Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma

Daly, Megan E.; Lieskovsky, Y.; Pawlicki, Todd; Yau, Jervis; Pinto, Harlan A.; Kaplan, Michael; Fee, Willard E.; Koong, Albert C.; Goffinet, Don R.; Li, Xing; Le, Quynh Thu

doi:10.1002/hed.20505

Cited by 82 publications

(46 citation statements)

References 49 publications

(70 reference statements)

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“…The observed low DM incidence rate of 7% (28/399 patients with initial M0-status, (Figure 1) is concordant with that of recent reports in the IMRT literature, ranging between ~ 8-12% (> 90% 3y DM-free survival) [4,6,19,30] following IMRT-chemotherapy, and seems to be lower than many published values following conventional radiation techniques, with ~ 8-25% of DM [1,2,3,8,11,14,24]. A relation between increasing localregional tumor control rates following IMRT and this tendency to decreasing DM rates can not be excluded.…”

Section: Discussionsupporting

confidence: 89%

“…The site of the primary may influence the rate of DM, with reported ~ 75-80% 2-3y DM-free survival rates in localregionally advanced nasopharyngeal [16,18,21,29], sinonasal [9,13,22], hypopharyngeal [27] and laryngeal tumors [5], ~ 85-95% in oropharyngeal tumors [4,7,15], and ~ 90-95% in oral cavity cancer (OCC) [3][4][5][6]10], respectively. For local-regionally advanced hypopharyngeal tumors, 3y-DM free survival rates of as low as 30% are reported [8,17].…”

Section: Discussionmentioning

confidence: 99%

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Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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Background and Purpose: Intensity modulated radiation therapy (IMRT) combined treatment approaches, surgical and radiodiagnostic advances, respectively, lead to improved local-regional control in head neck cancer (HNC). With increasing local-regional control, distant metastases (DM) become more meaningful. In some trials without concomitant chemotherapy, induction chemotherapy (IC) resulted in an absolute reduction of DM by ~10-15%. In order to define a more efficient selection of patients at risk for DM with respect to IC and M-staging, we analysed our patients treated by contemporary standards. Patients and Methods: Between 1/2002 to 12/2007, 409 HNC patients were treated with IMRT; 303/409 (74%) underwent definitive, 106 (26%) postoperative IMRT. The mean/median follow-up was 23/20 months (3-72). 70% tolerated 4-7, 9% 1-3 cycles of simultaneous cisplatin. Treatment followed a prospectively designed protocol. In a previous study with 172 HNC IMRT patients, gross tumor volume (GTV) was found the strongest predictor for local-regional control. In the current study, this criterion has been prospectively tested for DM. Numbers needed to treat were calculated for IC. Results: DM developed in 28/399 (7%) patients; 10 presented initially with DM (total 38/409). In 13/28 (46%), DM remained the only manifestation of disease. GTV was the strongest predictor for DM (p < 0.0001) of all tested. Only 4% of patients with GTV < 70 cc developed DM, vs. 25% (18/73) with > 70 cc; only 6 of them (6/73, 8%) developed isolated DM. Conclusion: GTV was the most significant predictor for DM, that could guide selective pre-treatment M-staging. The subgroup with isolated DM in the high risk group, that could benefit from IC, is small. (Table 1). Die Therapie folgte einem prospektiv festgelegten Protokoll. In einer früheren Studie mit 172 KHTPatienten mit definitiver IMRT wurde das "gross tumor volume" (GTV) als signifikantester Prädiktor für die Lokoregionalkontrolle nachgewiesen. In der hier präsentierten Studie wurde dasselbe volumetrische Staging-System getestet hinsichtlich dessen prä-diktiven Wert für DM, um eine allfällige IC wie auch die initiale Metastasensuche selektiver auf ein Hochrisikopatientensegment beschränken zu können. Ergebnisse: DM fanden sich bei 38/409 Patienten bzw. bei 28/399 mit initialem M0-Status (7%) (Abbildung 1, Tabelle 2); 10 Patienten hatten initial bereits DM. Bei nur 13/28 (46%) blieben DM die einzige Krankheitsmanifestation. Das GTV erwies sich als signifikantester aller getesteter Metastasenprädiktoren (p < 0,0001, Abbildung 2, Tabelle 3); nur 4% der Patienten mit einem GTV < 70 cc entwickelten DM, vs. 25% (18/73) mit GTV > 70 cc, von diesen nur 6 mit isolierter DM (6/73, 8%). IntroductionClinical implementation of intensity modulated radiation therapy (IMRT), together with combined treatment approaches in definitive and postoperative treatment settings, surgical and radio-diagnostic advances, respectively, lead to an encouraging improvement of the loco-regional control in head and neck cancer (HNC)...

