Prospective Assessment of Patterns of Failure After High-Precision Definitive (Chemo)Radiation in Head-and-Neck Squamous Cell Carcinoma

Gupta, Tejpal; Jain, Sandeep; Agarwal, Jai Prakash; Ghosh‐Laskar, Sarbani; Phurailatpam, Reena; Pai-Shetty, Rajershi; Dinshaw, Ketayun A.

doi:10.1016/j.ijrobp.2010.01.054

Cited by 16 publications

(17 citation statements)

References 35 publications

(42 reference statements)

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“…Vascular density of the early recurrent tumours was significantly lower compared with their matched primary samples in our series. Local recurrences in all 12 patients occurred in the high radiation dose area (⩾70 Gy), the common pattern of failure in HNSCC after RT ( Daly et al , 2011 ; Gupta et al , 2011 ).…”

Section: Discussionmentioning

confidence: 99%

Head and neck cancer relapse after chemoradiotherapy correlates with CD163+ macrophages in primary tumour and CD11b+ myeloid cells in recurrences

et al. 2014

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Background:We investigated the prognostic role of tumour-associated macrophages (TAMs) in patients with head and neck squamous cell carcinoma (HNSCC) treated with definitive chemoradiotherapy (CRT).Methods:The expression of CD68+, CD163+ and CD11b+ cells was assessed using immunohistochemistry in n=106 pre-treatment tumour biopsy samples and was correlated with clinicopathological characteristics, including T-stage, N-stage, grading, tumour localisation, age and sex as well as local failure-free survival (LFFS), distant metastases-free survival (DMFS), progression-free (PFS), and overall survival (OS). Finally, TAMs expression and vessel density (CD31) were examined in n=12 available early local recurrence samples and compared with their matched primary tumours . The diagnostic images and radiotherapy plans of these 12 patients were also analysed. All local recurrences occurred in the high radiation dose region (⩾70 Gy).Results:With a median follow-up of 40 months, OS at 2 years was 60.5%. High CD163 expression in primary tumours was associated with decreased OS (P=0.010), PFS (P=0.033), LFFS (P=0.036) and DMFS (P=0.038) in multivariate analysis. CD163 demonstrated a strong prognostic value only in human papillomavirus (p16INK4)-negative patients. Early local recurrence specimens demonstrated a significantly increased infiltration of CD11b+ myeloid cells (P=0.0097) but decreased CD31-positive vessel density (P=0.0004) compared with their matched primary samples.Conclusions:Altogether, baseline CD163 expression predicts for an unfavourable clinical outcome in HNSCC after definitive CRT. Early local recurrences showed increased infiltration by CD11b+ cells. These data provide important insight on the role of TAMs in mediating response to CRT in patients with HNSCC.

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Section: Discussionmentioning

confidence: 99%

Head and neck cancer relapse after chemoradiotherapy correlates with CD163+ macrophages in primary tumour and CD11b+ myeloid cells in recurrences

et al. 2014

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“…The majority of RT plans in that study were 3-dimensional (3D) conformal, and we demonstrated that PE is critical in the process of target volume delineation in those cases. Currently, in the era of intensity modulated radiation therapy (IMRT) and proton therapy (IMPT) with their high level of treatment precision, target volume definition is increasingly critical, particularly in head and neck cancer (8, 9). As a continuation of efforts to characterize the impact of a real-time peer review QA process, we performed an update of that previous study to assess the changes made during peer review in the setting of exclusive IMRT planning.…”

Section: Introductionmentioning

confidence: 99%

Prospective Qualitative and Quantitative Analysis of Real-Time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy

