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Rogacki KR, Teo PT, Gopalakrishnan M, Pachigolla SL, Lyons CE, Abazeed ME, Das I, Mittal BB, Gentile M. Clinical, Pathologic, and Dosimetric Predictors of Head and Neck Lymphedema Following Definitive or Adjuvant Radiation Therapy for Head and Neck Cancer. Adv Radiat Oncol 2024; 9:101545. [PMID: 39184143 PMCID: PMC11343725 DOI: 10.1016/j.adro.2024.101545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 04/01/2024] [Indexed: 08/27/2024] Open
Abstract
Purpose Head and neck lymphedema (HNL) following radiation therapy for head and neck cancer (HNC) causes patient morbidity. Predicting individual patients' risk of HNL after treatment is challenging. We aimed to identify the demographic, disease-related, and treatment-related factors associated with external and internal HNL following treatment of HNC with definitive or adjuvant radiation therapy. Methods and Materials Relevant clinical, pathologic, and dosimetric data for 76 consecutive patients who received definitive or adjuvant radiation ± chemotherapy were retrospectively collected from a single institution. Multivariable models predictive of external and internal lymphedema using clinicopathologic variables alone and in combination with dosimetric variables were constructed and optimized using competing risk regression. Results After median follow-up of 550 days, the incidence of external and internal HNL at 360 days was 70% and 34%, respectively. When evaluating clinical and treatment-related factors alone, number of lymph nodes removed and advanced adenopathy status were predictive of external lymphedema. With incorporation of dosimetric variables, the optimized model included the percentage volume of the contralateral lymph node level VII receiving 30Gy V30 ≥50%, number of lymph nodes removed, and advanced adenopathy status. For internal lymphedema, our clinicopathologic model identified both adjuvant radiation, as opposed to definitive radiation, and advanced adenopathy status. With inclusion of a dosimetric variable, the optimized model included larynx V45 ≥50% and advanced adenopathy. Conclusions HNL following HNC treatment is common. For both external and internal lymphedema, nodal disease burden at diagnosis predicts increased risk. For external lymphedema, increasing extent of lymph node dissection prior to adjuvant therapy increases risk. The contralateral level VII lymph node region is also predictive of external lymphedema when radiation dose to V30 is ≥50%, meriting investigation. For internal lymphedema, we confirm that increasing radiation dose to the larynx is the most significant dosimetric predictor of mucosal edema when larynx V45 is ≥50%.
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Affiliation(s)
- Kevin R. Rogacki
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - P. Troy Teo
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mahesh Gopalakrishnan
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | | | - Clayton E. Lyons
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Mohamed E. Abazeed
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Indra Das
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Bharat B. Mittal
- Department of Radiation Oncology, Northwestern Memorial Hospital, Robert H. Lurie Comprehensive Cancer Center, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Michelle Gentile
- Department of Radiation Oncology, University of Pennsylvania, Perelman Center for Advanced Medicine, Philadelphia, Pennsylvania
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Saroj DK, Yadav S, Paliwal N, Haldar S, Shende RB, Gupta G, Yogi V. Radiobiological analysis of VMAT treatment plan with flattened and flattening filter free photon beam: an EUD and TCP based comparative study. Rep Pract Oncol Radiother 2024; 29:77-89. [PMID: 39165604 PMCID: PMC11333070 DOI: 10.5603/rpor.99100] [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: 06/30/2023] [Accepted: 01/16/2024] [Indexed: 08/22/2024] Open
Abstract
Background This study aimed to evaluate the dosimetric and radiobiological differences between 6MV flattened filter (FF) and flattening filter free (FFF) using volumetric modulated arc (VMAT) technique for head and neck (H&N) cancer patients. Materials and methods Fifteen patients with H&N carcinoma were selected and treated with VMAT with FF (VMATFF) treatment plan. Retrospectively, additional VMAT treatment plans were developed using FFF beams (VMATFFF). Radiobiological parameters, such as equivalent uniform dose (EUD), tumor cure probability (TCP), and normal tissue complication probability (NTCP), were calculated using Niemierko's model for both VMATFF and VMATFFF. Correlation between dosimetric and radiobiological data were analyzed and compared. Results The conformity index (CI) was 0.975 ± 0.014 (VMATFF) and 0.964 ± 0. 019 (VMATFFF) with p ≥ 0.05. Statistically, there was an insignificant difference in the planning target volume (PTV) results for TCP (%) values, with values of 81.20 ± 0.88% (VMATFF) and 81.01 ± 0.92 (%) (VMATFF). Similarly, there was an insignificant difference in the EUD (Gy) values, which were 71.53 ± 0.33 Gy (VMATFF) and 71.46 ± 0.34 Gy (VMATFFF). The NTCP values for the spinal cord, left parotid, and right parotid were 6.54 × 10-07%, 8.04%, and 7.69%, respectively, in the case of VMATFF. For VMATFFF, the corresponding NTCP values for the spinal cord, parotids left, and parotid right were 3.09 × 10-07%, 6.57%, and 6.73%, respectively. Conclusion The EUD and Mean Dose to PTV were strongly correlated for VMATFFF. An increased mean dose to the PTV and greater TCP were reported for the VMATFF, which can enhance the delivery of the therapeutic dose to the target.
