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Yamazaki H, Suzuki G, Aibe N, Shiomi H, Oh RJ, Yoshida K, Nakamura S, Konishi K, Matsuyama T, Ogita M. Re-irradiation for isolated neck recurrence in head and neck tumor: impact of rN category. Sci Rep 2024; 14:3107. [PMID: 38326404 PMCID: PMC10850055 DOI: 10.1038/s41598-024-53438-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2022] [Accepted: 01/31/2024] [Indexed: 02/09/2024] Open
Abstract
Unresectable, isolated lymph node recurrence after radiotherapy is rare but a candidate for re-irradiation. However, severe toxicity is anticipated. Therefore, this study aimed to explore the efficacy and toxicity of re-irradiation in isolated lymph node recurrence of head and neck lesions. We analyzed 46 patients who received re-irradiation for lymph node recurrence without local progression. The primary tumor sites included the oral cavity in 17 patients, the hypopharynx in 12, the oropharynx in seven, the larynx in three, the nasopharynx in two, and other sites. During a median follow-up time of 10 months, the median survival time was 10.6 months, and the 1-year overall survival rate was 45.5%. The 1-year local control and progression-free survival rates were 49.8% and 39.3%, respectively. According to univariate analysis, age (≥ 65 years), the interval between treatment (≥ 12 months), rN category (rN1), and gross tumor volume (GTV < 25 cm3) were predisposing factors for better survival. In the multivariate analysis, the rN category and interval were identified as statistically significant predictors. Late toxicity grade ≥ 3 occurred in four patients (8.6%). These were all Grade 5 carotid blowout syndrome, which associated with tumor invasion of the carotid artery and/ or high doses administration for the carotid artery. Small-volume rN1 tumor that recur after a longer interval is a feasible candidate for re-irradiation. However, strict patient selection and meticulous care for the carotid are required.
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Affiliation(s)
- Hideya Yamazaki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan.
- CyberKnife Center, Soseikai General Hospital, Kyoto, Japan.
| | - Gen Suzuki
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Norihiro Aibe
- Department of Radiology, Graduate School of Medical Science, Kyoto Prefectural University of Medicine, 465 Kajiicho Kawaramachi Hirokoji, Kamigyo-Ku, Kyoto, 602-8566, Japan
| | - Hiroya Shiomi
- CyberKnife Center, Soseikai General Hospital, Kyoto, Japan
| | - Ryoong-Jin Oh
- Department of Radiation Oncology, Miyakojima IGRT Clinic, Osaka, Japan
| | - Ken Yoshida
- Department of Radiology, Kansai Medical University, Hirakata, Japan
| | - Satoaki Nakamura
- Department of Radiology, Kansai Medical University, Hirakata, Japan
| | - Koji Konishi
- Department of Radiation Oncology, Osaka International Cancer Institute, Osaka, Japan
| | - Tomohiko Matsuyama
- Department of Radiation Oncology, Kumamoto University Hospital, Kumamoto, Japan
| | - Mikio Ogita
- Radiotherapy Department, Fujimoto Hayasuzu Hospital, Miyakonojo, Japan
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2
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Szalkowski G, Karakas Z, Cengiz M, Schreiber E, Das S, Yazici G, Ozyigit G, Mavroidis P. Stereotactic body radiotherapy optimization to reduce the risk of carotid blowout syndrome using normal tissue complication probability objectives. J Appl Clin Med Phys 2022; 23:e13563. [PMID: 35194924 PMCID: PMC9121056 DOI: 10.1002/acm2.13563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2021] [Revised: 01/14/2022] [Accepted: 02/02/2022] [Indexed: 12/24/2022] Open
Abstract
Purpose To determine the possibility of further improving clinical stereotactic body radiotherapy (SBRT) plans using normal tissue complication probability (NTCP) objectives in order to minimize the risk for carotid blowout syndrome (CBOS). Methods 10 patients with inoperable locally recurrent head and neck cancer, who underwent SBRT using CyberKnife were analyzed. For each patient, three treatment plans were examined: (1) cone‐based without delineation of the ipsilateral internal carotid (clinical plan used to treat the patients); (2) cone‐based with the carotid retrospectively delineated and spared; and (3) Iris‐based with carotid sparing. The dose–volume histograms of the target and primary organs at risk were calculated. The three sets of plans were compared based on dosimetric and TCP/NTCP (tumor control and normal tissue complication probabilities) metrics. For the NTCP values of carotid, the relative seriality model was used with the following parameters: D50 = 40 Gy, γ = 0.75, and s = 1.0. Results Across the 10 patient plans, the average TCP did not significantly change when the plans were re‐optimized to spare the carotid. The estimated risk of CBOS was significantly decreased in the re‐optimized plans, by 14.9% ± 7.4% for the cone‐based plans and 17.7% ± 7.1% for the iris‐based plans (p = 0.002 for both). The iris‐based plans had significant (p = 0.02) reduced CBOS risk and delivery time (20.1% ± 7.4% time reduction, p = 0.002) compared to the cone‐based plans. Conclusion A significant improvement in the quality of the clinical plans could be achieved through the delineation of the internal carotids and the use of more modern treatment delivery modalities. In this way, for the same target coverage, a significant reduction in the risk of CBOS could be achieved. The range of risk reduction varied depending on the proximity of carotid artery to the target.
