Dose–volume histogram analysis of brainstem necrosis in head and neck tumors treated using carbon-ion radiotherapy

Shirai, Katsuyuki; Fukata, Kyohei; Adachi, Akiko; Saitoh, Jun; Musha, Atsushi; Abe, Takanori; Kanai, Tatsuaki; Kobayashi, Daijiro; Shigeta, Yuka; Yokoo, Satoshi; Chikamatsu, Kazuaki; Ohno, Tatsuya; Nakano, Takashi

doi:10.1016/j.radonc.2017.08.014

Cited by 17 publications

(33 citation statements)

References 23 publications

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“…However, the follow‐up durations for the surviving patients may still be insufficient for the assessment of late adverse events after carbon‐ion radiotherapy. Late toxicities such as osteonecrosis or brain necrosis could develop over several years after irradiation . Thus, further observation is desired.…”

Section: Discussionmentioning

confidence: 99%

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Carbon‐ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study

et al. 2019

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This study aimed to evaluate the efficacy of carbon‐ion radiotherapy in combination with chemotherapy using dacarbazine, nimustine, and vincristine (DAV therapy) in mucosal melanoma. Twenty‐one patients with clinically localized mucosal melanoma of the head and neck were enrolled. The primary endpoint was 3‐year overall survival (OS). Secondary endpoints included local control, progression‐free survival (PFS), and adverse event occurrence. Carbon‐ion radiotherapy with a dose of 57.6‐64.0 Gy (relative biological effectiveness) in 16 fractions was delivered concurrently with DAV therapy, and 2 cycles of adjuvant DAV therapy were administered every 6 weeks. The median follow‐up periods were 15.5 months for all patients, and 31.2 months for 12 surviving patients. All patients had locally advanced T4a or T4b disease in the rhino‐sinus area. In 16 patients (76.2%), 3 cycles of planned DAV therapy were completed. The 3‐year OS and PFS rates were 49.2% and 37.0% respectively. The 3‐year local control rate was 92.3%. Eleven patients (52%) developed distant metastasis, which was the most frequent pattern of the first failure. Commonly presenting acute grade 2‐3 toxicities associated with radiotherapy and chemotherapy were mucositis (11 patients [53%]) and leukopenia (9 patients [43%]), which improved with conservative therapy. None of the patients developed grade 3 or greater late toxicities. Carbon‐ion radiotherapy in combination with DAV therapy led to excellent local control for advanced mucosal melanoma within acceptable toxicities. The efficacy of additional DAV therapy in improving survival was weaker than expected as distant metastases still occurred frequently. Trial registration no. UMIN000007939.

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Section: Discussionmentioning

confidence: 99%

“…Late toxicities such as osteonecrosis or brain necrosis could develop over several years after irradiation. 31 Thus, further observation is desired.…”

Section: Discussionmentioning

confidence: 99%

Carbon‐ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study

et al. 2019

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“…In a study by Gondi et al [21], logistic regression modelling showed that an increase in mean dose from 0.0 to greater than 0.0 Gy led to 14.8 times increased odds of neurocognitive impairment. Increased doses to other critical neurological structures like the brainstem and temporal lobes have also been shown to have higher rates of radionecrosis [22,23].…”

Section: Discussionmentioning

confidence: 99%

Proton Versus Intensity-Modulated Radiation Therapy: First Dosimetric Comparison for Total Scalp Irradiation

