IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

Jensen, Alexandra D; Nikoghosyan, Anna; Lossner, Karen; Herfarth, Klaus; Debus, Jürgen; Münter, Marc W.

doi:10.1186/1471-2407-12-163

Cited by 13 publications

(9 citation statements)

References 26 publications

(48 reference statements)

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“…Although the rate of higher grade acute reactions appeared to be higher in our photon group, the difference was not statistically significant. Mucositis, conjunctivitis, and hearing changes were the most common acute reactions observed, corresponding to the majority of involved sites and supported by more recent data . Mucositis rates in the C12 group were comparatively low and were consistent with observations by our Japanese colleagues .…”

Section: Discussionsupporting

confidence: 90%

Combined intensity‐modulated radiotherapy plus raster‐scanned carbon ion boost for advanced adenoid cystic carcinoma of the head and neck results in superior locoregional control and overall survival

Jensen

Nikoghosyan

Poulakis

et al. 2015

Cancer

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BACKGROUND:Local control in patients with adenoid cystic carcinoma (ACC) of the head and neck remains a challenge because of the relative radioresistance of these tumors. This prospective carbon ion pilot project was designed to evaluate the efficacy and toxicity of intensity-modulated radiotherapy (IMRT) plus carbon ion (C12) boost (C12 therapy). The authors present the first analysis of long-term outcomes of raster-scanned C12 therapy compared with modern photon techniques. METHODS: Patients with inoperable or subtotally resected ACC received C12 therapy within the pilot project. Whenever C12 was not available, patients were offered IMRT or fractionated stereotactic radiotherapy (FSRT). Patients received either C12 therapy at a C12 dose of 3 Gray equivalents (GyE) per fraction up to 18 GyE followed by 54 Gray (Gy) of IMRT or IMRT up to a median total dose of 66 Gy. Toxicity was evaluated according to version 3 of the Common Toxicity Terminology for Adverse Events. Locoregional control (LC), progression-free survival (PFS), and overall survival (OS) were analyzed using the Kaplan-Meier method. RESULTS: Fifty-eight patients received C12 therapy, and 37 received photons (IMRT or FSRT). The median follow-up was 74 months in the C12 group and 63 months in the photon group. Overall, 90% of patients in the C12 group and 94% of those in the photon group had T4 tumors; and the most common disease sites were paranasal sinus, parotid with skull base invasion, and nasopharynx. LC, PFS, and OS at 5 years were significantly higher in the C12 group (59.6%, 48.4%, 76.5%, respectively) compared with the photon group (39.9%, 27%, and 58.7%, respectively). There was no significant difference between patients who had subtotally resected and inoperable ACC. CONCLUSIONS: C12 therapy resulted in superior LC, PFS, and OS without a significant difference between patients with inoperable and partially resected ACC. Extensive and morbid resections in patients with advanced ACC may need to be reconsidered. The most common site of locoregional recurrence remains in field, and further C12 dose escalation should be evaluated. Cancer 2015;121:3001-9.

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Section: Discussionsupporting

confidence: 90%

Combined intensity‐modulated radiotherapy plus raster‐scanned carbon ion boost for advanced adenoid cystic carcinoma of the head and neck results in superior locoregional control and overall survival

Jensen

Nikoghosyan

Poulakis

et al. 2015

Cancer

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“…Douglas et al showed that for patients with salivary gland neoplasms involving the base of skull, treatment with GammaKnife stereotactic radiosurgery boost, following neutron radiotherapy, improved local control rates to about 80% at 40 months compared to historical controls receiving neutron therapy alone ( 5 ). Recent results in dose escalation using particle therapy have been reported ( 15 – 17 ). Pommier et al treated 23 patients with adenoid cystic carcinoma and skull base invasion with proton dose escalation to 75.9 Gy (median) in various fractionation schemes with a reported 5-year LRC rate of 93% ( 17 ).…”

Section: Discussionmentioning

confidence: 99%

“…Dose escalation with carbon ion therapy in a Japanese series including a variety of head and neck cancers – eight salivary gland tumors of different histologies – showed 100% local control rate at 5 years ( 16 ). Most recently, interim analysis of the German COSMIC trial using dose escalation with carbon ion boost for salivary gland malignancies showed tolerable acute toxicities, but the follow-up was too short for assessment of survival outcomes or late toxicity ( 15 ).…”

