Safety and efficacy of hypofractionated stereotactic body reirradiation in head and neck cancer: Long‐term follow‐up of a large series

Kress, M.; Sen, Neilayan; Unger, Keith; Lominska, Chris; Deeken, John F.; Davidson, Bruce J.; Newkirk, Kenneth; Hwang, Jimmy J.; Harter, K. William

doi:10.1002/hed.23763

Cited by 47 publications

(35 citation statements)

References 28 publications

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“…Recent studies for head and neck cancer reirradiation using SBRT demonstrate 2‐year local/locoregional control rates of 28%‐31% and OS rates of 16%‐24%, with a low grade 3+ rate of 6% . Proton therapy reirradiation has shown emerging utility, with a recent multi‐institutional series reporting 1‐year locoregional control and OS rates of 75% and 65%, respectively .…”

Section: Discussionmentioning

confidence: 99%

“…20 Recent studies for head and neck cancer reirradiation using SBRT demonstrate 2-year local/locoregional control rates of 28%-31% and OS rates of 16%-24%, with a low grade 31 rate of 6%. 7,21 Proton therapy reirradiation has shown emerging utility, with a recent multi-institutional series reporting 1-year locoregional control and OS rates of 75% and 65%, respectively. 10 These newer radiotherapy approaches are achieving acceptable rates of local control but with lower toxicities as compared with more standard IMRT approaches.…”

Section: Discussionmentioning

confidence: 99%

“…Multiple radiation techniques are available, including intensity-modulated radiotherapy (IMRT), stereotactic body radiation therapy (SBRT), particle therapy, low-dose-rate brachytherapy, and high-dose-rate (HDR) brachytherapy. [5][6][7][8][9][10] In all cases, the goal is to limit the degree of previous radiation field overlap to reduce the risk of significant early and late toxicities.…”

Section: Introductionmentioning

confidence: 99%

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Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

et al. 2018

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

et al. 2018

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“…While we did not evaluate the effects of multiple treatments with 2 Gy on T-lymphocyte priming or tumor cell sensitivity to CTL killing, mounting evidence suggests that fractionated IR is immunosuppressive[23, 24, 28], potentially due to serial exposure of highly radiosensitive lymphocytes to IR. A comparison dose of 8 Gy was chosen based upon demonstrated safety of stereotactic body radiation therapy in patients with HNSCC with minimal toxicity in the reirradiation setting[29–31]. Our demonstration of enhanced antigen-specific T-lymphocyte priming with higher individual doses of IR will be instrumental for the design of clinical trials utilizing single fraction of hypofractionated IR as an adjuvant for immunotherapy.…”

Section: Discussionmentioning

confidence: 99%

Dose-dependent enhancement of T-lymphocyte priming and CTL lysis following ionizing radiation in an engineered model of oral cancer

et al. 2017

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Objectives Determine if direct tumor cell cytotoxicity, antigen release, and susceptibility to T-lymphocyte killing following radiation treatment is dose-dependent. Materials and Methods Mouse oral cancer cells were engineered to express full-length ovalbumin as a model antigen. Tumor antigen release with uptake and cross presentation of antigen by antigen presenting cells with subsequent priming and expansion of antigen-specific T-lymphocytes following radiation was modeled in vitro and in vivo. T-lymphocyte mediated killing was measured following radiation treatment using a novel impedance-based cytotoxicity assay. Results Radiation treatment induced dose-dependent induction of executioner caspase activity and apoptosis in MOC1 cells. In vitro modeling of antigen release and T-lymphocyte priming demonstrated enhanced proliferation of OT-1 T-lymphocytes with 8 Gy treatment of MOC1ova cells compared to 2 Gy. This was validated in vivo following treatment of established MOC1ova tumors and adoptive transfer of antigen-specific T-lymphocytes. Using a novel impedance – based cytotoxicity assay, 8 Gy enhanced tumor cell susceptibility to T-lymphocyte killing to a greater degree than 2 Gy. Conclusion In the context of using clinically-relevant doses of radiation treatment as an adjuvant for immunotherapy, 8 Gy is superior to 2 Gy for induction of antigen-specific immune responses and enhancing tumor cell susceptibility to T-lymphocyte killing. These findings have significant implications for the design of trials combining radiation and immunotherapy.

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“…However, single or hypofractionated dosage stereotactic radiation therapy provides benefit over conventional fractionated protocols due to reduced probability of cancer recurrence and increased comfort for the patient (Kranzinger et al, 2014, Polovnikov et al, 2013). Hypofractionated dosage protocols are commonly encountered in instances of medically inoperable head and neck cancer and/or as a boost therapy to malignancies previously treated with conventional external beam radiation therapy (Vargo et al, 2014; Yamazaki et al, 2014; Kress et al, 2014). …”

Section: Introductionmentioning

confidence: 99%

Short-term Peripheral Auditory Effects of Cranial Irradiation

Rutledge

Prasad

Emery

et al. 2015

Ann Otol Rhinol Laryngol

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Objectives Assess post-cranial irradiation short-term threshold shift short-term peripheral auditory histopathology the mouse as an experimental model Methods Adult mice were exposed to single-dose radiation of 10 – 60 Gy. Pre- and post-irradiation (baseline, 2 – 8 days) audiometric brainstem response data were recorded with analysis of cochlear ultrastructure. Results Significant threshold shift occurred at all test frequencies in mice exposed to ≥ 20 Gy at 4 – 6 days post-irradiation. Ultrastructurally in Rosenthal’s canal and the spiral lamina, neuronal density and extracellular matrix decreased dramatically. There was overall preservation of hair cells, stria vascularis, and vasculature. No difference within Gy group was noted in the frequency or severity of pathology along the length of the cochlea. Conclusions The initial impact of radiation in the first week post-exposure focuses on spiral ganglion cell bodies and peripheral projections, resulting in significant threshold shift for irradiation dosages ≥ 20 Gy. This study demonstrates that the mouse is a viable model for study of short-term peripheral auditory effects using single-dose cranial irradiation. Additionally, with access to a precise animal irradiator, the mouse may be used as an experimental model for a fractionated irradiation dosage of 10 Gy, simulating stereotactic therapeutic cranial irradiation.

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Safety and efficacy of hypofractionated stereotactic body reirradiation in head and neck cancer: Long‐term follow‐up of a large series

Abstract: SBRT reirradiation results in limited toxicity. Further research is needed to refine optimal roles for SBRT and intensity-modulated radiotherapy (IMRT) reirradiation.

Cited by 47 publications

References 28 publications

Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

Head and neck cancer reirradiation with interstitial high‐dose‐rate brachytherapy

Dose-dependent enhancement of T-lymphocyte priming and CTL lysis following ionizing radiation in an engineered model of oral cancer

Short-term Peripheral Auditory Effects of Cranial Irradiation

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