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Affiliation(s)
- Dinesh Kumar Saroj
- Department of Radiotherapy, BALCO Medical Center, A Unit of Vedanta medical Research Foundation, New Raipur, Chhattisgarh, India
- Department of Physics, Rabindranath Tagore University, Raisen, Madhya Pradesh, India
| | - Suresh Yadav
- Department of Radiation Oncology, Gandhi Medical College, Bhopal, India
| | - Neetu Paliwal
- Department of Physics, Rabindranath Tagore University, Raisen, Madhya Pradesh, India
| | - Subhash Haldar
- Department of Radiotherapy, Saroj Gupta Cancer Centre and Research Institute, Kolkata (West Bengal), India
| | - Ravindra B. Shende
- Department of Radiotherapy, BALCO Medical Center, A Unit of Vedanta medical Research Foundation, New Raipur, Chhattisgarh, India
| | - Gaurav Gupta
- Department of Radiotherapy, BALCO Medical Center, A Unit of Vedanta medical Research Foundation, New Raipur, Chhattisgarh, India
| | - Veenita Yogi
- Department of Radiation Oncology, Gandhi Medical College, Bhopal, India
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Wang X, Han Y, Zhi Z, Xu W, Ge J, Liang X, Li D, He J. Delineation of the "Oropharyngeal Mucosa" and Limiting its Dose in Head and Neck Cancer Patients Spares the Oropharynx Without Compromising Target Coverage. Cancer Control 2024; 31:10732748241283621. [PMID: 39275798 PMCID: PMC11401141 DOI: 10.1177/10732748241283621] [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] [Indexed: 09/16/2024] Open
Abstract
OBJECTIVES Radiation-induced oropharyngeal injury is a dose-limiting toxicity in head and neck cancer patients. Delineation of the "oropharyngeal mucosa" and limiting its dose to spare the oropharynx was investigated. METHODS In this retrospective study, computed tomography imaging from eight patients with previously untreated head and neck cancer was employed. An adaptive contouring brush within the planning software Monaco was used to create an air cavity within the oropharynx, and then the air cavity was expanded uniformly 2 mm to create the "oropharyngeal mucosa". Three plans were independently generated for each patient: Plan1: dose constraint was applied for the oropharynx; Plan2: dose constraints were applied for the oropharynx and the "oropharyngeal mucosa"; Plan3: dose constraint was applied for the "oropharyngeal mucosa". T-tests were used to compare the dosimetry variables. RESULTS All plans had adequate target coverage and there were no statistical differences among plans. The mean dose, D30%, D45%, D50%, D85%, D90%, D95%, D100%, V25 Gy, V30 Gy, V35 Gy, V40 Gy, and V45 Gy of the oropharynx and "oropharyngeal mucosa" in Plan1 were significantly higher than those in Plan2 and Plan3. There were no significant differences between Plan2 and Plan3. There were no significant differences in the dosimetric parameters of any other organs at risk. CONCLUSION Delineation of the "oropharyngeal mucosa" and limiting its dose should be an easy and effective method to spare the oropharynx.
