Head and Neck Tumor Control Probability: Radiation Dose–Volume Effects in Stereotactic Body Radiation Therapy for Locally Recurrent Previously-Irradiated Head and Neck Cancer: Report of the AAPM Working Group

Vargo, John A.; Moiseenko, Vitali; Grimm, Jimm; Caudell, Jimmy J.; Clump, D.A.; Yorke, Ellen; Xue, Jinyu; Vinogradskiy, Yevgeniy; Moros, Eduardo G.; Mavroidis, Panayiotis; Jain, Siddhant; Naqa, Issam El; Marks, Lawrence B.; Heron, Dwight E.

doi:10.1016/j.ijrobp.2018.01.044

Cited by 40 publications

(37 citation statements)

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“…In support to this, the same authors suggested the existence of dose-response relationship with superior local control and possibly improved OS for doses of 35 to 45 Gy (in 5 frs) compared with <30 Gy. 31 Of note, in our cohort, no patient received an SBRT dose higher than 30 Gy, partially justifying the lack of such clinical benefit with this approach at univariable Cox analysis. Again, we failed to establish a relationship between re-RT dose and survival.…”

Section: Discussionmentioning

confidence: 77%

“…3,7,8 Conversely, Tanveyanon and collegues 5 found tumor bulk at reirradiation, considered as a bidimensional continuous variable, to be one of the independent prognostic factors, whereas Vargo et al 30,31 found a volumetric cutoff of 25 cm 3 to be prognostic of inferior survival for patients treated with SBRT. Several studies considered surrogate parameters, such as T classification and PTV size, to express tumor volume demonstrating its relation with survival outcomes.…”

Section: Discussionmentioning

confidence: 99%

“…3,7,8 Conversely, Tanveyanon and collegues 5 found tumor bulk at reirradiation, considered as a bidimensional continuous variable, to be one of the independent prognostic factors, whereas Vargo et al 30,31 found a volumetric cutoff of 25 cm 3 to be prognostic of inferior survival for patients treated with SBRT. 31 Of note, in our cohort, no patient received an SBRT dose higher than 30 Gy, partially justifying the lack of such clinical benefit with this approach at univariable Cox analysis. As regards RT technique, IMRT showed better OS than SBRT only in univariable analysis.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies considered surrogate parameters, such as T classification and PTV size, to express tumor volume demonstrating its relation with survival outcomes. 3,7,8 Conversely, Tanveyanon and collegues 5 found tumor bulk at reirradiation, considered as a bidimensional continuous variable, to be one of the independent prognostic factors, whereas Vargo et al 30,31 found a volumetric cutoff of 25 cm 3 to be prognostic of inferior survival for patients treated with SBRT. In our study, a recurrence volume cutoff of 36 cm 3 was found, allowing the identification of two patient subgroups with different OS.…”

Section: Discussionmentioning

confidence: 99%

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Long‐term outcome of re‐irradiation for recurrent or second primary head and neck cancer: A multi‐institutional study of AIRO—Head and Neck working group

et al. 2019

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Background To report the long‐term outcome of patients undergoing re‐irradiation (re‐RT) for a recurrent or second primary head and neck cancer (RSPHNCs) in seven Italian tertiary centers, while testing the Multi‐Institution Reirradation (MIRI) recursive partitioning analysis (RPA) recently published. Methods We retrospectively analyzed 159 patients. Prognostic factors for overall survival (OS) selected by a random forest model were included in a multivariable Cox analysis. To externally validate MIRI RPA, we estimated the Kaplan‐Meier group‐stratified OS curves for the whole population. Results Five‐year OS was 43.5% (median follow‐up: 49.9 months). Nasopharyngeal site, no organ dysfunction, and re‐RT volume <36 cm3 were independent factors for better OS. By applying the MIRI RPA to our cohort, a Harrell C‐Index of 0.526 was found indicating poor discriminative ability. Conclusion Our data reinforce the survival benefit of Re‐RT for selected patients with RSPHNC. MIRI RPA was not validated in our population.