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Affiliation(s)
- Gregory Szalkowski
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Zeynep Karakas
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Mustafa Cengiz
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Eric Schreiber
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Shiva Das
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
| | - Gozde Yazici
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Gokhan Ozyigit
- Faculty of Medicine, Department of Radiation Oncology, Hacettepe University, Sihhiye, Ankara, Turkey
| | - Panayiotis Mavroidis
- Department of Radiation Oncology, University of North Carolina, North Carolina, Chapel Hill, USA
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Diao K, Nguyen TP, Moreno AC, Reddy JP, Garden AS, Wang CH, Tung S, Wang C, Wang XA, Rosenthal DI, Fuller CD, Gunn GB, Frank SJ, Morrison WH, Shah SJ, Lee A, Spiotto MT, Su SY, Ferrarotto R, Phan J. Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single-institution, modern cohort study. Head Neck 2021; 43:3331-3344. [PMID: 34269492 PMCID: PMC8511054 DOI: 10.1002/hed.26820] [Citation(s) in RCA: 18] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2021] [Revised: 06/18/2021] [Accepted: 07/09/2021] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses. METHODS We reviewed patients who received definitive-intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed. RESULTS One hundred and thirty-seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1-year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02). CONCLUSIONS In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.
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Affiliation(s)
- Kevin Diao
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Theresa P. Nguyen
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Amy C. Moreno
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jay P. Reddy
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Adam S. Garden
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Catherine H. Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Samuel Tung
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Congjun Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Xin A. Wang
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - David I. Rosenthal
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Clifton D. Fuller
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Gary B. Gunn
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Steven J. Frank
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - William H. Morrison
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shalin J. Shah
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Anna Lee
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Michael T. Spiotto
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Shirley Y. Su
- Department of Head and Neck Surgery, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Renata Ferrarotto
- Department of Thoracic Head and Neck Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jack Phan
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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4
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Zhang J, Wang L, Xu B, Huang M, Chen Y, Li X. Influence of Using a Contrast-Enhanced CT Image as the Primary Image on CyberKnife Brain Radiosurgery Treatment Plans. Front Oncol 2021; 11:705905. [PMID: 34604041 PMCID: PMC8483719 DOI: 10.3389/fonc.2021.705905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 08/30/2021] [Indexed: 11/13/2022] Open
Abstract
Background and Purpose This study aimed to quantify the differences between pre- and post-contrast agent (CA) CT for CyberKnife brain SRS plans. Materials and Methods Twenty-five patients were retrospectively analyzed. They were divided into two categories, inhomogeneous cases (13 patients) and homogeneous cases (12 patients), according to whether the tumor was close to the cavity and inhomogeneous tissues or not. The pre-CA and post-CA plans were designed and calculated using the same monitor unit and paths as those in the ray-tracing algorithm, respectively. Results The CT number difference of tumor between pre- and post-CA was significant (on average, 24.78 ± 18.56 HU, P-value < 0.01). The deviation value of the target was the largest at approximately 37 HU (inhomo-) and 13 HU (homo-) (P < 0.01), and the values of the organs at risk (OARs) were not statistically significant (P-value > 0.05). However, it was not statistically significant for the dose difference between the two groups with the injection of CA (P-value > 0.05). The absolute effective depth difference generally remained at a level of 1 mm, but the dose difference was quitely fluctuated sometimes more than 20%. The absolute effective depth difference of the inhomo-case (0.62 mm) was larger than that of the homo-case (0.37 mm) on median, as well as the variation amplitude (P-value < 0.05). Moreover, the relative dose differences between the two cases were 0.38% (inhomo-) and 0.2% (homo-), respectively (P-value < 0.05). At the criterion of 1 mm/1%, the gamma pass rate of the homo-case (95.89%) was larger than that of the inhomo-case (93.79%). For the OARs, except for the cochlea, the two cases were almost the same (>98.85%). The tumor control probability of the target was over 99.99% before and after injection of a CA, as well as the results for the homo-case and inhomo-case. Conclusions Considering the difference of evaluation indexes between pre- and post-CA images, we recommended plain CT to be employed as the primary image for improving the CK treatment accuracy of brain SRS, especially when the target was close to CA-sensitive OARs and cavity.
