Modern radiotherapy for head and neck cancer

Alterio, Daniela; Marvaso, Giulia; Ferrari, Annamaria; Volpe, Stefania; Orecchia, Roberto; Jereczek‐Fossa, Barbara Alicja

doi:10.1053/j.seminoncol.2019.07.002

Cited by 161 publications

(105 citation statements)

References 151 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…RT is a mainstay in the multimodality treatment of HNC and is often used in the adjuvant setting for tumors demonstrating high-risk features or, for certain early stage disease, as a primary treatment option for radiosensitive tumors [27]. In advanced, unresectable diseases (recurrence, brain metastasis, or oligometastases [distant metastasis in <5 locations]), reirradiation or stereotactic beam radiation therapy can be considered [144]. Previous traditional 3D conformal therapies have been replaced by intensity-modulated radiotherapy to better delineate target areas while sparing nearby structures [144].…”

Section: Emerging Developments: Radiation Therapymentioning

confidence: 99%

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

Yan

Knochelmann

Morgan

et al. 2020

Cancers

View full text Add to dashboard Cite

Cancers that arise in the head and neck region are comprised of a heterogeneous group of malignancies that include carcinogen- and human papillomavirus (HPV)-driven mucosal squamous cell carcinoma as well as skin cancers such as cutaneous squamous cell carcinoma, basal cell carcinoma, melanoma, and Merkel cell carcinoma. These malignancies develop in critical areas for eating, talking, and breathing and are associated with substantial morbidity and mortality despite advances in treatment. Understanding of advances in the management of these various cancers is important for all multidisciplinary providers who care for patients across the cancer care continuum. Additionally, the recent Coronavirus Disease 2019 (COVID-19) pandemic has necessitated adaptations to head and neck cancer care to accommodate the mitigation of COVID-19 risk and ensure timely treatment. This review explores advances in diagnostic criteria, prognostic factors, and management for subsites including head and neck squamous cell carcinoma and the various forms of skin cancer (basal cell carcinoma, cutaneous squamous cell carcinoma, Merkel cell carcinoma, and melanoma). Then, this review summarizes emerging developments in immunotherapy, radiation therapy, cancer survivorship, and the delivery of care during the COVID-19 era.

show abstract

Section: Emerging Developments: Radiation Therapymentioning

confidence: 99%

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

Yan

Knochelmann

Morgan

et al. 2020

Cancers

View full text Add to dashboard Cite

show abstract

“…intensity-modulated radiation therapy (IMRT) allows steep gradients. Inescapably, there is a growing necessity for higher precision in diagnostics and differentiation between tumour and adjacent healthy tissue [3]. This is directly relevant for target volume definition for RT and thus decides about tumour recurrence patterns and toxicity to healthy tissue [4].…”

Section: Introductionmentioning

confidence: 99%

Fibroblast activation protein inhibitor (FAPI) PET for diagnostics and advanced targeted radiotherapy in head and neck cancers

Syed

Flechsig

Liermann

et al. 2020

Eur J Nucl Med Mol Imaging

126

View full text Add to dashboard Cite

Purpose Cancer-associated fibroblasts (CAFs) expressing fibroblast activation protein (FAP) have been associated with the aggressive nature of head and neck cancers (HNCs). These tumours grow diffusely, leading to extremely challenging differentiation between tumour and healthy tissue. This analysis aims to introduce a novel approach of tumour detection, contouring and targeted radiotherapy of HNCs using visualisation of CAFs: PET-CT with 68Ga-radiolabeled inhibitors of FAP (FAPI). Methods FAPI PET-CT was performed without complications prior to radiotherapy in addition to contrast enhanced CT (CE-CT) and MRI on 14 patients with HNC. First, for tissue biodistribution analysis, volumes of interest were defined to quantify SUVmean and SUVmax in tumour and healthy parenchyma. Secondly, using four thresholds of three-, five-, seven- and tenfold increase of FAPI enhancement in the tumour as compared with normal tissue, four different gross tumour volumes (FAPI-GTV) were created automatically. These were compared with GTVs created conventionally with CE-CT and MRI (CT-GTV). Results The biodistribution analysis revealed high FAPI avidity within tumorous lesions (e.g. primary tumours, SUVmax 14.62 ± 4.44; SUVmean 7.41 ± 2.39). In contrast, low background uptake was measured in healthy tissues of the head and neck region (e.g. salivary glands: SUVmax 1.76 ± 0.31; SUVmean 1.23 ± 0.28). Considering radiation planning, CT-GTV was of 27.3 ml, whereas contouring with FAPI resulted in significantly different GTVs of 67.7 ml (FAPI × 3, p = 0.0134), 22.1 ml (FAPI × 5, p = 0.0419), 7.6 ml (FAPI × 7, p = 0.0001) and 2.3 ml (FAPI × 10, p = 0.0001). Taking these significant disparities between the GTVs into consideration, we merged FAPI-GTVs with CT-GTVs. This resulted in median volumes, that were, as compared to CT-GTVs, significantly larger with FAPI × 3 (54.7 ml, + 200.5% relative increase, p = 0.0005) and FAPI × 5 (15.0 ml, + 54.9%, p = 0.0122). Furthermore, FAPI-GTVs were not covered by CE-CT-based planning target volumes (CT-PTVs) in several cases. Conclusion We present first evidence of diagnostic and therapeutic potential of FAPI ligands in head and neck cancer. Larger studies with histopathological correlation are required to validate our findings.

