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Kil WJ, Eisaman S, Wilke C, Mowery Y, Smith W, Herndon C, Cousins D. Pharyngeal Constrictor-Sparing Salvage Stereotactic Body Radiation Therapy With Tongue-Out for In-Field Recurrence After Definitive Radiation Therapy for Head and Neck Cancer: Guide to Tongue-Out Radiation Therapy. Pract Radiat Oncol 2024:S1879-8500(24)00162-0. [PMID: 39047905 DOI: 10.1016/j.prro.2024.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/27/2024]
Abstract
This report details a pharyngeal constrictor muscle (PCM)-sparing stereotactic body radiation therapy (SBRT) using our institutional technique of "tongue-out" radiation therapy (TORT) for treating a local recurrent cancer in the uvula (GTVuvula) in a patient with history of a definitive chemotherapy with radiation therapy (70 Gy with weekly cisplatin) for a locally advanced laryngeal cancer 4 years ago. TORT includes optimizing the patients' reproducible tongue-out position using readily available medicine cup (30 cc) followed by sculping the thermoplastic mask with tongue-out, and real-time visual monitoring of the tongue position during the computed tomography simulation scan, cone beam computed tomography acquisition, and treatment. Between arcs during volumetric modulated arc therapy, time for tongue relaxation and saliva swallowing can be given to the patient. Without TORT, the patient's GTVuvula abutted the medial aspect of superior PCM (medial-sPCM) and a substantial volume of the previously irradiated superior PCM (sPCM) would have received high radiation dose from this salvage SBRT (32.5 Gy in 5 fractions). Comparing without TORT, the shortest distance between medial-sPCM-to-GTVuvula was increased by 13 mm with TORT, which reduced radiation dose to sPCM in the salvage SBRT plan. The mean dose to sPCM was decreased from 20.5 Gy without TORT to 12.7 Gy with TORT. With TORT, minimal sPCM volumes fell within higher isodose line: volume receiving ≥ 60% prescription dose (V60%Rx), V80%Rx, and V100%Rx to sPCM was, 4.8 versus 0.7 cc (without vs with TORT, respectively), 2.9 versus 0.19 cc, and 1.6 versus 0.04 cc, respectively. Maximum dose (Dmax) to medial-sPCM was 34.6 Gy without TORT versus 22.7 Gy with TORT. These high doses to the sPCM and intrafractional swallowing-related geographic misses of GTVuvula were avoided through the application of TORT in this salvage reirradiation setting. The patient successfully finished salvage SBRT with TORT resulting in no dysphagia or mucositis and maintained complete response at 12 months after treatment.
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Affiliation(s)
- Whoon Jong Kil
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
| | - Subarna Eisaman
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center at John P. Murtha Pavilion, Johnstown, Pennsylvania
| | - Christopher Wilke
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Shadyside/Presbyterian, Pittsburgh, Pennsylvania
| | - Yvonne Mowery
- Department of Radiation Oncology, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania; Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Shadyside/Presbyterian, Pittsburgh, Pennsylvania
| | - Wyatt Smith
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
| | - Craig Herndon
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
| | - David Cousins
- Department of Radiation Oncology, University of Pittsburgh Medical Center Hillman Cancer Center, Williamsport, Pennsylvania
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Paetkau O, Weppler S, Kwok J, Quon HC, Gomes da Rocha C, Smith W, Tchistiakova E, Kirkby C. RE: Pharyngeal Constrictor Muscle Sparing in Head and Neck Radiotherapy. Clin Oncol (R Coll Radiol) 2024; 36:e240-e241. [PMID: 38644087 DOI: 10.1016/j.clon.2024.03.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 03/28/2024] [Indexed: 04/23/2024]
Affiliation(s)
- O Paetkau
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - S Weppler
- Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - J Kwok
- Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada; Division of Radiation Oncology, Department of Oncology, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - H C Quon
- Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - C Gomes da Rocha
- Department of Physics and Astronomy, University of Calgary, Calgary, AB, Canada; Hotchkiss Brain Institute, University of Calgary, Calgary, AB, Canada; Institute for Quantum Science and Technology, University of Calgary, Calgary, AB, Canada; University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - W Smith
- Varian Medical Systems - A Siemens Healthineers Company, 3100 Hansen Way, Palo Alto, CA 94304, USA
| | - E Tchistiakova
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - C Kirkby
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
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Paetkau O, Weppler S, Quon HC, Tchistiakova E, Kirkby C. Developing and validating multi-omics prediction models for late patient-reported dysphagia in head and neck radiotherapy. Biomed Phys Eng Express 2024; 10:045014. [PMID: 38697028 DOI: 10.1088/2057-1976/ad4651] [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: 02/28/2024] [Accepted: 05/02/2024] [Indexed: 05/04/2024]
Abstract
Background and purpose. To investigate models developed using radiomic and dosiomic (multi-omics) features from planning and treatment imaging for late patient-reported dysphagia in head and neck radiotherapy.Materials and methods. Training (n = 64) and testing (n = 23) cohorts of head and neck cancer patients treated with curative intent chemo-radiotherapy with a follow-up time greater than 12 months were retrospectively examined. Patients completed the MD Anderson Dysphagia Inventory and a composite score ≤60 was interpreted as patient-reported dysphagia. A chart review collected baseline dysphagia and clinical factors. Multi-omic features were extracted from planning and last synthetic CT images using the pharyngeal constrictor muscle contours as a region of interest. Late patient-reported dysphagia models were developed using a random forest backbone, with feature selection and up-sampling methods to account for the imbalanced data. Models were developed and validated for multi-omic feature combinations for both timepoints.Results. A clinical and radiomic feature model developed using the planning CT achieved good performance (validation: sensitivity = 80 ± 27% / balanced accuracy = 71 ± 23%, testing: sensitivity = 80 ± 10% / balanced accuracy = 73 ± 11%). The synthetic CT models did not show improvement over the plan CT multi-omics models, with poor reliability of the radiomic features on these images. Dosiomic features extracted from the synthetic CT showed promise in predicting late patient-reported dysphagia.Conclusion. Multi-omics models can predict late patient-reported dysphagia in head and neck radiotherapy patients. Synthetic CT dosiomic features show promise in developing successful models to account for changes in delivered dose distribution. Multi-center or prospective studies are required prior to clinical implementation of these models.
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Affiliation(s)
- Owen Paetkau
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Sarah Weppler
- Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Harvey C Quon
- Tom Baker Cancer Center, 1331 29 St NW, Calgary, AB, T2N 4N2, Canada
| | - Ekaterina Tchistiakova
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
| | - Charles Kirkby
- Department of Physics and Astronomy, University of Calgary, 2500 University Dr NW, Calgary, AB T2N 1N4, Canada
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Oguejiofor K, Boon CS, Ramkumar S, Boon IS. Pharyngeal Constrictor Muscle Sparing in Head and Neck Radiotherapy. Clin Oncol (R Coll Radiol) 2024; 36:e118. [PMID: 38395635 DOI: 10.1016/j.clon.2024.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 02/09/2024] [Indexed: 02/25/2024]
Affiliation(s)
- K Oguejiofor
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - C S Boon
- Department of Clinical Oncology, University Hospitals of Derby and Burton NHS Foundation Trust, Derby, UK
| | - S Ramkumar
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - I S Boon
- Department of Clinical Oncology, University Hospital Southampton NHS Foundation Trust, Southampton, UK.
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