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Affiliation(s)
- Jianping Zhang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Lin Wang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Benhua Xu
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
| | - Miaoyun Huang
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China
| | - Yuangui Chen
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China
| | - Xiaobo Li
- Department of Radiation Oncology, Fujian Medical University Union Hospital, Fuzhou, China.,Fujian Medical University Union Clinical Medicine College, Fujian Medical University, Fuzhou, China.,Department of Medical Imaging Technology, College of Medical Technology and Engineering, Fujian Medical University, Fuzhou, China
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5
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Grimm J, Vargo JA, Mavroidis P, Moiseenko V, Emami B, Jain S, Caudell JJ, Clump DA, Ling DC, Das S, Moros EG, Vinogradskiy Y, Xue J, Heron DE. Initial Data Pooling for Radiation Dose-Volume Tolerance for Carotid Artery Blowout and Other Bleeding Events in Hypofractionated Head and Neck Retreatments. Int J Radiat Oncol Biol Phys 2021; 110:147-159. [PMID: 33583641 DOI: 10.1016/j.ijrobp.2020.12.037] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2020] [Revised: 12/17/2020] [Accepted: 12/22/2020] [Indexed: 12/25/2022]
Abstract
PURPOSE Dose-volume data for injury to carotid artery and other major vessels in stereotactic body radiation therapy (SBRT)/SABR head and neck reirradiation were reviewed, modeled, and summarized. METHODS AND MATERIALS A PubMed search of the English-language literature (stereotactic and carotid and radiation) in April 2018 found 238 major vessel maximum point doses in 6 articles that were pooled for logistic modeling. Two subsequent studies with dose-volume major vessel data were modeled separately for comparison. Attempts were made to separate carotid blowout syndrome from other bleeding events (BE) in the analysis, but we acknowledge that all except 1 data set has some element of BE interspersed. RESULTS Prior radiation therapy (RT) dose was not uniformly reported per patient in the studies included, but a course on the order of conventionally fractionated 70 Gy was considered for the purposes of the analysis (with an approximately ≥6-month estimated interval between prior and subsequent treatment in most cases). Factors likely associated with reduced risk of BE include nonconsecutive daily treatment, lower extent of circumferential tumor involvement around the vessel, and no surgical manipulation before or after SBRT. CONCLUSIONS Initial data pooling for reirradiation involving the carotid artery resulted in 3 preliminary models compared in this Hypofractionated Treatment Effects in the Clinic (HyTEC) report. More recent experiences with alternating fractionation schedules and additional risk-reduction strategies are also presented. Complications data for the most critical structures such as spinal cord and carotid artery are so limited that they cannot be viewed as strong conclusions of probability of risk, but rather, as a general guideline for consideration. There is a great need for better reporting standards as noted in the High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic introductory paper.
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Affiliation(s)
- Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania; Department of Medical Imaging and Radiation Sciences, Thomas Jefferson University, Philadelphia, Pennsylvania.
