Postoperative radiotherapy after flap reconstructive surgery in patients with head and neck cancer: A retrospective monocentric study with flap delineation to assess toxicity and relapse

Gerard, M; Guévelou, Jennifer Le; Jacksic, N.; Lequesne, Justine; Bastit, Vianney; Géry, B.; Jeanne, Corinne; Batalla, A.; Lacroix, Jeannine; Kammerer, Emmanuel; Lasne-Cardon, Audrey; Thariat, Juliette

doi:10.1016/j.canrad.2020.06.024

Cited by 8 publications

(9 citation statements)

References 18 publications

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“…Considerable gaps in knowledge exist on how to handle a flap when poRT is needed and the transfer of flap-related advances to poRT ( 7 , 45 , 104 , 112 – 114 ). Flaps now represent a substantial proportion of patients operated on for mucosal HNC ( 11 ).…”

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

“…The current approach often encompasses over 80% of flaps in target volumes, typically focusing on the hypodense fatty portion of the flap ( 112 ). Dose–volume effects, unfortunately, have been scarcely documented ( 112 ). To address this, automatic segmentation tools utilizing neural networks may facilitate a more systematic flap delineation.…”

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

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Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

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BackgroundMajor advances have been made in reconstructive surgery in the last decades to reduce morbidity in head and neck cancer. Flaps are now present in 80% of patients with oral cavity cancer to cover anatomic, functional, and cosmetic needs. However, gaps in interdisciplinary innovation transfer from surgery to postoperative radiotherapy (poRT) remain challenging. We aimed to provide an interdisciplinary view of the challenges encountered by radiation oncologists in planning head and neck postoperative radiotherapy.MethodsA systematic and critical review was conducted to address areas of optimization in surgery and radiology that may be relevant to poRT.ResultsDespite extensive surgical literature on flap techniques and salvage surgery, 13 retrospective series were identified, where flap outcomes were indirectly compared between surgery alone or poRT. These low-evidence studies suggest that radiotherapy accelerates flap atrophy, fibrosis, and osteoradionecrosis and deteriorates functional outcomes. Preliminary evidence suggests that tumor spread occurs at the flap–tissue junction rather than in the flaps. One prospective 15-patient study showed 31.3% vs. 39.2% flap volume reduction without or with poRT. In an international consensus, experts recognized the needs for optimized flap-sparing poRT against flap-related functional deterioration and bone damage. CT, MRI, and PET-CT modalities show potential for the delineation of the junction area between native tissues and flap for flap segmentation and to characterize flap-specific changes quantitatively and correlate them with patterns of relapse or complications.ConclusionFlap management in poRT is insufficiently documented, but poRT seems to damage flaps. Current gaps in knowledge underscore the need for prospective flap assessment and interdisciplinary trials investigating flap morbidity minimization by flap-sparing poRT planning.

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Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

Section: Effects Of Postoperative Radiotherapy On Flapsmentioning

confidence: 99%

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Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Thariat,

Carsuzaa,

Beddok

et al. 2024

Front. Oncol.

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“…To assess dose-effect relationships of flaps and functional outcomes in comparison with surgery only, radiation oncologists will have to be able to delineate flaps on their planning CT or MRI as was done in conventional head and neck sites ( 85 ). Current practice for free flaps seems to include flaps in the target volumes with clinical target volumes centered on flap hypodense fatty portion ( 86 ). For that, a perfect knowledge of the tumor location (tumor implantation, and sites of involved margins), the type of surgery and reconstruction performed with comprehensive operatory reports are critical for the radiation oncologists ( Figure 7 ).…”

Section: Impact Of Sinonasal Reconstruction On Radiotherapy Planningmentioning

confidence: 99%

Interdisciplinary challenges and aims of flap or graft reconstruction surgery of sinonasal cancers: What radiologists and radiation oncologists need to know

Carsuzaa

Vérillaud

Marcy³

et al. 2022

Front. Oncol.

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In sinonasal cancer surgery, a fundamental challenge is to understand the postoperative imaging changes after reconstruction. Misinterpretation of post-operative imaging may lead to a misdiagnosis of tumor recurrence. Because radiotherapy planning is based on imaging, there are many gaps in knowledge to be filled in the interpretation of postoperative imaging to properly define radiotherapy tumor volumes in the presence of flaps. On the other hand, radiotherapy may be responsible for tissue fibrosis or atrophy, the anatomy of the reconstructed region and the functional outcomes may change after radiotherapy compared to surgery alone. This narrative review illustrates the interdisciplinary aims and challenges of sinonasal reconstructive surgery using flaps or grafts. It is particularly relevant to radiologists and radiation oncologists, at a time when intensity modulated radiotherapy and proton therapy have the potential to further contribute to reduction of morbidity.

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“…Based on data in breast cancer patients, fat in a flap could promote tumor growth (unless such observations are due to confounding obesity-related or hormone-related issues) [23]. A monocentric pilot study showed that radiation oncologists included most of the flap in their CTV-T. Noteworthy, 81% of the body flap was indeed included in CTV-T (Figure 1), suggesting that flap borders were inaccurately identified during delineation [24]. Full flap inclusion in the CTV results in increased irradiated volumes (especially for large flaps), and subsequent risk of excess toxicities and worse functional outcomes [25][26][27][28][29].…”

Section: Introductionmentioning

confidence: 99%

Flap delineation guidelines in postoperative head and neck radiation therapy for head and neck cancers

Guévelou

Bastit

Marcy³

et al. 2020

Radiotherapy and Oncology

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Postoperative radiotherapy after flap reconstructive surgery in patients with head and neck cancer: A retrospective monocentric study with flap delineation to assess toxicity and relapse

Cited by 8 publications

References 18 publications

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Reconstructive flap surgery in head and neck cancer patients: an interdisciplinary view of the challenges encountered by radiation oncologists in postoperative radiotherapy

Interdisciplinary challenges and aims of flap or graft reconstruction surgery of sinonasal cancers: What radiologists and radiation oncologists need to know

Flap delineation guidelines in postoperative head and neck radiation therapy for head and neck cancers

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