Magnetic Resonance Guided Radiotherapy for Head and Neck Cancers

Gharzai, L.A.; Rosen, Benjamin; Mittal, Bharat B.; Yadav, Poonam

doi:10.3390/jcm11051388

Cited by 5 publications

(4 citation statements)

References 43 publications

(44 reference statements)

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“…Previous work has illustrated that MRI-derived parameters are predictive of treatment response after 70 Gy of chemoradiation for head and neck cancer 43-46 ; however, its role in de-escalation remains an active area of investigation. We were not able to predict hypoxia resolution on the basis of MRI parameters.…”

Section: Discussionmentioning

confidence: 99%

Hypoxia-Directed Treatment of Human Papillomavirus–Related Oropharyngeal Carcinoma

Lee,

Sherman,

Schöder

et al. 2024

JCO

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PURPOSE Standard curative-intent chemoradiotherapy for human papillomavirus (HPV)–related oropharyngeal carcinoma results in significant toxicity. Since hypoxic tumors are radioresistant, we posited that the aerobic state of a tumor could identify patients eligible for de-escalation of chemoradiotherapy while maintaining treatment efficacy. METHODS We enrolled patients with HPV-related oropharyngeal carcinoma to receive de-escalated definitive chemoradiotherapy in a phase II study (ClinicalTrials.gov identifier: NCT03323463 ). Patients first underwent surgical removal of disease at their primary site, but not of gross disease in the neck. A baseline 18F-fluoromisonidazole positron emission tomography scan was used to measure tumor hypoxia and was repeated 1-2 weeks intratreatment. Patients with nonhypoxic tumors received 30 Gy (3 weeks) with chemotherapy, whereas those with hypoxic tumors received standard chemoradiotherapy to 70 Gy (7 weeks). The primary objective was achieving a 2-year locoregional control (LRC) of 95% with a 7% noninferiority margin. RESULTS One hundred fifty-eight patients with T0-2/N1-N2c were enrolled, of which 152 patients were eligible for analyses. Of these, 128 patients met criteria for 30 Gy and 24 patients received 70 Gy. The 2-year LRC was 94.7% (95% CI, 89.8 to 97.7), meeting our primary objective. With a median follow-up time of 38.3 (range, 22.1-58.4) months, the 2-year progression-free survival (PFS) and overall survival (OS) rates were 94% and 100%, respectively, for the 30-Gy cohort. The 70-Gy cohort had similar 2-year PFS and OS rates at 96% and 96%, respectively. Acute grade 3-4 adverse events were more common in 70 Gy versus 30 Gy (58.3% v 32%; P = .02). Late grade 3-4 adverse events only occurred in the 70-Gy cohort, in which 4.5% complained of late dysphagia. CONCLUSION Tumor hypoxia is a promising approach to direct dosing of curative-intent chemoradiotherapy for HPV-related carcinomas with preserved efficacy and substantially reduced toxicity that requires further investigation.

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Section: Discussionmentioning

confidence: 99%

Hypoxia-Directed Treatment of Human Papillomavirus–Related Oropharyngeal Carcinoma

Lee,

Sherman,

Schöder

et al. 2024

JCO

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“…We therefore expect that the clinical implementation of MRI-based auto-delineation will be enabled by the novel evolutions in MRI-guided RT for HNC, e.g. MRI simulation [27,28]. Substantial differences in GTV delineation among ROs have been observed in the past, mainly driven by clinical experience and expertise [2,3].…”

Section: Discussionmentioning

confidence: 99%

Benefits of automated gross tumor volume segmentation in head and neck cancer using multi-modality information

Bollen

Willems

Wegge

et al. 2023

Radiotherapy and Oncology

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“…Although the current standard for a diagnostic MRI is a 3 Tesla (T) magnet, the two currently available MR-Linac machines offer 0.35 T and 1.5 T magnets, respectively. The 0.35 T magnet offers many benefits, such as higher frames per second, faster tissue tracking, and lower electron return effect, but it is yet to be determined if it will offer sufficient image quality to translate in clinically impactful effects for head and neck cancer patients [ 62 ].…”

Section: Current Challenges and Limitationsmentioning

confidence: 99%

“…Additional shielding on the MR-Linac is also needed to compensate for the mutually detrimental effects of the linear accelerator components and the magnetic field of the MRI, adding significant complexity to gantry design. The complexity and added weight of the gantry preclude simultaneous rotation and treatment delivery, currently limiting its application to static IMRT [ 62 ]. This is a particularly important barrier to the adoption of MRgRT in head and neck cancers, as the now standard volumetric modulated arc therapy (VMAT) is associated with better sparing of critical organs at risk such as the brainstem, parotid, esophagus, and oral cavity [ 64 ].…”

Section: Current Challenges and Limitationsmentioning

confidence: 99%

Magnetic Resonance-Guided Radiation Therapy for Head and Neck Cancers

Lavigne

O’Sullivan

et al. 2022

Current Oncology

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Despite the significant evolution of radiation therapy (RT) techniques in recent years, many patients with head and neck cancer still experience significant toxicities during and after treatments. The increased soft tissue contrast and functional sequences of magnetic resonance imaging (MRI) are particularly attractive in head and neck cancer and have led to the increasing development of magnetic resonance-guided RT (MRgRT). This approach refers to the inclusion of the additional information acquired from a diagnostic or planning MRI in radiation treatment planning, and now extends to online high-quality daily imaging generated by the recently developed MR-Linac. MRgRT holds numerous potentials, including enhanced baseline and planning evaluations, anatomical and functional treatment adaptation, potential for hypofractionation, and multiparametric assessment of response. This article offers a structured review of the current literature on these established and upcoming roles of MRI for patients with head and neck cancer undergoing RT.

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Magnetic Resonance Guided Radiotherapy for Head and Neck Cancers

Cited by 5 publications

References 43 publications

Hypoxia-Directed Treatment of Human Papillomavirus–Related Oropharyngeal Carcinoma

Hypoxia-Directed Treatment of Human Papillomavirus–Related Oropharyngeal Carcinoma

Benefits of automated gross tumor volume segmentation in head and neck cancer using multi-modality information

Magnetic Resonance-Guided Radiation Therapy for Head and Neck Cancers

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