Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Cui, Taoran; Ward, Matthew C.; Joshi, Nikhil; Woody, N.M.; Murray, Eric; Potter, John D.; Dorfmeyer, A.; Greskovich, J.F.; Koyfman, Shlomo A.; Xia, Peng

doi:10.1002/hed.25594

Cited by 11 publications

(11 citation statements)

References 25 publications

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“…Compared with IMRT, we found that VMAT was better at preventing Xer2y. This finding supported the previous work [ 19 ]. Furthermore, we revealed that VMAT conserves salivary function when coMD is established.…”

Section: Discussionsupporting

confidence: 94%

A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era

Yang

Xie

Zhang

et al. 2021

Aging

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Background: Dry mouth sensation cannot be improved completely even though parotids are spared correctly. Our purpose is to develop a nomogram to predict the moderate-to-severe late radiation xerostomia for patients with locoregionally advanced nasopharyngeal carcinoma (LA-NPC) in intensity modulated radiation therapy (IMRT) / volumetric modulated arc radiotherapy (VMAT) era. Methods: A dataset of 311 patients was retrospectively collected between January 2010 and February 2013. The binary logistic regression was to estimate each factor’s prognostic value for development of moderate-to-severe patient-reported xerostomia at least 2 years (Xer2y) after completion of radiotherapy. Therefore, we can develop a nomogram according to binary logistic regression coefficients. This novel model was validated by bootstrapping analyses. Results: Contralateral Parotid mean dose (coMD<24.4Gy), VMAT (yes), and platinum-based concurrent chemoradiotherapy (no) were significantly related to patient-reported xerostomia at least 2 years (Xer2y) (all p < 0.001), and were included in the nomogram. Receiver operating characteristic (ROC) analysis revealed AUC (area under the ROC curve) with the value of 0.811 (0.710-0.912) of the nomogram, which was significantly higher than coMD 0.698 (0.560-0.840) from QUANTEC2010 (p<0.001). Calibration plots illustrated that the predicted Xer2y was close to the actual observation, and decision curve analyses (DCA) indicated valid positive net benefits. Conclusion: We developed a feasible nomogram to predict patient-rated Xer2y based on comprehensive individual data in patients with LA-NPC in the real world. The proposed model is able to facilitate the development of treatment plan and quality of life improvement.

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Section: Discussionsupporting

confidence: 94%

A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era

Yang

Xie

Zhang

et al. 2021

Aging

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“…All the treatment plans were dosimetric compared. In the group of patients irradiated by VMAT technique, the toxicities were signifi cantly lower 7 .…”

Section: Intensity Modulated Volumetric Therapy (Vmat) In Hnsccmentioning

confidence: 91%

Modern Radiotherapy for Head and Neck Cancers: Benefits and Pitfalls - a Literature Review

Mireștean¹,

Buzea²,

Iancu³

et al. 2019

Rev. Med. Mod.

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Curative radiotherapy is part of the multimodal treatment for locally advanced head and neck cancers. The technical revolution in the fi eld of radiation therapy and medical imaging has made possible a better conformation of the target volumes with irregular shapes with a dose reduction at the radiosensitive organs in the vicinity. Three-dimensional Conformal Radiotherapy (3D-CRT) has been replaced by Intensity Modulated Radiotherapy (IMRT), and more recently the Intensity Modulated Volumetric Arc Therapy (VMAT) technique is being used on an ever-expanding scale as a replacement for the "step and shot" IMRT technique. The benefi ts of the IMRT/VMAT techniques were mainly consisting of a better conformation for the target volumes with irregular shapes and the reduction of acute and late xerostomia. The results in the tumor control are considered similar to those obtained by the 3D-CRT technique except for nasopharyngeal cancer in which the use of chemo-radiotherapy by the IMRT technique has led to an improved local survival and local and regional control rate. Increasing the incidence of HPV-positive head and neck cancers with a better prognosis and the need to improve quality of life would be an argument in favor of using treatments with a low toxicity profi le. By reducing the dose of healthy tissue, the use of modern irradiation techniques opens new horizons for the re-irradiation with high radiation doses of recurrent head and neck tumors.

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“…AP has been extensively used for various sites in our department with consistently reasonable results. The AP optimization objectives used in this study were determined based on our prior experience in planning and treating for OPSCC [ 10 , 11 ]. To achieve consistent dosimetric qualities, both plans were optimized with the same set of objectives without any manual adjustment to eliminate any planner bias.…”

Section: Methodsmentioning

confidence: 99%

Dosimetric Benefits of Omitting Primary Tumor Beds in Postoperative Radiotherapy After Transoral Robotic Surgery Using the Auto-Planning Technique

Cui

Ward

Kittel

et al. 2021

Cureus

Self Cite

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Introduction: It has been suggested that post-transoral robotic surgery (post-TORS) radiotherapy (RT) might reduce the dose to organs at risk (OARs) adjacent to the primary tumor bed; however, the evidence supporting this has yet to be sufficient. This study examined the radiation dose reduction to OARs by omitting the primary tumor bed through the use of an Auto-Planning (AP)-based workflow. Methods: Twelve patients were identified who underwent post-TORS RT to the primary tumor bed and the unilateral/bilateral neck lymph nodes. In each patient, two treatment plans were designed: a Comprehensive (Comp)-plan treating the original planning target volume (PTV) including both the primary tumor bed and the lymph nodes, and a Neck-plan treating only the lymph nodes and omitting the primary tumor bed. Both plans were optimized using AP to ensure plan quality consistency. We compared the doses received by 95% of the primary tumor beds and lymph nodes (D95%) and our institutional dose constraints for the OARs between the Comp- and Neck-plans. Statistical analysis was performed using R Statistical Software (R Foundation for Statistical Computing, Vienna, Austria) with a two-tailed paired Wilcoxon signed-rank test. Results: All plans met target dose coverage requirements with at least 95% of the PTVs covered with the corresponding prescription doses. The primary tumor bed in the Neck-plans was spared with a significantly lower mean D95% (25.9 Gy vs. 60.0 Gy; p < 0.01; Wilcoxon test). The mean dose to the oral cavity (20.9 Gy vs. 28.1 Gy; p < 0.01) and the supraglottis (36.9 Gy vs. 28.2 Gy; p < 0.01) was significantly lower in the Neck-plans. Conclusion: This study suggests that sparing the primary tumor bed during post-TORS RT offers dosimetric benefits to nearby OARs with significant dose reductions to the oral cavity and supraglottis. Further study of the clinical risks and benefits afforded by this strategy is needed.

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Correlation between plan quality improvements and reduced acute dysphagia and xerostomia in the definitive treatment of oropharyngeal squamous cell carcinoma

Cited by 11 publications

References 25 publications

A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era

A nomogram for predicting late radiation-induced xerostomia among locoregionally advanced nasopharyngeal carcinoma in intensity modulated radiation therapy era

Modern Radiotherapy for Head and Neck Cancers: Benefits and Pitfalls - a Literature Review

Dosimetric Benefits of Omitting Primary Tumor Beds in Postoperative Radiotherapy After Transoral Robotic Surgery Using the Auto-Planning Technique

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