Possibilities of rehabilitation methods and support therapy in ensuring the continuity of the course of radiation therapy for patients with tumors of the head and neck

Abstract

Relevance. Radiation therapy (photon, neutron, proton) alone/in combination or as a component of complex or combined treatment is indicated for more than 64% of patients with head and neck tumors (HNCT). Practice shows that the choice of an aggressive treatment method (radiation therapy course duration less than 40 days) directly affects the three-year survival rate, but is accompanied by undesirable toxicity in the form of grade III-IV mucositis, the incidence of which in patients is 51.2% versus 55.6% (p> 0.05). According to the results of a survey of radiation therapists in the USA and the Russian Federation (n=120), the management tactics for the occurrence of grade I-II skin manifestations of radiation toxicity in the first half of the EBRT course were: 1) 34% — a 10-14 day break in treatment, maintenance therapy; 2) 67% — a reduction in the number of planned fractions of the course, without reducing the effective dose; 3) 11% – reduction in the number of planned course fractions, lower effective dose. In turn, nutritional support, local antiseptics, painkillers, and low-intensity lasers can reduce the incidence of mucosal lesions by 6-fold (from 6.4% to 40.4%). Study objective: To evaluate the potential of rehabilitation and supportive therapy methods in ensuring continuity of radiation therapy in patients with head and neck tumors. Materials and methods: 297 patients with malignant neoplasms of the head and neck who underwent combined photon-neutron therapy (neutron contribution SOD = 2.4 Gy) from 1999 to 2005, as part of a radical independent radiation/chemoradiation course. Of these, 134 patients (45.11%) underwent laser therapy sessions through a quartz fiber for non-specific prevention and treatment of existing radiation reactions, with an exposure of 2-3 minutes for 5 days, along with accompanying symptomatic treatment; 112 patients (38.04%) were given a break in case of grade I-II radiation toxicity detected during the first stage of treatment, or worsening of their somatic status, with subsequent resumption of treatment after 10-14 days. Results and discussion. Acute radiation reactions of grades I-III according to the RTOG scale were more common in the second group (153 patients, 94%) than in the first (79 patients, 59.1%). The immediate treatment outcomes were comparable in the first and second groups: complete response (81.6%) and 80.1%, partial response (18.4%) and 19.9%. However, the rate of continuous radiation therapy was higher in Group 1 – 98 patients (73%), despite maintenance therapy with modern drugs and laser therapy. In Group 2, this figure was only 27 patients (16.85%). When assessing the long-term three-year survival results, the rate in Group 1 was 89.42% and in Group 2 – 78.17%, respectively (p>0.05). Conclusion. The most common complaints of patients requiring a forced treatment interruption were skin and mucosal reactions and dysphagia, which significantly reduce quality of life, impact their overall well-being, psychological state, emotional and social apathy, and even reduce the frequency of meals/nutrition. This observed trend requires further study and consideration of other rehabilitation methods, patients' comorbid status, continuity, and compliance.

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