Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer

Sher, David J.; Pham, Nhat; Shah, Jennifer; Sen, Neilayan; Williams, Kimberly A.; Subramaniam, Rathan M.; Moore, William; Chorley, Regina; Ahn, Chul; Khan, Saad

doi:10.1016/j.ijrobp.2020.09.063

Cited by 37 publications

(22 citation statements)

References 21 publications

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“…Compared with NPC, oral cavity cancer treated with LNS irradiation has not yet been reported, and oropharyngeal cancer managed by such method had only one study. In the phase 2 study of David et al, volume de-escalation for elective neck irradiation did not lead to solitary neck recurrence in oropharyngeal and laryngeal cancer [ 22 ]. The field of elective neck irradiation included the adjacent cervical lymph node chain if the region involved a node.…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of adjuvant radiotherapy in oral cavity or oropharyngeal cancer: Feasibility of omitting lower-neck irradiation

Kao

Hsiao

et al. 2022

PLoS ONE

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Objectives Adjuvant radiotherapy is the standard of care in locally advanced head and neck cancers. The radiation field is correlated with the surgical field in the adjuvant radiotherapy setting; therefore, tailoring the irradiation field is reasonable. Materials and methods We retrospectively analyzed patients with oral cavity and oropharyngeal cancers included in the cancer registry between 2015 and 2019 in the study hospital. Patients who underwent whole-neck irradiation (WNI) were compared with those who underwent lower-neck–sparing (LNS) irradiation. Results A total of 167 patients with oral cavity and oropharyngeal cancers were included in the study. Cancer recurrence was recorded in 33% of the patients. The rate of recurrence of oral cavity and oropharyngeal cancer at neck level IV was 8%. The 2-year incidence of level IV recurrence was lower in the WNI group than in the LNS group (2% vs. 10%; p = 0.04). The 2-year disease-free survival rates were 75% and 63% in the WNI and LNS groups, respectively (p = 0.08). Conclusion The rate of level IV recurrence was higher in the LNS group than in the WNI group. Trends of improvement in disease-free survival with lower-neck irradiation suggested that it is premature to consider LNS irradiation as daily practice in patients with oral cavity and oropharyngeal cancer.

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Section: Discussionmentioning

confidence: 99%

Retrospective analysis of adjuvant radiotherapy in oral cavity or oropharyngeal cancer: Feasibility of omitting lower-neck irradiation

Kao

Hsiao

et al. 2022

PLoS ONE

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“…Other groups investigate de-intensification of ENI as well. Three previously published studies succeeded in decreasing the dose to the elective neck to 36–40 Gy [7] , [8] or excluded LN levels [24] without increasing the RR. Other ongoing studies are selecting fewer LN levels based on LN drainage patterns [25] or imaging parameters [26] .…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance guided elective neck irradiation targeting individual lymph nodes: A new concept

Reinders¹,

Heijst²,

Mases

et al. 2021

Physics and Imaging in Radiation Oncology

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Highlights Individual elective lymph nodes can be identified using multiple Dixon T2-weighted turbo spin echo with fat suppression. Magnetic Resonance guided individual lymph node irradiation results in lower dose to the organs at risk. Especially the submandibular glands, carotid arteries and thyroid can be spared. The magnetic field on the magnetic resonance imaging - linear accelerator did not lead to increased skin dose depositions.

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“…Sher et al recently reported no elective regional failures in patients with nonwell‐lateralized primary oropharynx tumors receiving elective contralateral radiation to level II. This approach resulted in a reduction in the contralateral parotid gland dose to 16.9 Gy compared to 22.9 Gy to the ipsilateral superficial parotid gland 37 . A similar approach is being evaluated in the Canadian Evader trial for patients with low‐risk HPV‐positive OPSCC (NCT03822897).…”

Section: Discussionmentioning

confidence: 99%

Defining high‐risk elective contralateral neck radiation volumes for oropharynx cancer

et al. 2021

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Background To define the location of the initial contralateral lymph node (LN) metastasis in patients with oropharynx cancer. Methods The location of the LN centroids from patients with oropharynx cancer and a single radiographically positive contralateral LN was defined. A clinical target volume (CTV) inclusive of all LN centroids was created, and its impact on dose to organs at risk was assessed. Results We identified 55 patients of which 49/55 had a single contralateral LN in level IIA, 4/55 in level III, 1/55 in level IIB, and 1/55 in the retropharynx. Mean radiation dose to the contralateral parotid gland was 15.1 and 21.0 Gy, (p <0.001) using the modeled high‐risk elective CTV and a consensus CTV, respectively. Conclusions We present a systematic approach for identifying the contralateral nodal regions at highest risk of harboring subclinical disease in patients with oropharynx cancer that warrants prospective clinical study.

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Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer

Cited by 37 publications

References 21 publications

Retrospective analysis of adjuvant radiotherapy in oral cavity or oropharyngeal cancer: Feasibility of omitting lower-neck irradiation

Retrospective analysis of adjuvant radiotherapy in oral cavity or oropharyngeal cancer: Feasibility of omitting lower-neck irradiation

Magnetic resonance guided elective neck irradiation targeting individual lymph nodes: A new concept

Defining high‐risk elective contralateral neck radiation volumes for oropharynx cancer

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