| | - John A Vargo
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Panayiotis Mavroidis
- Department of Radiation Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Vitali Moiseenko
- Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Bahman Emami
- Department of Radiation Oncology, Loyola University, Maywood, Illinois
| | - Sheena Jain
- Bott Cancer Center, Holy Redeemer Hospital, Meadowbrook, Pennsylvania
| | - Jimmy J Caudell
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - David A Clump
- UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Diane C Ling
- Department of Radiation Oncology, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Shiva Das
- Department of Radiation Oncology and Lineberger Comprehensive Cancer Center, University of North Carolina School of Medicine, Chapel Hill, North Carolina
| | - Eduardo G Moros
- Department of Radiation Oncology, H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | | | - Jinyu Xue
- Department of Radiation Oncology, New York University School of Medicine, New York, New York
| | - Dwight E Heron
- Department of Radiation Oncology, Bon Secours Mercy Health System, Youngstown, Ohio
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Moiseenko V, Marks LB, Grimm J, Jackson A, Milano MT, Hattangadi-Gluth JA, Huynh-Le MP, Pettersson N, Yorke E, El Naqa I. A Primer on Dose-Response Data Modeling in Radiation Therapy. Int J Radiat Oncol Biol Phys 2020; 110:11-20. [PMID: 33358230 DOI: 10.1016/j.ijrobp.2020.11.020] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2020] [Revised: 11/05/2020] [Accepted: 11/05/2020] [Indexed: 12/11/2022]
Abstract
An overview of common approaches used to assess a dose response for radiation therapy-associated endpoints is presented, using lung toxicity data sets analyzed as a part of the High Dose per Fraction, Hypofractionated Treatment Effects in the Clinic effort as an example. Each component presented (eg, data-driven analysis, dose-response analysis, and calculating uncertainties on model prediction) is addressed using established approaches. Specifically, the maximum likelihood method was used to calculate best parameter values of the commonly used logistic model, the profile-likelihood to calculate confidence intervals on model parameters, and the likelihood ratio to determine whether the observed data fit is statistically significant. The bootstrap method was used to calculate confidence intervals for model predictions. Correlated behavior of model parameters and implication for interpreting dose response are discussed.
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Affiliation(s)
- Vitali Moiseenko
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California.
| | - Lawrence B Marks
- Department of Radiation Oncology and the Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Jimm Grimm
- Department of Radiation Oncology, Geisinger Health System, Danville, Pennsylvania
| | - Andrew Jackson
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Michael T Milano
- Department of Radiation Oncology, University of Rochester, Rochester, New York
| | - Jona A Hattangadi-Gluth
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Minh-Phuong Huynh-Le
- Department of Radiation Medicine and Applied Sciences, University of California, San Diego, La Jolla, California
| | - Niclas Pettersson
- Department of Radiation Physics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Medical Physics and Biomedical Engineering, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Ellen Yorke
- Department of Medical Physics, Memorial Sloan Kettering Cancer Center, New York, New York
| | - Issam El Naqa
- Department of Machine Learning, Moffitt Cancer Center, Tampa, Florida
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7
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Inal A, Duman E, Ozkan EE. Evaluating different radiotherapy treatment plans, in terms of critical organ scoring index, conformity index, tumor control probability, and normal tissue complication probability calculations in early glottic larynx carcinoma. J Cancer Res Ther 2020; 16:485-493. [PMID: 32719255 DOI: 10.4103/jcrt.jcrt_888_18] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
Purpose In this study, it is aimed to compare three different radiotherapy treatment planning techniques in terms of critical organ scoring index (COSI), two different conformity index (CI), tumor control probability (TCP), and normal tissue complication probability (NTCP) calculations in early (T1) glottic larynx carcinoma (T1GL). Furthermore, it is aimed to investigate these parameters compliance with dose-volume histograms (DVH) parameters. Materials and Methods Ten T1GL patients were immobilized in a supine position with a head and neck thermoplastic mask. Treatment plans were created with opposed lateral fields (OLAFs) and intensity-modulated radiation therapy (IMRT) techniques with a total dose of 66 Gy in 33 fraction with 2 Gy/day. IMRT fields were selected as five fields (5IMRT) and seven fields (7IMRT). Dosimetric evaluation of three different treatment plans for T1GL carcinoma was performed in two consequential steps. First step was the assessment of planning target volume (PTV), all organs at risks (OARs), and normal tissue (NT) dose calculations according to given dose constraint directions and comparing the plans via DVH. In the second step, for PTV, the compatibility of DVH data with CIs-TCP was investigated where COSI-NTCP was compared with DVH for OARs. The DVH data were considered as reference in all evaluations. Results The CIRTOG mean values were significantly closer to 1 with IMRT plans when compared to OLAF plans (P = 0.005). The CIPADDICK mean values revealed that OLAF plans were significantly worse than IMRT plans (P = 0.005). No statistically significant difference was found between all three plans in terms of homogeneity index mean values (P = 0.076). The calculated mean TCP values were significantly better for 7IMRT plans when compared to OLAF and 5IMRT plans (P = 0.007 and P = 0.017, respectively). Both NTCP and COSI evaluations, which is compatible with DVH, significantly favored OLAF plan for spinal cord and 7IMRT for thyroid gland. The COSI evaluations, which are compatible with DVH, significantly favored 7IMRT plan for carotid arteries and 5IMRT plan for NT. Conclusion Our results demonstrated that CIPADDICK-TCP calculations for PTV and COSI-NTCP calculations for OARs were compatible with DVH in T1 GL plans. Therefore, we suggest such parameters as valuable tools for choosing the feasible one among multiple plans and even with different treatment machines.