show abstract

“…We did not test our patients with p16 immunohistochemistry to identify HPV-associated oropharyngeal cancer which is now established as a distinct clinical entity with prognostic implications and a separate new staging system (28). Apart from increasing availability of particle beam therapy with its unique depth-dose characteristics (29), the last decade has also witnessed further technological improvements in photon-based treatment planning, delivery, and veri cation (30) with the introduction of volumetric modulated arc therapy/rotational IMRT, robust optimization, in-room image-guidance, and adaptive RT, none of which was used in our study.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial

Gupta

Sinha

Laskar

et al. 2020

Preprint

View full text Add to dashboard Cite

Purpose: To compare long-term disease-related outcomes and late radiation morbidity between intensity-modulated radiation therapy (IMRT) and three-dimensional conformal radiotherapy (3D-CRT) in head and neck squamous cell carcinoma (HNSCC) in the setting of a prospective randomized controlled trial.Methods: Previously untreated patients with early to moderately advanced non-metastatic squamous carcinoma of the oropharynx, larynx, or hypopharynx (T1-T3, N0-N2b, M0) planned for comprehensive irradiation of primary site and bilateral neck nodes were randomly assigned to either IMRT or 3D-CRT after written informed consent. Patients were treated with 6MV photons to a total dose of 70Gy/35 fractions over 7 weeks (3D-CRT) or 66Gy/30 fractions over 6 weeks (IMRT). A sample size of 60 patients was estimated to demonstrate 35% absolute difference in the incidence of ≥grade 2 acute xerostomia between the two arms. All time-to-event outcomes were calculated from date of randomization until the defined event using the Kaplan-Meier method. Results: At a median follow-up of 140 months for surviving patients, 10-year Kaplan-Meier estimates of loco-regional control (LRC); progression-free survival (PFS); and overall survival (OS) with 95% confidence interval (95%CI) were 73.6% (95%CI: 61.2-86%); 45.2% (95%CI: 32-58.4%); and 50.3% (95%CI: 37.1-63.5%) respectively. There were no significant differences in 10-year disease-related outcomes between 3D-CRT and IMRT for LRC [79.2% (95%CI: 62.2-96.2%) vs 68.7% (95%CI: 51.1-86.3%), p=0.39]; PFS [41.3% (95%CI: 22.3-60.3%) vs 48.6% (95%CI: 30.6-66.6%), p=0.59]; or OS [44.9% (95%CI: 25.7-64.1%) vs 55.0% (95%CI: 37-73%), p=0.49]. Significantly lesser proportion of patients in the IMRT arm experienced ≥grade 2 late xerostomia and subcutaneous fibrosis at all time-points. However, at longer follow-up, fewer patients remained evaluable for late radiation toxicity reducing statistical power and precision. Conclusions: IMRT provides a clinically meaningful and sustained reduction in the incidence of moderate to severe xerostomia and subcutaneous fibrosis compared to 3D-CRT without compromising disease-related outcomes in long-term survivors of non-nasopharyngeal HNSCC.

show abstract

Modern radiotherapy for head and neck cancer

Cited by 161 publications

References 151 publications

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

The Evolution of Care of Cancers of the Head and Neck Region: State of the Science in 2020

Fibroblast activation protein inhibitor (FAPI) PET for diagnostics and advanced targeted radiotherapy in head and neck cancers

Intensity-modulated radiation therapy versus three-dimensional conformal radiotherapy in head and neck squamous cell carcinoma: long-term and mature outcomes of a prospective randomized trial

Contact Info

Product

Resources

About