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Affiliation(s)
- Xueqi Wang
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Yanyan Han
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Zheng Zhi
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Wenzhong Xu
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Jianli Ge
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Xi Liang
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Diancheng Li
- Department of Radiology, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
| | - Jianming He
- Department of Radiotherapy, Hebei Province Hospital of Chinese Medicine, Shijiazhuang, China
- Key Laboratory of Integrated Chinese and Western Medicine for Gastroenterology Research (Hebei), Shijiazhuang, China
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Tajiki S, Joya M, Gharekhani V, Richeson D, Gholami S. A systematic review of the normal tissue complication probability models and parameters: Head and neck cancers treated with conformal radiotherapy. Head Neck 2023; 45:3146-3156. [PMID: 37767820 DOI: 10.1002/hed.27469] [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: 03/24/2023] [Revised: 07/05/2023] [Accepted: 07/06/2023] [Indexed: 09/29/2023] Open
Abstract
This systematic review study aims to provide comprehensive data on different radiobiological models, parameters, and endpoints used for calculating the normal tissue complication probability (NTCP) based on clinical data from head and neck cancer patients treated with conformal radiotherapy. A systematic literature search was carried out according to the PRISMA guideline for the identification of relevant publications in six electronic databases of Embase, PubMed, Scopus, and Google Scholar to July 2022 using specific keywords in the paper's title and abstract. The initial search resulted in 1368 articles for all organs for the review article about the NTCP parameters. One hundred and seventy-eight articles were accepted for all organs with complete parameters for the mentioned models and finally, 20 head and neck cancer articles were accepted for review. Analysis of the studies shows that the Lyman-Kutcher-Burman (LKB) model properly links the NTCP curve parameters to the postradiotherapy endpoints. In the LKB model for esophagus, the minimum, and maximum corresponding parameters were reported as TD50 = 2.61 Gy with grade ≥3 radiation-induced esophagitis endpoints as the minimum TD50 and TD50 = 68 Gy as the maximum ones. nmin = 0.06, nmax = 1.04, mmin = 0.1, and mmax = 0.65, respectively. Unfortunately, there was not a wide range of published articles on other organs at risk like ear or cauda equina except Burman et al. (Fitting of normal tissue tolerance data to an analytic function. Int J Radiat Oncol Biol Phys Ther. 1991;21:123-135). Findings suggest that the validation of different radiobiological models and their corresponding parameters need to be investigated in vivo and in vitro for developing a more accurate NTCP model to be used for radiotherapy treatment planning optimization.
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Affiliation(s)
- Sareh Tajiki
- Radiotherapy Oncology Research Centre, Cancer Institute, Tehran University of Medical Sciences, Tehran, Iran
| | - Musa Joya
- Department of Medical Physics and Biomedical Engineering, Tehran University of Medical Sciences, Tehran, Iran
| | - Vahideh Gharekhani
- Department of Radiobiology, Faculty of Paramedical, Tehran University of Medical Sciences, Tehran, Iran
| | - Dylan Richeson
- Department of Radiation Oncology, Virginia Commonwealth University, Richmond, Virginia, USA
| | - Somayeh Gholami
- Department of Radiation Oncology, University of Arkansas for Medical Sciences, Little Rock, Arkansas, USA
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Alvarez de Linera Alperi M, Ferran de la Cierva S, Palacios Berraquero M, Terrasa Czapiewska D, Alfonso A, Fernandez Gonzalez S. Severe laryngeal edema after CAR-T cell treatment in a patient with multiple myeloma: A case report. Clin Case Rep 2023; 11:e7281. [PMID: 37287622 PMCID: PMC10242084 DOI: 10.1002/ccr3.7281] [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: 12/22/2022] [Revised: 03/07/2023] [Accepted: 04/12/2023] [Indexed: 06/09/2023] Open
Abstract
This case aims to report an unusual clinical situation with uncommon and severe side effects, which can even be life threatening for the patient. The ENT and Hematology specialist should be aware of diagnosing and treating adequately.
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Affiliation(s)
| | | | | | | | - Ana Alfonso
- Department of HaematologyClinica Universidad de NavarraPamplonaSpain
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Iijima Y, Takaoka Y, Motono N, Uramoto H. Temporary tracheotomy for post-intubation laryngeal edema after lung cancer surgery: a case report. J Cardiothorac Surg 2023; 18:88. [PMID: 36941666 PMCID: PMC10026421 DOI: 10.1186/s13019-023-02187-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 03/12/2023] [Indexed: 03/23/2023] Open
Abstract
BACKGROUND In the post-intubation period, laryngeal edema is one of the most severe complications, which can cause significant morbidity and even death. Herein, we report a case in which we performed a temporary tracheostomy during surgery because of the risk of postoperative laryngeal edema, successfully avoiding post-intubation laryngeal edema complications. CASE PRESENTATION A 78-year-old man underwent surgery for left upper lobe lung cancer. He had a history of chemoradiotherapy for laryngeal cancer, bronchial asthma, and chronic obstructive pulmonary disease. He was diagnosed with grade 1 laryngeal edema using computed tomography, and there was a risk of developing post-intubation laryngeal edema. Additionally, there was a decrease in laryngeal and pulmonary functions; therefore, postoperative aspiration pneumonia was judged to be a fatal risk. A temporary tracheostomy was performed during surgery to avoid postoperative intubation laryngeal edema. He was found to have exacerbated laryngeal edema, which is a serious complication of airway stenosis. CONCLUSIONS Temporary tracheostomy should be considered to avoid airway stenosis due to post-intubation laryngeal edema in patients with laryngeal edema after radiotherapy.