Cárdenas

Mohamed

Tao

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

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Purpose and Objectives Our department has a long-established comprehensive quality assurance (QA) planning clinic for patients undergoing radiation therapy (RT) for head and neck cancer. Our aim is to assess the impact of a real-time peer review QA process on the quantitative and qualitative radiation therapy plan changes in the era of intensity modulated RT (IMRT). Methods and Materials Prospective data for 85 patients undergoing head and neck IMRT who presented at a biweekly QA clinic after simulation and contouring were collected. A standard data collection form was used to document alterations made during this process. The original pre-QA clinical target volumes (CTVs) approved by the treating-attending physicians were saved before QA and compared with post-QA consensus CTVs. Qualitative assessment was done according to predefined criteria. Dice similarity coefficients (DSC) and other volume overlap metrics were calculated for each CTV level and were used for quantitative comparison. Changes are categorized as major, minor, and trivial according to the degree of overlap. Patterns of failure were analyzed and correlated to plan changes. Results All 85 patients were examined by at least 1 head and neck subspecialist radiation oncologist who was not the treating-attending physician; 80 (94%) were examined by ≥3 faculty members. New clinical findings on physical examination were found in 12 patients (14%) leading to major plan changes. Quantitative DSC analysis revealed significantly better agreement in CTV1 (0.94 ± 0.10) contours that in CTV2 (0.82 ± 0.25) and CTV3 (0.86 ± 0.2) contours (P=.0002 and P=.03, respectively; matched-pair Wil-coxon test). The experience of the treating-attending radiation oncologist significantly affected DSC values when all CTV levels were considered (P=.012; matched-pair Wil-coxon text). After a median follow-up time of 38 months, only 10 patients (12%) had local recurrence, regional recurrence, or both, mostly in central high-dose areas. Conclusions Comprehensive peer review planning clinic is an essential component of IMRT QA that led to major changes in one third of the study population. This process ensured safety related to target definition and led to favorable disease control profiles, with no identifiable recurrences attributable to geometric misses or delineation errors.

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“…With the technological developments in RT, information about the patterns of failure of treatment techniques currently in practice are fundamental to identify the steps of the RT workflow where more aggressive strategies or practice improvements may bring additional therapeutic benefits. The steep penumbras of IMRT dose distributions, aimed at protecting radiosensitive normal tissues, raised some initial concerns about geographical misses in target borders [ 4 , 5 ]. However, in previous studies the majority of locoregional treatment failures originated in regions irradiated with high doses and seldom from the boundaries between the target volume and the parotids, oral cavity or submandibular glands [ 6 - 8 ].…”

Section: Introductionmentioning

confidence: 99%

“…The most common method of classification of locoregional recurrences is based on the quantification of the intersection between the volume of the recurrence and the 95% prescription isodose [ 5 , 6 , 8 , 10 ]. This isodose surface encompasses the treated volume or the tissues that received the therapeutic dose.…”

Section: Introductionmentioning

confidence: 99%

Assessment and topographic characterization of locoregional recurrences in head and neck tumours

et al. 2015

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PurposeTo evaluate the differences between three methods of classification of recurrences in patients with head and neck tumours treated with Radiation Therapy (RT).Materials and methods367 patients with head and neck tumours were included in the study. Tumour recurrences were delineated in the CT images taken during patient follow-up and deformable registration was used to transfer this volume into the planning CT. The methods used to classify recurrences were: method CTV quantified the intersection volume between the recurrence and the Clinical Target Volume (CTV); method TV quantified the intersection between the Treated Volume and the recurrence (for method CTV and TV, recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and outfield otherwise); and method COM was based on the position of the Centre Of Mass of the recurrence. A dose assessment in the recurrence volume was also made.ResultsThe 2-year Kaplan-Meier locoregional recurrence incidence was 10%. Tumour recurrences occurred in 22 patients in a mean time of 16.5 ± 9.4 months resulting in 28 recurrence volumes. The percentage of in-field recurrences for methods CTV, TV and COM was 7%, 43% and 50%, respectively. Agreement between the three methods in characterizing individually in-field and marginal recurrences was found only in six cases. Methods CTV and COM agreed in 14. The percentage of outfield recurrences was 29% using all methods. For local recurrences (in-field or marginal to gross disease) the average difference between the prescribed dose and D98% in the recurrence volume was -5.2 ± 3.5% (range: -10.1%-0.9%).ConclusionsThe classification of in-field and marginal recurrences is very dependent on the method used to characterize recurrences. Using methods TV and COM the largest percentage of tumour recurrences occurred in-field in tissues irradiated with high doses.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-015-0345-4) contains supplementary material, which is available to authorized users.

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Prospective Assessment of Patterns of Failure After High-Precision Definitive (Chemo)Radiation in Head-and-Neck Squamous Cell Carcinoma

Cited by 16 publications

References 35 publications

Head and neck cancer relapse after chemoradiotherapy correlates with CD163+ macrophages in primary tumour and CD11b+ myeloid cells in recurrences

Head and neck cancer relapse after chemoradiotherapy correlates with CD163+ macrophages in primary tumour and CD11b+ myeloid cells in recurrences

Prospective Qualitative and Quantitative Analysis of Real-Time Peer Review Quality Assurance Rounds Incorporating Direct Physical Examination for Head and Neck Cancer Radiation Therapy

Assessment and topographic characterization of locoregional recurrences in head and neck tumours

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