Salvage Stereotactic Reirradiation With or Without Cetuximab for Locally Recurrent Head-and-Neck Cancer: A Feasibility Study

Comet, B.; Kramar, Andrew; Faivre-Pierret, M.; Dewas, S.; Coche‐Dequeant, B.; Degardin, M.; Lefebvre, Jean‐Louis; Lacornerie, T.; Lartigau, Éric

doi:10.1016/j.ijrobp.2011.11.054

Cited by 95 publications

(77 citation statements)

References 39 publications

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“…The toxicity results reported appear acceptable in the context of those reported in heterogeneous retrospective series for IMRT in rSCCHN, which reported grade 4þ toxicity rates of 18% to 44% (11,12,25). Earlier reports from the SBRT literature have reported higher rates of carotid blowout syndrome (26,27) not seen in our experience or in the French experience (21,28). This may relate in part to differences in fractionation schema where SBRT was delivered every other day rather than every day (29,30).…”

Section: Discussionmentioning

confidence: 48%

A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

Vargo

Ferris

Ohr

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

128

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Section: Discussionmentioning

confidence: 48%

A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

Vargo

Ferris

Ohr

et al. 2015

International Journal of Radiation Oncology*Biology*Physics

128

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“…Similarly, stereotactic body radiotherapy (SBRT) is an advanced radiation planning and delivery technique that delivers a highly focused radiation dose per fraction (≥6 Gy) in 1–5 fractions and is a well-established curative strategy for medical-inoperable early-stage lung cancers especially in elderly populations (10). SBRT ± cetuximab has emerged as a promising salvage strategy for unresectable locally recurrent previously irradiated squamous-cell carcinomas of the head and neck (11–14). When compared to conventionally fractionated external beam radiotherapy, primary benefits of short overall treatment time (five fractions over 1–2 weeks) and minimal acute toxicity makes SBRT ± cetuximab a potentially attractive treatment strategy in elderly patients.…”

Section: Introductionmentioning

confidence: 99%

Stereotactic Body Radiotherapy as Primary Treatment for Elderly Patients with Medically Inoperable Head and Neck Cancer

et al. 2014

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Purpose: With a growing elderly population, elderly patients with head and neck cancers represent an increasing challenge with limited prospective data to guide management. The complex interplay between advanced age, associated co-morbidities, and conventional local therapies, such as surgery and external beam radiotherapy ± chemotherapy, can significantly impact elderly patients’ quality of life (QoL). Stereotactic body radiotherapy (SBRT) is a well-established curative strategy for medical-inoperable early-stage lung cancers even in elderly populations; however, there is limited data examining SBRT as primary therapy in head and neck cancer.Material/methods: Twelve patients with medically inoperable head and neck cancer treated with SBRT ± cetuximab from 2002 to 2013 were retrospectively reviewed. SBRT consisted of primarily 44 Gy in five fractions delivered on alternating days over 1–2 weeks. Concurrent cetuximab was administered at a dose of 400 mg/m2 on day −7 followed by 250 mg/m2 on day 0 and +7 in n = 3 (25%). Patient-reported quality of life (PRQoL) was prospectively recorded using the previously validated University of Washington quality of life revised (UW-QoL-R).Results: Median clinical follow-up was 6 months (range: 0.5–29 months). The 1-year actuarial local progression-free survival, distant progression-free survival, progression-free survival, and overall survival for definitively treated patients were 69, 100, 69, and 64%, respectively. One patient (8%) experienced acute grade 3 dysphagia and one patient (8%) experienced late grade 3 mucositis; there were no grade 4–5 toxicities. Prospective collection of PRQoL as assessed by UW-QoL-R was preserved across domains.Conclusion: Stereotactic body radiotherapy shows encouraging survival and relatively low toxicity in elderly patients with unresectable head and neck cancer, which may provide an aggressive potentially curative local therapy while maintaining QoL.