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Section: Discussionmentioning

confidence: 77%

Section: Discussionmentioning

confidence: 99%

“…3,7,8 Conversely, Tanveyanon and collegues 5 found tumor bulk at reirradiation, considered as a bidimensional continuous variable, to be one of the independent prognostic factors, whereas Vargo et al 30,31 found a volumetric cutoff of 25 cm 3 to be prognostic of inferior survival for patients treated with SBRT. 31 Of note, in our cohort, no patient received an SBRT dose higher than 30 Gy, partially justifying the lack of such clinical benefit with this approach at univariable Cox analysis. As regards RT technique, IMRT showed better OS than SBRT only in univariable analysis.…”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

Long‐term outcome of re‐irradiation for recurrent or second primary head and neck cancer: A multi‐institutional study of AIRO—Head and Neck working group

et al. 2019

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“…Logistic regression was used to fit the dose and volume responses. Confidence intervals for the dose and volume responses were obtained using Bootstrap methods with 1000 samples . All analyses were conducted using R (version 3.5.0, Vienna, Austria) or MatLab (version R2017a).…”

Section: Methodsmentioning

confidence: 99%

Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Lee

Fung

et al. 2019

Head & Neck

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Background: This study analyzed the dose volume effects of re-irradiation for locally recurrent nasopharyngeal carcinoma (NPC) and attempts to determine the optimal dose for the best survival. Methods: Ninety-one patients were studied. The local control, fatal complication, and overall survival were analyzed against the dose (in Equivalent Dose at 2 Gy/fractions) and recurrent gross tumor volume (GTV). Results: The local control and fatal complication rate appear to increase with prescribed dose. The overall survival peaks at around 60 Gy 10 . Local control decreases significantly with increasing GTV (P < .001) while overall survival shows similar trend (P = .06). No correlation was observed between the fatal complication rate and GTV volume. The dose response of local control appears to be stronger for smaller tumors. Conclusion: GTV volume plays a significant role in local control. A 60 Gy 10 appears to be optimal for the best survival outcome; higher doses might be considered for small tumors.

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Three discipline collaborative radiation therapy (3DCRT) special debate: We should treat all cancer patients with hypofractionation

Green

Nest

Soisson

et al. 2020

J Applied Clin Med Phys

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Radiation Oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplinesmedicine, physics, and biology. As a result, discussion of controversies or changes in practice within radiation oncology must involve input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit. 1-3 In light of these results, we endeavor here to adopt this "team-science" approach to the traditional debates featured in this journal. This article is part of a series of special debates entitled "Three Discipline Collaborative Radiation Therapy (3DCRT)" in which each debate team will include a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. 2 | INTRODUCTION Better Physics, just within this 21st century, now enables us to deliver radiation to a target volume with accuracy better than 1 mm. Given this accuracy, why fractionate at all? If we can put dose only on the cancer, and extremely little on critical normal tissue, then surely just give a high single dose to that cancer, and job done. Local tumor control is 100% with minimal toxicity. If only. Two linked issues keep Biology (radiobiology) in the clinical game. First, our ability to identify, localize, and immobilize anatomy and pathology does not yet correspond with this submillimeter accuracy of radiotherapy delivery. Second, even if that imaging resolution is reached it could still not detect occult disease. Consequently, unless the cancer is truly isolated, which it sometimes may be, for example, in organ-confined early-stage prostate cancer, it is always necessary to "degrade" the treatment plan by defining a CTV and PTV into which the radiation delivery is expanded. This inevitably imposes a risk of normaltissue radiotoxicity, therefore we must use fractionation to minimize that risk. Traditionally, that fractionation has been carried out with doses close to 2 Gy per fraction. In fractionation, the Linear-Quadratic (LQ) model describes the relationship between total dose and dose per fraction, for isoeffect. A lower α/β value indicates a steeper relationship. Generally late-reacting normal tissues exhibit lower α/β and early-reacting normal tissues exhibit higher α/β. Malignancies can have lower or higher α/β depending on the tumor type. In some malignancies, notably human prostate, clinical data indeed indicate α/ β as low as 1.5 and thus in prostate cancers, and likewise in earlystage breast cancers, hypofractionation, arbitrarily defined as a dose per fraction> 2.2 Gy, has become standard of care. In early-stage non-small cell lung cancers a higher α/β is seen, similar to early-reacting normal tissue, but these isolated malignancies can still be more effectively controlled with radical hypofractionation wh...

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Head and Neck Tumor Control Probability: Radiation Dose–Volume Effects in Stereotactic Body Radiation Therapy for Locally Recurrent Previously-Irradiated Head and Neck Cancer: Report of the AAPM Working Group

Abstract: Stereotactic body radiation therapy doses equivalent to 5-fraction doses of 40 to 50 Gy are suggested for retreatment.

Cited by 40 publications

References 41 publications

Long‐term outcome of re‐irradiation for recurrent or second primary head and neck cancer: A multi‐institutional study of AIRO—Head and Neck working group

Long‐term outcome of re‐irradiation for recurrent or second primary head and neck cancer: A multi‐institutional study of AIRO—Head and Neck working group

Dose volume effects of re‐irradiation for locally recurrent nasopharyngeal carcinoma

Three discipline collaborative radiation therapy (3DCRT) special debate: We should treat all cancer patients with hypofractionation

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