Volumetric modulated arc therapy (VMAT) and simultaneous integrated boost in head-and-neck cancer: is there a place for critical swallowing structures dose sparing?

Cilla, Savino; Deodato, Francesco; Macchia, G.; Digesù, Cinzia; Ianiro, A.; Piermattei, Angelo; Valentini, Vincenzo; Morganti, Alessio Giuseppe

doi:10.1259/bjr.20150764

Cited by 7 publications

(4 citation statements)

References 42 publications

(65 reference statements)

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“…Evidence from the published literature on swallowsparing radiotherapy strategies suggests that this approach is promising and requires further validation to confirm its clinical impact. As our quest for the optimal dysphagia-sparing radiotherapy strategy continues, encouraging dosimetric data are beginning to emerge for rotational IMRT [53] and, together with adaptive radiotherapy, this represents the next phase of investigative efforts to improve swallowing function. It is important to appreciate, however, that improvements in long-term swallow achievable through technological innovations in IMRT are finite, and by itself unlikely to eradicate deleterious post-radiation effects.…”

Section: Resultsmentioning

confidence: 99%

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

et al. 2017

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Dysphagia after primary chemoradiotherapy or radiation alone in pharyngeal cancers can have a devastating impact on a patient's physical, social and emotional state. Establishing and validating efficient dysphagia-optimised radiotherapy techniques is, therefore, of paramount importance in an era where health-related quality of life measures are increasingly influential determinants of curative management strategies, particularly as the incidence of good prognosis, human papillomavirus-driven pharyngeal cancer in younger patients continues to rise. The preferential sparing achievable with intensity-modulated radiotherapy (IMRT) of key swallowing structures implicated in post-radiation dysfunction, such as the pharyngeal constrictor muscles (PCM), has generated significant research into toxicity-mitigating strategies. The lack of randomised evidence, however, means that there remains uncertainty about the true clinical benefits of the dosimetric gains offered by technological advances in radiotherapy. As a result, we feel that IMRT techniques that spare PCM cannot be incorporated into routine practice. In this review, we discuss the swallowing structures responsible for functional impairment, analyse the studies that have explored the dose-response relationship between these critical structures and late dysphagia, and consider the merits of reported dysphagia-optimised IMRT (Do-IMRT) approaches, thus far. Finally, we discuss the dysphagia/aspiration-related structures (DARS) study (ISRCTN 25458988), which is the first phase III randomised controlled trial designed to investigate the impact of swallow-sparing strategies on improving long-term function. To maximise patient benefits, improvements in radiation delivery will need to integrate with novel treatment paradigms and comprehensive rehabilitation strategies to eventually provide a patient-centric, personalised treatment plan.

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Section: Resultsmentioning

confidence: 99%

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

et al. 2017

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“…Aspiration, quite often of a silent nature, yields a high risk of potentially life threatening aspiration pneumonia [4][5][6][7][8][9][10]. Considering the clinical and social relevance of swallowing problems, many radiation oncologists introduced swallowing sparing strategies, using Intensity Modulated Radiation Therapy (IMRT) or Volumetric Modulated Arc Therapy (VMAT) [11][12][13]. To preserve swallowing function and increase consistency of published results, a consensus on the definition of swallowing organs at risk (SWOARs) has been established [14,15].…”

mentioning

confidence: 99%

Functional Swallowing Units (FSUs) as organs-at-risk for radiotherapy. PART 1: Physiology and anatomy

Gawryszuk

Bijl

Holwerda

et al. 2019

Radiotherapy and Oncology

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“…Assessing normal tissue complication probabilities (NTCP) for late dysphagia, with a radiobiological model proposed by Christianen et al, Cilla and collaborators evaluated the risk of dysphagia associated with SIB-VMAT treatment plans using total doses of 70.5 (67.5), 60.0 and 55.5 Gy delivered in 30 fractions. Considering the pharyngeal constrictor muscles (PCM) and glottic and supra-glottic larynx (SGL) as organs at risk (OARs), the SIB-VMAT plan focused on reducing dysphagia, providing a dose reduction of 3.9 Gy and 4.5 Gy to the superior pharyngeal constrictor muscles (uPCM), respectively SGL [ 17 , 18 , 19 ].…”

Section: Sib Vs Sequential Boost Imrt/vmat In Hnc—from “In Silico” Tr...mentioning

confidence: 99%

Simultaneous Integrated Boost (SIB) vs. Sequential Boost in Head and Neck Cancer (HNC) Radiotherapy: A Radiomics-Based Decision Proof of Concept

Mireștean

Iancu

2023

JCM

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Artificial intelligence (AI) and in particular radiomics has opened new horizons by extracting data from medical imaging that could be used not only to improve diagnostic accuracy, but also to be included in predictive models contributing to treatment stratification of cancer. Head and neck cancers (HNC) are associated with higher recurrence rates, especially in advanced stages of disease. It is considered that approximately 50% of cases will evolve with loco-regional recurrence, even if they will benefit from a current standard treatment consisting of definitive chemo-radiotherapy. Radiotherapy, the cornerstone treatment in locally advanced HNC, could be delivered either by the simultaneous integrated boost (SIB) technique or by the sequential boost technique, the decision often being a subjective one. The principles of radiobiology could be the basis of an optimal decision between the two methods of radiation dose delivery, but the heterogeneity of HNC radio-sensitivity makes this approach difficult. Radiomics has demonstrated the ability to non-invasively predict radio-sensitivity and the risk of relapse in HNC. Tumor heterogeneity evaluated with radiomics, the inclusion of coarseness, entropy and other first order features extracted from gross tumor volume (GTV) in multivariate models could identify pre-treatment cases that will benefit from one of the approaches (SIB or sequential boost radio-chemotherapy) considered the current standard of care for locally advanced HNC. Computer tomography (CT) simulation and daily cone beam CT (CBCT) could be chosen as imaging source for radiomic analysis.

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Volumetric modulated arc therapy (VMAT) and simultaneous integrated boost in head-and-neck cancer: is there a place for critical swallowing structures dose sparing?

Cited by 7 publications

References 42 publications

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

Dysphagia-optimised Intensity-modulated Radiotherapy Techniques in Pharyngeal Cancers: Is Anyone Going to Swallow it?

Functional Swallowing Units (FSUs) as organs-at-risk for radiotherapy. PART 1: Physiology and anatomy

Simultaneous Integrated Boost (SIB) vs. Sequential Boost in Head and Neck Cancer (HNC) Radiotherapy: A Radiomics-Based Decision Proof of Concept

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