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Affiliation(s)
- Aysun Inal
- Department of Radiation Oncology, Medical Physics Division, Antalya Research and Treatment Hospital, Medical Sciences University, Antalya, Turkey
| | - Evrim Duman
- Department of Radiation Oncology, Antalya Research and Treatment Hospital, Medical Sciences University, Antalya, Turkey
| | - Elif E Ozkan
- Department of Radiation Oncology, Suleyman Demirel University, Isparta, Turkey
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Alterio D, Turturici I, Volpe S, Ferrari A, Russell-Edu SW, Vischioni B, Mardighian D, Preda L, Gandini S, Marvaso G, Augugliaro M, Durante S, Arculeo S, Patti F, Boccuzzi D, Casbarra A, Starzynska A, Santoni R, Jereczek-Fossa BA. Carotid blowout syndrome after reirradiation for head and neck malignancies: a comprehensive systematic review for a pragmatic multidisciplinary approach. Crit Rev Oncol Hematol 2020; 155:103088. [PMID: 32956946 DOI: 10.1016/j.critrevonc.2020.103088] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Revised: 07/30/2020] [Accepted: 08/17/2020] [Indexed: 12/18/2022] Open
Abstract
AIM To provide a literature review on risk factors and strategies to prevent acute carotid blowout (CBO) syndrome in patients who underwent reirradiation (reRT) for recurrent head and neck (HN) malignancies. PATIENTS AND METHODS Inclusion criteria were: 1) CBO following reRT in the HN region, 2) description on patient-, tumor- or treatment-related risk factors, 3) clinical or radiological signs of threatened or impending CBO, and 4) CBO prevention strategies. RESULTS Thirty-five studies were selected for the analysis from five hundred seventy-seven records. Results provided indications on clinical, radiological and dosimetric parameters possibly associated with higher risk of CBO. Endovascular procedures (artery occlusion and stenting) to prevent acute massive hemorrhage in high risk patients were discussed. CONCLUSION Literature data are still scarce with a low level of evidence. Nevertheless, the present work provides a comprehensive review useful for clinicians as a multidisciplinary pragmatic tool in their clinical practice.
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Affiliation(s)
- Daniela Alterio
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Irene Turturici
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefania Volpe
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy.
| | - Annamaria Ferrari
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | | | - Barbara Vischioni
- National Center of Oncological Hadrontherapy (Fondazione CNAO), Pavia, Italy
| | | | - Lorenzo Preda
- Department of Clinical, Surgical, Diagnostic and Pediatric Sciences, University of Pavia, Pavia, Italy; Department of Radiology, Fondazione IRCCS Policlinico San Matteo Pavia, Pavia, Italy
| | - Sara Gandini
- Department of Experimental Oncology, IEO European Institute of Oncology IRCSS, Milan, Italy
| | - Giulia Marvaso
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Matteo Augugliaro
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Stefano Durante
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy
| | - Simona Arculeo
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Filippo Patti
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Dario Boccuzzi
- Diagnostic Radiology Residency School, University of Pavia, Pavia, Italy
| | - Alessia Casbarra
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
| | - Anna Starzynska
- Department of Oral Surgery, Medical University of Gdansk, Poland
| | - Riccardo Santoni
- Radiation Oncology Department, Fondazione Policlinico Tor Vergata, Rome, Italy
| | - Barbara Alicja Jereczek-Fossa
- Division of Radiation Oncology, IEO, European Institute of Oncology IRCCS, Milan, Italy; Department of Oncology and Hemato-Oncology, University of Milan, Milan, Italy