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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“…However, IMRT requires very high precision in determining the target volumes in order to avoid marginal misses. There are reports in the literature indicating an increased risk of recurrence in the margins of the irradiated field [51,52,53]. Chen et al [54] reported the need for careful analysis of preoperative imaging studies, operative notes and histopathological reports to determine the appropriate target volumes and postoperative radiotherapy doses.…”

Section: Discussionmentioning

confidence: 99%

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Mucha-Małecka¹,

Składowski²,

Lange³

2015

pjp

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The aim of the study was to assess the prognostic value of postoperative histopathological factors as well as the clinical usefulness of the modified risk score for recurrence. In a group of 197 patients with laryngeal cancer who underwent surgery followed by radiation therapy, partial resection was performed in 21.5% of patients and total resection in 78.5%. The majority of patients had T3 or T4 (74%) and N0 (63%) cancer. Macroscopically positive margins were reported in 10% of patients after partial resection and in 7% of patients after total resection, whereas microscopically positive margins were observed in 31% and 20% of cases, respectively. Extracapsular extension was observed in 22% of patients. In order to estimate local and nodal recurrence risk rates, criteria developed by Peters were used. Five-year local control (LC) was achieved in 88% of patients, disease-free survival (DFS) in 68% of patients and overall survival (OS) in 73% of patients. In the case of macroscopically positive margins, the 5-year DFS was 33% lower compared to radical surgery and 25% lower in the case of microscopically positive margins. The 5-year DFS was reduced by 29% due to extracapsular extension. Cox model analysis indicated that the degree of recurrence risk was the most potent independent prognostic factor for postoperative radiation therapy in laryngeal cancer. Negative histopathological factors influencing results of combined treatment of laryngeal cancer include macro-and microscopically positive margins, neck lymph node involvement and extracapsular extension.

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“…IMRT results in better dose conformation to the PTV and improved sparing of adjacent uninvolved normal tissues compared with conventional radiotherapy. Numerous studies showed a reduction in the incidence and severity of xerostomia following parotid-sparing IMRT [19][20][21][22][23][24][25][26][27][28][29][30], with post-treatment recovery of saliva production and resultant improvement in patient-reported quality of life [31]. Three randomised controlled trials comparing parotid-sparing IMRT and conventional radiotherapy were reported [12,32,33].…”

Section: Discussion and Literature Reviewmentioning

confidence: 99%

Interobserver variation in parotid gland delineation: a study of its impact on intensity-modulated radiotherapy solutions with a systematic review of the literature

Loo

Martin²,

Smith³

et al. 2012

The British Journal of Radiology

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Objectives: This study evaluates the interobserver variation in parotid gland delineation and its impact on intensity-modulated radiotherapy (IMRT) solutions. Methods: The CT volumetric data sets of 10 patients with oropharyngeal squamous cell carcinoma who had been treated with parotid-sparing IMRT were used. Four radiation oncologists and three radiologists delineated the parotid gland that had been spared using IMRT. The dose-volume histogram (DVH) for each study contour was calculated using the IMRT plan actually delivered for that patient. This was compared with the original DVH obtained when the plan was used clinically. Results: 70 study contours were analysed. The mean parotid dose achieved during the actual treatment was within 10% of 24 Gy for all cases. Using the study contours, the mean parotid dose obtained was within 10% of 24 Gy for only 53% of volumes by radiation oncologists and 55% of volumes by radiologists. The parotid DVHs of 46% of the study contours were sufficiently different from those used clinically, such that a different IMRT plan would have been produced. Conclusion: Interobserver variation in parotid gland delineation is significant. Further studies are required to determine ways of improving the interobserver consistency in parotid gland definition.

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Evaluation of patterns of failure and subjective salivary function in patients treated with intensity modulated radiotherapy for head and neck squamous cell carcinoma

Abstract: The predominant pattern of failure in IMRT-treated patients is in the gross tumor volume. Parotid sparing with IMRT resulted in less subjective xerostomia and may improve quality of life in irradiated HNSCC patients.

Cited by 82 publications

References 49 publications

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Histopathological factors influencing results of combined treatment in patients with laryngeal cancer

Interobserver variation in parotid gland delineation: a study of its impact on intensity-modulated radiotherapy solutions with a systematic review of the literature

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