Proton therapy for head and neck cancer: expanding the therapeutic window

Leeman, Jonathan E.; Romesser, Paul B.; Zhou, Ying; McBride, Sean; Riaz, Nadeem; Sherman, Eric J.; Cohen, Marc A.; Cahlon, Oren; Lee, Nancy

doi:10.1016/s1470-2045(17)30179-1

Cited by 120 publications

(98 citation statements)

References 76 publications

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“…Therefore, in the case of PSI, much less conservative constraints for optic structures could be considered to yield higher dose coverage in GTV-P. In addition, proton therapy, with its superiority in conformality, allows for better sparing of normal tissues (39) and thus merits future investigation.…”

Section: Discussionmentioning

confidence: 99%

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

Zhou

Xue

et al. 2020

Front. Oncol.

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Purpose: This study aims to investigate the prognostic value and dosimetric impact of paranasal sinus invasion (PSI) in patients with nasopharyngeal carcinoma (NPC), and further to explore the feasibility of an integrative prognostic model based on anatomic, volumetric, and dosimetric features.Methods: Two hundred six patients with T3 NPC receiving intensity-modulated radiation therapy (IMRT) were retrospectively analyzed. Dosimetric parameters were calculated from dose-volume histograms. Primary gross tumor volume (GTV-P) and dosimetric parameters were categorized using optimal cutpoints determined by R. Local recurrence-free survival (LRFS) was estimated using Kaplan-Meier method. Independent risk factors for LRFS were identified through univariable and multivariable analyses by Cox proportional hazards models.Results: The incidence of PSI was 10.7% (22/206). Patients with PSI had significantly inferior 5-year LRFS (77.3 vs. 93.8%, P = 0.006). IMRT plans for patients with PSI had larger dose heterogeneity, higher frequency of underdosing, and higher maximum dose to optic structures. When categorized by optimal cutpoints, GTV-P > 38.67 cm 3 (5-year LRFS, 84.8 vs. 97.4%, P = 0.008), and V66.88 < 89.87% (5-year LRFS, 67.1 vs. 94.5%, P < 0.001) were associated with significantly worse local outcome. Multivariable analyses showed that PSI, GTV-P > 38.67 cm 3 , and V66.88 < 89.87% were independent risk factors for local relapse, either in patients with or without concurrent chemotherapy. An integrative prognostic model was then established upon the cumulative score of risk factors. Subgroups with score of 0, 1-2, and 3 had distinctive local outcomes; the 5-year LRFS was 96.6, 84.7, and 58.3%, respectively (P < 0.001).Zhou et al. Impact of PSI on NPC Following IMRTConclusions: Paranasal sinus invasion jeopardized local control in T3 NPC patients due to large tumor burden and inadequate radiation dose in GTV-P. The presence of PSI, GTV-P, and radiation underdosing combined are critical for the risk stratification of local failure.

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Section: Discussionmentioning

confidence: 99%

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

Zhou

Xue

et al. 2020

Front. Oncol.

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“…This procedure may cause significant losses in skin-sparing effects, especially in those targets requiring modulation (i.e. targets in close proximity to the skin) [21]. In summary, the advantage of proton radiotherapy is to reduce the integral dose, being partly due to the absence of an exit dose beyond the Bragg peak.…”

Section: Discussionmentioning

confidence: 99%

The tolerance of proton radiotherapy — preliminary results

Sas-Korczyńska

Pluta²,

Chrostowska³

et al. 2017

Nowotwory. Journal of Oncology

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“…Stereotactic RT planning and dose delivery take conformality one step further and place greater importance on accurate target contouring and disease delineation, a known area of potential weakness in the RT planning process . The effect of a highly conformal dose distribution and steep dose gradients on marginal and out‐of‐field failure is uncertain and of particular relevance in the era of increasingly conformal dose distributions and the increasing utilization of proton beam therapy . The primary objective of this study was to assess patterns of locoregional failures with respect to RT fields following SBRT boost for OPSCC.…”

Section: Introductionmentioning

confidence: 99%

“…10 The effect of a highly conformal dose distribution and steep dose gradients on marginal and out-of-field failure is uncertain and of particular relevance in the era of increasingly conformal dose distributions and the increasing utilization of proton beam therapy. 11 The primary objective of this study was to assess patterns of locoregional failures with respect to RT fields following SBRT boost for OPSCC. Secondary objectives were to determine prognostic factors for local and regional recurrences, and overall rates of local and regional control.…”

Section: Introductionmentioning

confidence: 99%

Locoregional failures and their relation to radiation fields following stereotactic body radiotherapy boost for oropharyngeal squamous cell carcinoma

et al. 2019

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Background To investigate the location of recurrences with respect to the radiation fields in oropharynx cancer after intensity‐modulated radiotherapy and stereotactic body radiotherapy (SBRT) boost. Methods Local and regional recurrences were delineated on diagnostic scans which were rigidly coregistered with treatment planning scans, then classified based on the location of the center of mass (COM) as well as volumetrically. Results In 195 patients, the 5‐year local and regional control were 90% and 93%, respectively. By COM, 76% of local recurrences were in‐field; 24% were out‐of‐field, significantly higher than 0%‐5% in the literature for conventional regimens (P < 0.01). Regional recurrences (19 in 12 patients) were largely within unirradiated neck levels (47%) and electively irradiated regions (42%). Conclusions The regimen with biological equivalent dose intensification provides excellent overall and in‐field local control. The highly conformal boost technique was, however, associated with increased out‐of‐field local failure.

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Proton therapy for head and neck cancer: expanding the therapeutic window

Cited by 120 publications

References 76 publications

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

Impact of Paranasal Sinus Invasion on Oncologic and Dosimetric Outcomes in Nasopharyngeal Carcinoma Following Intensity-Modulated Radiation Therapy—Implications for Risk Stratification and Planning Optimization

The tolerance of proton radiotherapy — preliminary results

Locoregional failures and their relation to radiation fields following stereotactic body radiotherapy boost for oropharyngeal squamous cell carcinoma

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