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Boustani J, Ruffier A, Moya-Plana A, Tao Y, Nguyen F, Even C, Berthold C, Casiraghi O, Temam S, Blanchard P. Long-term outcomes and safety after reirradiation in locally recurrent nasopharyngeal carcinoma in a non-endemic area. Strahlenther Onkol 2020; 197:188-197. [PMID: 32514613 DOI: 10.1007/s00066-020-01647-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2020] [Accepted: 05/25/2020] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine outcomes and toxicities after reirradiation for locally recurrent nasopharyngeal carcinoma (rNPC) and to apply a prognostic index in a non-endemic region. METHODS We retrospectively reported progression-free survival (PFS), overall survival (OS), and treatment-related toxicities in patients treated with curative intent for locally rNPC. We applied the prognostic model for OS and grade 5 radiotherapy (RT)-related toxicities published by Li et al. and evaluated its prognostic accuracy by receiver operating characteristic (ROC) curve analysis. RESULTS Between 2005 and 2018, 33 patients were treated for rNPC in our institution. Median follow-up was 60 months. The mean time to local recurrence was 75 months. Six (18%) patients had a persistent grade 3 toxicity from a previous RT course. The median re-RT dose was 66 Gy. After re-RT, 13 patients had local failure and 3 patients had metastatic recurrence. Median PFS was 18 months with a 5-year PFS rate of 29%. Median OS was 35 months with a 5-year OS rate of 37%. Grade 3 or higher toxicities rate was 74%. There were 21% grade 5 toxicities. The median time to a grade 5 toxicity was less than 6 months following re-RT. The prognostic nomogram was not predictive for OS or grade 5 toxicities. CONCLUSION Reirradiation of rNPC is an effective treatment but is associated with a high rate of life-threatening toxicity. Stratification of patients based on their risk of developing severe toxicity is needed to select patients who will most likely benefit from re-RT.
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Affiliation(s)
- J Boustani
- Department of Radiation Oncology, Georges François Leclerc, Dijon, France.
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France.
| | - A Ruffier
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - A Moya-Plana
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - Y Tao
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - F Nguyen
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - C Even
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - C Berthold
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
| | - O Casiraghi
- Department of Pathology, Gustave Roussy, Villejuif, France
| | - S Temam
- Department of Head and Neck Oncology, Gustave Roussy, Villejuif, France
| | - P Blanchard
- Department of Radiation Oncology, Gustave Roussy, 114 rue Edouard Vaillant, 94800, Villejuif, France
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Ling DC, Vargo JA, Gebhardt BJ, Grimm RJ, Clump DA, Ferris RL, Ohr JP, Heron DE. Dose-response modeling the risk of carotid bleeding events after stereotactic body radiation therapy for previously irradiated head and neck cancer. JOURNAL OF RADIOSURGERY AND SBRT 2019; 6:83-89. [PMID: 31641545 PMCID: PMC6774490] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/24/2018] [Accepted: 01/15/2019] [Indexed: 06/10/2023]
Abstract
Given the lack of clear dose constraints for the carotid artery, we created dose-response models to better quantify the risk of carotid bleeding events following re-irradiation stereotactic body radiation therapy (SBRT) for head and neck cancer (HNC). We performed a retrospective analysis on 75 patients treated with SBRT for recurrent, previously irradiated HNC. Logistic dose-response models were created to predict the risk of a carotid bleeding event, defined as any mucosal bleeding event or bleeding resulting from rupture of the carotid artery or its major branches in the setting of controlled disease. According to the models, the risk of a carotid bleeding event with a cumulative D0.1cc of 20 Gy from SBRT is 0.8% (95% CI 0.1%-3.9%), and rises to 5.0% with a D0.1cc of 50 Gy. No patient experienced a carotid bleeding event with D0.1cc < 39.4 Gy, and none experienced carotid blowout syndrome with a cumulative D0.1cc < 47.6 Gy.
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Affiliation(s)
- Diane C. Ling
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - John A. Vargo
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Brian J. Gebhardt
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | | | - David A. Clump
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
| | - Robert L. Ferris
- Department of Otolaryngology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - James P. Ohr
- Department of Medical Oncology, UPMC Hillman Cancer Center, Pittsburgh, PA, USA
| | - Dwight E. Heron
- Department of Radiation Oncology, UPMC Hillman Cancer Center, University of Pittsburgh School of Medicine, Pittsburgh, PA, USA
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