Sharma

Kowalski

McGovern

et al. 2019

International Journal of Particle Therapy

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Purpose: Total scalp irradiation (TSI) is used to treat malignancies of the scalp and face, including angiosarcomas, nonmelanoma skin cancers, and cutaneous lymphomas. Owing to the irregularity of the scalp contour and the presence of underlying critical organs at risk (OARs), radiation planning is challenging and technically difficult. To address these complexities, several different radiation therapy techniques have been used. These include the combined lateral photon-electron technique (3DRT), intensitymodulated radiation therapy (IMRT)/volumetric arc therapy (VMAT), helical tomotherapy (HT), and mold-based high-dose-rate brachytherapy (HDR BT). However, the use of proton radiation therapy (PRT) has never been documented. Materials and Methods: A 71-year-old, immunosuppressed man presented with recurrent nonmelanoma skin cancer of the scalp. He was successfully treated at our center with PRT to deliver TSI. A comparative VMAT treatment plan was generated and dose to critical OARs was compared. Results: We present the first clinical case report of PRT for TSI and dosimetric comparison to a VMAT plan. The PRT and VMAT plans provided equivalent target volume coverage; however, the PRT plan significantly reduced dose to the brain, hippocampi, and optical apparatus. Conclusion: TSI planned with PRT is relatively straightforward from a planning perspective and does not require a bolus. It also has the potential to decrease radiation therapy-related toxicity. However, PRT is relatively expensive and not universally available. The uncertainty surrounding the end-range of the proton beam is a consideration. Although there are potential disadvantages to using PRT for TSI, its use should be considered by treating radiation oncologists and referring physicians.

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“…In all patients with highly advanced tumor who were expected to develop high‐grade adverse events, careful and adequate explanation was given repeatedly and informed consent was obtained prior to the treatment. Recently, much effort has been made to reduce adverse events . For example, we identified the optimal cutoff dose constraints for predicting the occurrence of brain necrosis by analysis of past cases and the dose constraints might help minimize brainstem necrosis after C‐ion RT .…”

Section: Discussionmentioning

confidence: 99%

“…Recently, much effort has been made to reduce adverse events . For example, we identified the optimal cutoff dose constraints for predicting the occurrence of brain necrosis by analysis of past cases and the dose constraints might help minimize brainstem necrosis after C‐ion RT . We have shared these experiences within J‐CROS and all institutions treat patients with unified dose‐fractionation schedules and accumulate their clinical results to clarify the efficacy and toxicity profiles of C‐ion RT for non‐squamous cell malignant tumors of the nasopharynx.…”

Section: Discussionmentioning

confidence: 99%

A multi‐institutional retrospective study of carbon‐ion radiotherapy for non‐squamous cell malignant tumors of the nasopharynx: Subanalysis of Japan Carbon‐Ion Radiation Oncology Study Group study 1402 HN

et al. 2018

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BackgroundThis multi‐institutional retrospective study focused on the clinical outcome of carbon‐ion radiotherapy (C‐ion RT) for non‐squamous cell malignant tumors of the nasopharynx.MethodsThe Japan Carbon‐ion Radiation Oncology Study Group collected and analyzed data for 43 patients with non‐squamous cell malignant tumors of the nasopharynx treated with C‐ion RT at four institutions in Japan.ResultsTwenty‐nine patients had adenoid cystic carcinomas, seven had malignant melanomas, three had adenocarcinomas, two had mucoepidermoid carcinomas, and two had other pathologies. Twenty‐six of the 43 patients (61%) had T4 tumors. The most common dose‐fractionation schedule was 64 Gy (relative biological effectiveness) in 16 fractions. The median follow‐up period was 30 months. The 2‐year local control (LC) and overall survival (OS) rates were 88% and 84%, respectively. For late toxicity, one patient developed grade 4 optic nerve disorder and two developed grade 5 pharyngeal hemorrhage. Actual incidence of grade 3 or higher late adverse events was 19%, and included cranial nerve dysfunction, jaw bone necrosis, central nervous system necrosis, and ear inflammation.ConclusionsC‐ion RT provided good LC and OS rates with acceptable toxicity for treatment of non‐squamous cell malignant tumors of the nasopharynx.

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Dose–volume histogram analysis of brainstem necrosis in head and neck tumors treated using carbon-ion radiotherapy

Abstract: The present study indicated that the dose constraints might help minimize brainstem necrosis after carbon-ion radiotherapy.

Cited by 17 publications

References 23 publications

Carbon‐ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study

Carbon‐ion radiotherapy combined with chemotherapy for head and neck mucosal melanoma: Prospective observational study

Proton Versus Intensity-Modulated Radiation Therapy: First Dosimetric Comparison for Total Scalp Irradiation

A multi‐institutional retrospective study of carbon‐ion radiotherapy for non‐squamous cell malignant tumors of the nasopharynx: Subanalysis of Japan Carbon‐Ion Radiation Oncology Study Group study 1402 HN

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