly
> > tell you if he personally has ever had to come in on a weekend to
> > treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> > my training." They saw it because as a *fellow* or whatever, they had
> > to come in and do it <G>.
> >
>
> Happens to me 5-6 times per year
Really? 10% of your patients and it gets you only 5 times a year?
Once in every 10 weeks? Your own two factoids don't even agree, if I
was to take them a face value. Which of course I don't, for reasons
explained above.
Let's see you back the fact of 5 to 6 rad-onc emergencies a year, with
your department chairman or program's phone number. I will check it,
you know. Right now-- Oh, anonymous rad onc wonk, I think you're
BS'ing us. Prove me wrong.
> > As for hyperfractionated dose therapy, don't tout it until you see how
> > it's done. Some is 7 days a week, but a good fraction of the studies
> > are twice a day for 5 days a week. Guess which 5?
> >
> > SBH
>
> I think you have an attitude, based on very few facts..
Un-huh. How many accelerated regimin patients do you do yourself?
Please describe. As for facts, I have medline, same as you. Why don't
you look up 10 hyperfractionation studies at random, and get back to
us? The literature is full of hyperfractionation studies which are not
accelerated. Or are 6 days a week and not 7. Here's the first example
I pulled off medline. Hell, they can't even do people on weekends for
a formal phase III study.
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):7-16.
Comment in:
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):1-2.
Int J Radiat Oncol Biol Phys. 2000 Aug 1;48(1):3-6.
Int J Radiat Oncol Biol Phys. 2001 Apr 1;49(5):1517-8.
Int J Radiat Oncol Biol Phys. 2001 Oct 1;51(2):563.
A Radiation Therapy Oncology Group (RTOG) phase III randomized study
to compare
hyperfractionation and two variants of accelerated fractionation to
standard
fractionation radiotherapy for head and neck squamous cell carcinomas:
first
report of RTOG 9003.
Fu KK, Pajak TF, Trotti A, Jones CU, Spencer SA, Phillips TL, Garden
AS, Ridge
JA, Cooper JS, Ang KK.
Department of Radiation Oncology, University of California San
Francisco,
94143-0226, USA. f...@radonc17.ucsf.edu
PURPOSE: The optimal fractionation schedule for radiotherapy of head
and neck
cancer has been controversial. The objective of this randomized trial
was to
test the efficacy of hyperfractionation and two types of accelerated
fractionation individually against standard fractionation. METHODS AND
MATERIALS: Patients with locally advanced head and neck cancer were
randomly
assigned to receive radiotherapy delivered with: 1) standard
fractionation at 2
Gy/fraction/day, 5 days/week, to 70 Gy/35 fractions/7 weeks; 2)
hyperfractionation at 1. 2 Gy/fraction, twice daily, 5 days/week to
81.6 Gy/68
fractions/7 weeks; 3) accelerated fractionation with split at 1.6
Gy/fraction,
twice daily, 5 days/week, to 67.2 Gy/42 fractions/6 weeks including a
2-week
rest after 38.4 Gy; or 4) accelerated fractionation with concomitant
boost at
1.8 Gy/fraction/day, 5 days/week and 1.5 Gy/fraction/day to a boost
field as a
second daily treatment for the last 12 treatment days to 72 Gy/42
fractions/6
weeks. Of the 1113 patients entered, 1073 patients were analyzable for
outcome.
The median follow-up was 23 months for all analyzable patients and
41.2 months
for patients alive. RESULTS: Patients treated with hyperfractionation
and
accelerated fractionation with concomitant boost had significantly
better
local-regional control (p = 0.045 and p = 0.050 respectively) than
those treated
with standard fractionation. There was also a trend toward improved
disease-free
survival (p = 0.067 and p = 0.054 respectively) although the
difference in
overall survival was not significant. Patients treated with
accelerated
fractionation with split had similar outcome to those treated with
standard
fractionation. All three altered fractionation groups had
significantly greater
acute side effects compared to standard fractionation. However, there
was no
significant increase of late effects. CONCLUSIONS: Hyperfractionation
and
accelerated fractionation with concomitant boost are more efficacious
than
standard fractionation for locally advanced head and neck cancer.
Acute but not
late effects are also increased.
Publication Types:
Clinical Trial
Clinical Trial, Phase III
Multicenter Study
Randomized Controlled Trial
PMID: 10924966 [PubMed - indexed for MEDLINE]
Orac
sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
wrote:
> "Steph" <st...@vancouver.island> wrote in message
> news:<_v4db.27751$TM4.19144@pd7tw2no>...
