Background
Labeling locoregional failures in head and neck cancer (HNC) as “local” and “regional” becomes incomplete when treating with intensity modulated radiotherapy (IMRT). Target delineation and delivery errors, dose in‐homogeneity complicate the assessment of failures. A combination of focal point and dosimetric method might attempt at simplifying failure analysis.
Methods
One hundred eleven patients with locally advanced HNC treated with chemoradiation using IMRT were enrolled. Patients with documented failure had their recurrence volume assessed using focal point and dosimetric method.
Results
With a median follow‐up of 20 (range 0‐39) months and median locoregional control (LRC) of 30 (range 24.8‐34.5) months, the patients had a 3‐year overall survival and LRC of 70.6% and 48.9%, respectively. Of 39 failures, there were 69.2%, 7.6%, 5.1%, 12.8%, and 5.1% type A, B, C, D, and E, respectively using the focal point and dosimetric method.
Conclusion
With the current classification, majority of the recurrences were high dose failures suggesting inherent radioresistance. While minority of failures were potentially preventable and needed modifying existing IMRT workflow.
The SMART boost technique can be a feasible alternative fractionation schedule that reduces the overall treatment time, maintaining comparable toxicity and survival compared with SIB-IMRT.
Ewing sarcoma (ES) is an undifferentiated small round blue cell tumor most commonly originating in the bone of adolescents 10-20 years of age, although 30% are diagnosed in adults. The most important prognostic factor is the presence of metastatic disease. Results of the EURO-EWING 99 trial of ES patients showed that local treatment of not only the primary, but also of the sites of metastatic disease should be considered to improve event-free survival. The use of stereotactic body radiotherapy (SBRT) has been extensively reported for tumors of lung, liver, pancreas, and spine. The use of SBRT in these sites is well-accepted. Here, we report a detailed case of SBRT to multisite metastatic ES. We demonstrate the feasibility, safety, and efficacy of aggressive local control with multisite SBRT for the treatment of metastatic ES.Ewing sarcoma (ES) is an undifferentiated small round blue cell tumor most commonly originating in the bone of adolescents 10-20 years of age, although 30% are diagnosed in adults. The most important prognostic factor is the presence of metastatic disease, and even patients who present with locally confined disease at diagnosis have high risk of metastatic disease with only local therapy (1). Patients with metastatic disease require multi-agent chemotherapy as the backbone of their treatment, and may benefit from targeted agents based on molecular profile. The EURO-EWING 99 trial of ES patients with multiple extra-pulmonary metastases consisted of high dose multi-agent chemotherapy followed by consideration of local treatment to the primary site as well as to all sites of metastatic disease. Three year event-free survival was significantly improved at 39% for patients who received local treatment to the primary and metastatic disease compared with 17% for those who received local treatment to the primary or metastatic disease and 14% for patients received no local therapy (p<0.001) (2). Given this evidence, local treatment of not only the primary, but also the sites of metastatic disease should be considered in an effort to improve event free survival when deemed safe. Although most patients treated on EURO-EWING 99 received conventional radiation therapy, stereotactic body radiation therapy (SBRT) provides several advantages including enhanced biologic effective dose, fewer treatments resulting in decreased chemotherapy disruption and less impact on everyday life, and decreased radiation exposure of the bone marrow and immune system (3). We present the outcomes of an adult with metastatic ES treated with SBRT to multiple sites with concurrent chemotherapy.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.