A Review of Modern Radiation Therapy Dose Escalation in Locally Advanced Head and Neck Cancer

Background and PurposeMost locoregional recurrences after definitive radiotherapy for head and neck squamous cell carcinoma (HNSCC) develop “in-field.” Dose escalation while sparing organs at risk can be a good solution for improving local control without increasing adverse effects. This study investigated the safety and effectiveness of volumetric modulated arc therapy (VMAT) using intentionally internal high-dose policy (IIHDP) to treat neck lymph node metastases (NLNM) ≥ 2 cm in HNSCC patients.Materials and MethodsWe analyzed 71 NLNM from 51 HNSCC patients who had received definitive radiotherapy to treat NLNM ≥ 2 cm using the VMAT technique in our institution between February 2017 and August 2019. Thirty-seven NLNM from 25 patients were treated using IIHDP VMAT (group A), and 34 NLNM from 27 patients were treated with homogeneous-dose distribution policy (HDDP) VMAT (group B). One patient with three NLNM had one lymph node assigned to group A and the other two to group B. Adverse events and local recurrence-free survival (LRFS) was compared between the two groups.ResultsIn the median follow-up period of 527 days, there were no significant differences between the groups in terms of dermatitis or mucositis ≥ grade 2/3, but LRFS was significantly longer in group A (p = 0.007). In the Cox regression analysis after adjustment for the propensity score, group A also showed an apparently superior LFRS.ConclusionOur initial experience of IIHDP VMAT suggested that IIHDP VMAT to treat HNSCC neck lymph node metastases measuring ≥ 2 cm was feasible and possibly led to better local control than HDDP VMAT.

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“…Some previous studies have reported dose escalation using a VMAT technique in head and neck cancer ( 7 , 12 – 17 ). Lauve et al.…”

Section: Discussionmentioning

confidence: 99%

“…Therefore, IIHDP VMAT could be more effective technique for improving local control of the tumors. Some previous studies have reported dose escalation using a VMAT technique in head and neck cancer (7,(12)(13)(14)(15)(16)(17). Lauve et al reported the results of the phase I trial of dose escalation to GTV in bulky HNSCC patients (12).…”

Section: Discussionmentioning

confidence: 99%

Initial Experience of Intentional Internal High-Dose Policy Volumetric Modulated Arc Therapy of Neck Lymph Node Metastases ≥ 2 cm in Patients With Head and Neck Squamous Cell Carcinoma

et al. 2021

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“…Radiation therapy (RT) is employed to cure localized cancers and is known to act both by killing malignant cells and by activating anti-tumor immune responses (Atwell et al, 2019(Atwell et al, , 2020Bellia et al, 2019;Fellin et al, 2019;Gupta and Chatterjee, 2020;Koukourakis and Giatromanolaki, 2020). Despite the wide use of RT to overcome the main problem of cancer resistance, the mechanisms by which radiations activate immune system to kill cancer cells are still under intense debate.…”

Section: Microfluidic Devices For Studying the Effects Of Radiations mentioning

confidence: 99%

Oncoimmunology Meets Organs-on-Chip

Mattei

Andreone

Mencattini

et al. 2021

Front. Mol. Biosci.

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Oncoimmunology represents a biomedical research discipline coined to study the roles of immune system in cancer progression with the aim of discovering novel strategies to arm it against the malignancy. Infiltration of immune cells within the tumor microenvironment is an early event that results in the establishment of a dynamic cross-talk. Here, immune cells sense antigenic cues to mount a specific anti-tumor response while cancer cells emanate inhibitory signals to dampen it. Animals models have led to giant steps in this research context, and several tools to investigate the effect of immune infiltration in the tumor microenvironment are currently available. However, the use of animals represents a challenge due to ethical issues and long duration of experiments. Organs-on-chip are innovative tools not only to study how cells derived from different organs interact with each other, but also to investigate on the crosstalk between immune cells and different types of cancer cells. In this review, we describe the state-of-the-art of microfluidics and the impact of OOC in the field of oncoimmunology underlining the importance of this system in the advancements on the complexity of tumor microenvironment.

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“…These findings indicate that a better RT boost to TV is possible. The quantitative data provided by DW-MRI could reflect intratumoral heterogeneity, highlighting more radioresistant areas (14,15). Subsequently, elective dose escalation can be individually delivered to these areas.…”

Section: Diffusion-weighted Mrimentioning

confidence: 99%

Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment

Zhang

Yang

2021

Front. Oncol.

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Advances in radiation technology, such as intensity-modulated radiation therapy (IMRT), have largely enabled a biological dose escalation of the target volume (TV) and reduce the dose to adjacent tissues or organs at risk (OARs). However, the risk of radiation-induced injury increases as more radiation dose utilized during radiation therapy (RT), which predominantly limits further increases in TV dose distribution and reduces the local control rate. Thus, the accurate target delineation is crucial. Recently, technological improvements for precise target delineation have obtained more attention in the field of RT. The addition of functional imaging to RT can provide a more accurate anatomy of the tumor and normal tissues (such as location and size), along with biological information that aids to optimize the therapeutic index (TI) of RT. In this review, we discuss the application of some common MRI-based functional imaging techniques in clinical practice. In addition, we summarize the main challenges and prospects of these imaging technologies, expecting more inspiring developments and more productive research paths in the near future.

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A Review of Modern Radiation Therapy Dose Escalation in Locally Advanced Head and Neck Cancer

Cited by 25 publications

References 39 publications

Initial Experience of Intentional Internal High-Dose Policy Volumetric Modulated Arc Therapy of Neck Lymph Node Metastases ≥ 2 cm in Patients With Head and Neck Squamous Cell Carcinoma

Initial Experience of Intentional Internal High-Dose Policy Volumetric Modulated Arc Therapy of Neck Lymph Node Metastases ≥ 2 cm in Patients With Head and Neck Squamous Cell Carcinoma

Oncoimmunology Meets Organs-on-Chip

Role of MRI-Based Functional Imaging in Improving the Therapeutic Index of Radiotherapy in Cancer Treatment

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