> >
> > sbha...@ix.netcom.com (Steve Harris sbha...@ROMAN9.netcom.com)
> > wrote:
> > > But ask a rad onc guy to honestly
> > > tell you if he personally has ever had to come in on a weekend to
> > > treat a case, and you'll get an embarrassed "no." Or "yeah.... once in
> > > my training." They saw it because as a *fellow* or whatever, they had
> > > to come in and do it <G>.
> > >
> >
> > Happens to me 5-6 times per year
>
>
> Really? 10% of your patients and it gets you only 5 times a year?
> Once in every 10 weeks? Your own two factoids don't even agree, if I
> was to take them a face value. Which of course I don't, for reasons
> explained above.
>
> Let's see you back the fact of 5 to 6 rad-onc emergencies a year, with
> your department chairman or program's phone number. I will check it,
> you know. Right now-- Oh, anonymous rad onc wonk, I think you're
> BS'ing us. Prove me wrong.
Personally, I think *you're* getting way out of control here and need to
take a chill pill. I don't know what your major malfunction is or what
your beef is with radiation oncologists, but your attacks are getting
increasingly petty and you're getting increasingly nasty for no apparent
reason.
[Tirades snipped]
Matti Narkia
<Orac-529521.2...@news4.srv.hcvlny.cv.net> Orac <Or...@wabcmail.com>
wrote:
Is that so? IMHO Dr. Harris (who unlike most of the other MDs or "MD"s in the
usenet has the honesty and courage to write with his own name) has been
sticking to subject with his usual colorful and witty style, and backing his
statements with evidence, while your latest comment is sadly devoid of facts.
Prove him wrong, if you can, instead of resorting to ad hominem.
--
Matti Narkia
Orac
Matti Narkia <mn...@despammed.com> wrote:
"Colorful and witty"? More like unnecessarily nasty to me.
As for facts, my record on this newsgroup speaks for itself regarding
the use of facts and scientific studies. In this instance, my question
was not for the most part over facts but over why Dr. Harris has such a
hostile attitude towards radiation oncologists.
> Prove him wrong, if you can, instead of resorting to ad hominem.
I was not using "ad hominem" attacks when I was pointing out that his
attacks were becoming increasingly petty and nasty. That was arguably
true, based his own words and the obvious attitude behind them, and it
is my opinion that he was getting out of control.
As for "proving him wrong," that was not the point of my post, and you
know it. The question was not about whether Dr. Harris was right or not.
Indeed, I never even really addressed that question all that much. It
was about why his naked hostility towards radiation oncologists and
wondering why he had such an attitude. I have no interest in continuing
any further a pissing contest with him (or you) over whether radiation
oncologists are as lazy as he apparently thinks they are.
So I'll boil it down to the essence and leave open the question to both
Dr. Harris and you:
Why such undisguised contempt for radiation oncologists? It's a simple
question.
Steve Harris sbharris@ROMAN9.netcom.com
> Personally, I think *you're* getting way out of control here and need to
> take a chill pill. I don't know what your major malfunction is or what
> your beef is with radiation oncologists, but your attacks are getting
> increasingly petty and you're getting increasingly nasty for no apparent
> reason.
I've given my reasons and my beefs in detail and you seem to have
difficulty understanding them. Your problem.
I'm one of the few physicians here who posts under my own name, taking
open responsiblity for what I say. And I give my reasons for my
opinions, citing literature and experience where I can. That means I'm
open to getting my nose rubbed in it. For example, had I not been able
to find any 5 day a week hyperfraction studies, I've had looked pretty
silly. But I found them being done in San Francisco (they are done all
over the world, actually), and so my point is made. It's not my fault
if you don't get it.
Who are you, oh anonmyous one?
Steve Harris
toolz toolz
money they recieve. Some might feel they are ripping the public off. Some
might even feel that rad, is not effective on many, if not most cases. AND
some might think that you are an ass.
Steve Harris sbharris@ROMAN9.netcom.com
> Man, you seem to have a bug up your butt about radiation oncologists.
> You seem to be downright hostile here. I actually did some of my lab
> research in a very prestigious radiation oncology department; so I know
> a few radiation oncologists.
So what? So do I. I know very well they rarely (read: almost never)
work weekends. They are rather like dermatologists and most kinds of
pathologists. Personally this doesn't bother me, except when it
appears to be warping scientific perspective. Which (looking at the
literature) I see that it has.