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“…Stereotactic radiosurgery has been used for the treatment of skull base tumors over the past few decades and has demonstrated durable tumor control and symptomatic relief with acceptable toxicity in the patients with malignant tumors less than 4 cm in diameter. (18,19) Many researchers have described the utilization of SRT for reirradiation of head and neck tumors, primarily using CyberKnife (Accuray Inc., Sunnyvale, CA) radiosurgery (20)(21)(22)(23)(24) and linac-based SRT. (25,26) Specifically, Unger and colleagues (20) presented a feasibility study reirradiating head and neck cancer patients using CyberKnife technique with fractionated-SRS scheme.…”

Section: Discussionmentioning

confidence: 99%

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy

Pokhrel

McClinton

Sood

et al. 2016

J Applied Clin Med Phys

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The purpose of this study was to generate Monte Carlo computed dose distributions with the X-ray voxel Monte Carlo (XVMC) algorithm in the treatment of head and neck cancer patients using stereotactic radiotherapy (SRT) and compare to heterogeneity corrected pencil-beam (PB-hete) algorithm. This study includes 10 head and neck cancer patients who underwent SRT re-irradiation using heterogeneity corrected pencil-beam (PB-hete) algorithm for dose calculation. Prescription dose was 24-40 Gy in 3-5 fractions (treated 3-5 fractions per week) with at least 95% of the PTV volume receiving 100% of the prescription dose. A stereotactic head and neck localization box was attached to the base of the thermoplastic mask fixation for target localization. The gross tumor volume (GTV) and organs-at-risk (OARs) were contoured on the 3D CT images. The planning target volume (PTV) was generated from the GTV with 0 to 5 mm uniform expansion; PTV ranged from 10.2 to 64.3 cc (average = 35.0±17.5 cc). OARs were contoured on the 3D planning CT and consisted of spinal cord, brainstem, optic structures, parotids, and skin. In the BrainLab treatment planning system (TPS), clinically optimal SRT plans were generated using hybrid planning technique (combination of 3D conformal noncoplanar arcs and nonopposing static beams) for the Novalis-Tx linear accelerator consisting of high-definition multileaf collimators (HD-MLCs: 2.5 mm leaf width at isocenter) and 6 MV-SRS (1000 MU/min) beam. For the purposes of this study, treatment plans were recomputed using XVMC algorithm utilizing identical beam geometry, multileaf positions, and monitor units and compared to the corresponding clinical PB-hete plans. The Monte Carlo calculated dose distributions show small decreases (< 1.5%) in calculated dose for D 99 , D mean , and D max of the PTV coverage between the two algorithms. However, the average target volume encompassed by the prescribed percent dose (V p ) was about 2.5% less with XVMC vs. PB-hete and ranged between -0.1 and 7.8%. The averages for D 100 and D 10 of the GTV were lower by about 2% and ranged between -0.8 and 3.1%. For the spinal cord, both the maximal dose difference and the dose to 0.35 cc of the structure were higher by an average of 4.2% (ranged 1.2 to -13.6%) and 1.4% (ranged 7.5 to -11.3%), respectively, with XVMC calculation. For the brainstem, the maximal dose differences and the dose to 0.5 cc of the structure were, on average, higher by 2.4% (ranged 6.4 to -8.0%) and 3.6% (ranged 6.4 to -9.0%), respectively. For the parotids, both the mean dose and the dose to 20 cc of parotids were higher by an average of 3% (ranged -0.2 to -5.9%) and 4% (ranged -0.2 to -8%), respectively, with XVMC calculation. For the optic apparatus, results from both algorithms were similar. However, the mean dose to skin was 3% higher (ranged 0 to -6%), on average, with XVMC compared to PB-hete, although the maximum dose to skin was 2%

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Salvage Stereotactic Reirradiation With or Without Cetuximab for Locally Recurrent Head-and-Neck Cancer: A Feasibility Study

Cited by 95 publications

References 39 publications

A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

A Prospective Phase 2 Trial of Reirradiation With Stereotactic Body Radiation Therapy Plus Cetuximab in Patients With Previously Irradiated Recurrent Squamous Cell Carcinoma of the Head and Neck

Stereotactic Body Radiotherapy as Primary Treatment for Elderly Patients with Medically Inoperable Head and Neck Cancer

Monte Carlo evaluation of tissue heterogeneities corrections in the treatment of head and neck cancer patients using stereotactic radiotherapy

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