Voice outcomes after radiotherapy treatment for early glottic cancer: assessment using multidimensional tools

BACKGROUND: This is the first prospective study to use instrumental and both clinician- and client-rated auditory-perceptual measures to examine voice and voice-related quality of life changes in patients after curative radiotherapy for early glottic cancer. METHOD: Thirty patients undergoing curative radiotherapy treatment for early glottic cancer completed the following: 3 voice tasks for acoustic, aerodynamic, and auditory-perceptual voice measures (therapist-rated); a patient self-report rating of voice quality; and a voice-related quality of life assessment before and 12 months after radiotherapy. RESULTS: Patients' perceptions of their voice quality and their voice-related quality of life significantly improved posttreatment, as did acoustic, aerodynamic, and auditory-perceptual voice measures. Mean speaking fundamental frequency did not change significantly, although breathiness and strain in the voice recordings were demonstrably reduced. CONCLUSION: In describing postradiotherapy voices in this study, pertinent measures of voice outcomes have been established, setting the benchmark for comparison in future cohort studies.     

Fractionation in adjuvant radiotherapy for invasive breast cancer and ductal carcinoma in situ in Ontario,Canada from 2009 to 2015

The use of hypofractionated radiotherapy (HFRT) in patients with breast cancer and ductal carcinoma in situ (DCIS) in Ontario, Canada, from 2009 to 2015 was reported. A retrospective cohort study was conducted using data from the Institute for Clinical Evaluative Sciences (ICES). Patients with a breast cancer or DCIS diagnosis between 2009 and 2015 who received adjuvant breast or chest wall radiation were included. Trends in HFRT use (≤16 fractions) and factors associated with HFRT use in a multivariable logistic regression model with physician‐level random effect were reported. The approximate number of hours that could be saved if all patients were to receive HFRT was calculated. A total of 42 072 patients were included. All included characteristics were significantly associated with HFRT use. Hypofractionated radiotherapy use in patients with breast cancer and DCIS increased to around 75% in 2015. In stage I/II patients with mastectomy and chest wall radiation, HFRT use increased to 40% in 2015. Hypofractionated radiotherapy use in patients with regional nodal radiation or reconstruction has increased but remains under 20%. For breast cancer patients with breast‐conserving surgery (BCS) and breast radiation, 56 265 visits corresponding to 7200 hours of treatment or 3500 additional HFRT courses could have been saved. In conclusion, HFRT use in Ontario has increased in all patient populations but is nonuniform among physicians and institutions. Use of HFRT in chest wall and regional nodal radiation remains relatively lower than in breast cancer and DCIS patients with BCS.     

The evolution of adjuvant radiation therapy for early‐stage and locally advanced breast cancer

Adjuvant radiation therapy is often delivered after breast cancer surgery, both in the post‐lumpectomy and post‐mastectomy settings. Standard fractionation whole breast irradiation (SF‐WBI), which is typically delivered over 5‐7 weeks, was previously considered the standard of care. More recent data has helped to establish hypofractionated whole breast irradiation (HF‐WBI), which consists of a 3‐4 week regimen, as a new standard of care. This article provides an overview of the major randomized trials that support the routine use of HF‐WBI for the majority of patients undergoing breast‐conserving surgery for early‐stage breast cancer. Newer data on the use of a hypofractionated approach in the post‐mastectomy setting, as well as ongoing randomized trials addressing this topic, are also discussed.