Section: Discussionmentioning

confidence: 99%

IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies: A Case Series

et al. 2014

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Patients with high risk salivary gland malignancies are at increased risk of local failure. We present our institutional experience with dose escalation using hypofractionated stereotactic body radiotherapy (SBRT) in a subset of this rare disease. Over the course of 9 years, 10 patients presenting with skull base invasion, gross disease with one or more adverse features, or those treated with adjuvant radiation with three or more pathologic features were treated with intensity-modulated radiation therapy followed by hypofractionated SBRT boost. Patients presented with variable tumor histologies, and in all but one, the tumors were classified as poorly differentiated high grade. Four patients had gross disease, three had gross residual disease, three had skull base invasion, and two patients had rapidly recurrent disease (≤6 months) that had been previously treated with surgical resection. The median stereotactic radiosurgery boost dose was 17.5 Gy (range 10–30 Gy) given in a median of five fractions (range 3–6 fractions) for a total median cumulative dose of 81.2 Gy (range 73.2–95.6 Gy). The majority of the patients received platinum based concurrent chemotherapy with their radiation. At a median follow-up of 32 months (range 12–120) for all patients and 43 months for surviving patients (range 12–120), actuarial 3-year locoregional control, distant control, progression-free survival, and overall survival were 88, 81, 68, and 79%, respectively. Only one patient failed locally and two failed distantly. Serious late toxicity included graft ulceration in one patient and osteoradionecrosis in another patient, both of which underwent surgical reconstruction. Six patients developed fibrosis. In a subset of patients with salivary gland malignancies with skull base invasion, gross disease, or those treated adjuvantly with three or more adverse pathologic features, hypofractionated SBRT boost to intensity-modulated radiotherapy yields good local control rates and acceptable toxicity.

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“…The CIRT has been used to treat several tumors of the head and neck area. It has not been employed for squamocellular carcinoma-the most common entity-but rather, for other, radioresistant histologies, such as salivary gland tumors [15][16][17][18][19][20][21][22], paranasal sinuses tumors (including sinonasal undifferentiated carcinoma, sinonasal adenocarcinoma, intestinal-type adenocarcinoma, and esthesioneuroblastoma, among others) [15,23], mucosal melanoma [24][25][26][27][28], lacrimal gland tumors [29][30][31], and bone and soft tissue sarcoma (including tumors of the skull base and cervical spine [32][33][34][35][36][37][38] At MedAustron, CIRT was begun in July 2019. Until September 2020, 91 patients have been treated and 42 of them had tumors in the head and neck.…”

Section: Cirt Protocols For Head and Neck In Medaustronmentioning

confidence: 99%

Carbon Ion Dose Constraints in the Head and Neck and Skull Base: Review of MedAustron Institutional Protocols

Fossati

Perpar

Georg

et al. 2021

International Journal of Particle Therapy

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Background Dose constraints are of paramount importance for the outcome of any radiotherapy treatment. In this article, we report dose-volume constraints as well as currently used fractionation schedules for carbon ion radiotherapy as applied in MedAustron (Wiener Neustadt, Austria). Materials and Methods For fractionation schedules, both German and Japanese regimes were used. From the clinical experience of National Institute of Radiological Sciences (Chiba, Japan) and Heidelberg Ion Therapy (Heidelberg, Germany; formerly GSI Helmholtzzentrum für Schwerionenforschung, Darmstadt, Germany) and the work by colleagues in Centro Nazionale Adroterapia Oncologica (Pavia, Italy) recalculating the dose from the microdosimetric kinetic model to the local effect model, we have set the dose constraints for critical organs of the head and neck area. Where no clinical data was available, an educated guess was made, based on data available from photon and proton series. Results We report the constraints for the optic nerve and chiasm, brainstem, spinal cord, cochlea, brain parenchyma, salivary gland, eye and adnexa, and mandibular/maxillary bone; constraints are grouped based on a fractionation scheme (German versus Japanese) and the risk of toxicity (safe, low to middle, and middle to high). Conclusion We think validation of dose constraints should present a relevant part of the activity of any carbon ion radiotherapy facility, and we anticipate future multicentric, joint evaluations.

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IMRT and carbon ion boost for malignant salivary gland tumors: interim analysis of the COSMIC trial

Cited by 13 publications

References 26 publications

Combined intensity‐modulated radiotherapy plus raster‐scanned carbon ion boost for advanced adenoid cystic carcinoma of the head and neck results in superior locoregional control and overall survival

Combined intensity‐modulated radiotherapy plus raster‐scanned carbon ion boost for advanced adenoid cystic carcinoma of the head and neck results in superior locoregional control and overall survival

IMRT with Stereotactic Body Radiotherapy Boost for High Risk Malignant Salivary Gland Malignancies: A Case Series

Carbon Ion Dose Constraints in the Head and Neck and Skull Base: Review of MedAustron Institutional Protocols

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