There is no reason for the large number of trials of hyperfractionated
radiation that look at 5 and 6 day weeks. If it's worth giving
radiation more than once a day, it's certainly worth giving on
weekends. Giving radiation only during banker's hours isn't being done
for the benefit of the *patients*. They've got cancer, and would just
as soon be done on a few weekends (five of them for the average
course). In fact, not a few patients need to drive into a large city
if they are getting radiated by any kind of expensive or rare machine
(conformal, cyberknife, protons and other hadrons-- you name it), and
THOSE patients and their caregivers would be VERY happy to not deal
with as many days of weekday traffic. Even those coming in from far
out of town and temporarily staying close to the radiation center may
have an accelerated course which might be shortened from 7 weeks to 5
if treatment was every day, thus saving 2 weeks of hotel expenses. No,
for the patients it's a wash, or even an inconvenience, not to get
therapy on weekends. The studies, and the standard treatment
schedules, were constructed the convenience of doctors. If it turns
out that doing that kills some fraction of people because it's not
quite as good, then it's a real ethical embarrassment. How come the
rad onc people didn't set up the studies sooner to find THAT out?
> I count the Chairman of the particular
> department where I did my research as a friend and someone who has
> helped my career greatly. Those guys worked hard, although admittedly
> they were in an academic medical center and had to do research along
> with patient care.
Yeah, so? I think you have me mistaken for the nuts who don't think
radiation therapy for cancer is a good thing, that medical doctors are
misguided, and so on. Wrong. For the record, I believe that *radiation
oncology is a noble profession* on the whole, and that radiation
treatment (in conjunction with chemo and even alone) is quite capable
of curing many cancers. It's nearly painless, and when it works, it's
very nearly magical.
I saw a case recently of a nearly magic cure using the proton facility
at Loma Linda. But you know what? It was 5 days a week treatment. The
proton accelerator at Loma Linda, one of only 2 or 3 in the country
(don't know if Texas is online yet) just sits there idle on weekends.
Is that because there aren't patients who could use it then? No. Is
weekend idling of the proton accelerator because there are great
studies showing that protons 5 days a week are just as good as protons
6 or 7 days a week? No. No such studies exist. Hmmm. It sits there
idle because it's convenient, and by analogy it's assumed that protons
behave like photons, and some not very well-checked older studies on a
few types of cancer (not all) show that pHoton therapy does as well 5
days a week as 7.
These same studies have been clung to by radiation oncologists for 30
years or more. They were easy to believe because it was convenient.
And they were generalized as necessary, as for example in the pRoton
radiation schedules being designed from the old pHoton studies.
Induction is easy when the result is pleasing, and no bother.
But now turn that around and you'll see induction doesn't work so well
when it's not convenient. Protons got a 5 day per week schedule
because it supposedly worked for photons-- no better reasoning than
that. But now that there are beginning to be studies which suggest
that accelerated therapy with photons is better for some head and neck
cancers, do you think that the proton people will go to
hyperfractionation or 7 days a week (including sabbath at Loma Linda)
on the very same kind of evidence?
**Not on your life.** They'll say that the evidence can't be expected
to apply to the unique proton accelerator. Suddenly, when the golf
game is threatened, now professional scepticism sets in.
I'm merely pointing out that that kind of thinking is not science. As
a scientist and physican I know that very well. So what's *your*
problem?
SBH
Orac
"toolz toolz" <medt...@earthlink.net> wrote:
> "Orac" <Or...@wabcmail.com> wrote in message
> news:Orac-3C9810.1...@news4-ge1.srv.hcvlny.cv.net...
> > Why such undisguised contempt for radiation oncologists? It's a simple
> > question.
> >
> Are you realy this dumb? Some might feel that they do very little for the
> money they recieve. Some might feel they are ripping the public off. Some
> might even feel that rad, is not effective on many, if not most cases. AND
> some might think that you are an ass.
Some, on the other hand, KNOW you are an ass.
Matti Narkia
<Orac-3C9810.1...@news4-ge1.srv.hcvlny.cv.net> Orac
<Or...@wabcmail.com> wrote:
>
>So I'll boil it down to the essence and leave open the question to both
>Dr. Harris and you:
>
>Why such undisguised contempt for radiation oncologists? It's a simple
>question.
Contempt? Hardly. But IMHO patients, who are receiving radiation therapy twice
a day, because it has supposedly been proven to be more effective than once a
day therapy, are entitled to wonder, why on earth they should have a two day
break every 5 days, when hyperfractionation is so great? And feel a little
pissed off, when they come to obvious conclusion. It seems that the problem
here is that that apparently you don't accept the conclusion I mean, but
haven't provided any other plausible explanation either.
Similarly, true scientists and doctors with high ethical standards, who come to
the same conclusion, may feel to express their dissatisfaction with the status
quo occasionally with a bit colorful language to get their point noticed.
--
Matti Narkia