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Affiliation(s)
- Yoshihito Iijima
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan.
| | - Yuki Takaoka
- Department of Head and Neck Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Nozomu Motono
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan
| | - Hidetaka Uramoto
- Department of Thoracic Surgery, Kanazawa Medical University, 1-1 Daigaku, Uchinada-Machi, Kahoku-gun, Ishikawa, 920-0293, Japan
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Shahbazi-Gahrouei D, Bagherzadeh S, Torabinezhad F, Mahdavi SM, Fadavi P, Salmanian S. Binary logistic regression modeling of voice impairment and voice assessment in iranian patients with nonlaryngeal head-and-neck cancers after chemoradiation therapy: Objective and subjective voice evaluation. JOURNAL OF MEDICAL SIGNALS & SENSORS 2023. [DOI: 10.4103/jmss.jmss_143_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
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MRI-based adaptive radiotherapy has the potential to reduce dysphagia in patients with head and neck cancer. Phys Med 2023; 105:102511. [PMID: 36563523 DOI: 10.1016/j.ejmp.2022.12.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 11/24/2022] [Accepted: 12/12/2022] [Indexed: 12/24/2022] Open
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Liu WS, Chien JC, Huang YH, Chen PC, Huang WL, Chiang SW, Lee CC, Kang BH, Hu YC. High Superior-Middle Pharyngeal Constrictor Muscle Mean Dose Correlates with Severe Late Lung Infection and Survival in Nasopharyngeal Cancer Patients. Cancer Manag Res 2022; 14:1063-1073. [PMID: 35300065 PMCID: PMC8923639 DOI: 10.2147/cmar.s350714] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2021] [Accepted: 02/28/2022] [Indexed: 01/23/2023] Open
Abstract
Purpose The study aimed to evaluate 1) the correlation of doses of swallowing-related organs at risk (OAR) with severe swallowing-related late adverse effects (AE) in nasopharyngeal carcinoma (NPC) patients and 2) the effect of high mean doses of OARs on overall survival (OS). Patients and Methods This retrospective cohort study enrolled non-metastatic Stage I–IV NPC patients from January 2012 to June 2017. OAR mean doses and severe (≥G3) swallowing-related late AE (xerostomia, dysphagia, and lung infection) were evaluated by t-test and validated using receiver operating characteristic curves. The risk factors of OS were calculated by Cox regression methods. Results This study enrolled 185 (43 female, 142 male) NPC patients, mean age 52.4 years, primarily with Stage III (93, 50.3%) or Stage IV (67, 36.2%) disease. The mean doses of pharyngeal constrictor muscle (PCM), superior-middle PCM (SMPCM), and superior PCM (SPCM) were significantly higher in those with severe (≥G3) lung infection than in those without (65.7 vs 62.2 Gy, p = 0.036; 68.1 vs 64.2 Gy, p = 0.015; and 70.0 vs 65.9 Gy, p = 0.012, respectively). Patients with severe (≥G3) dysphagia had significant higher mean doses of base of tongue (56.2 vs 50.2 Gy, p = 0.008), laryngeal box (50.6 vs 46.4 Gy, p = 0.036), PCM (65.4 vs 62.1 Gy, p = 0.008), SMPCM (67.1 vs 64.2 Gy, p = 0.014), and SPCM (69.3 vs 65.8 Gy, p = 0.004). Mean SMPCM dose >64.9 Gy (adjusted hazard ratio [aHR] = 3.2, 95% confidence interval [CI] 1.2–8.8, p = 0.021), age >62 years (aHR = 2.7, 95% CI 1.1–6.9, p = 0.032), N3 status (aHR = 4.0, 95% CI 1.8–9.0, p = 001), and severe late AE of lung infection (aHR = 4.6, 95% CI 1.5–14.0, p = 0.007) significantly affected OS. Conclusion Severe lung infection and dysphagia were associated with significantly higher mean doses of PCM, SMPCM, and SPCM. Among these OARs, only a high SMPCM mean dose was a risk factor for OS in NPC patients.
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Affiliation(s)
- Wen-Shan Liu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
- Department of Nursing, Meiho University, Pingtung, Taiwan
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Correspondence: Wen-Shan Liu, Department of Radiation Oncology, Kaohsiung Veterans General Hospital, No. 386, Dazhong 1st Road, Zuoying Dist., Kaohsiung City, 813414, Taiwan, Tel +886934075313, Email
| | - Ju-Chun Chien
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Hsien Huang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Po-Chun Chen
- Department of Radiation Oncology, Pingtung Christian Hospital, Pingtung, Taiwan
- Graduate Institute of Bioresources, National Pingtung University of Science and Technology, Pingtung, Taiwan
| | - Wei-Lun Huang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Shao-Wei Chiang
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Ching-Chih Lee
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Bor-Hwang Kang
- School of Medicine, National Defense Medical Center, Taipei, Taiwan
- Department of Otorhinolaryngology - Head and Neck Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yu-Chang Hu
- Department of Radiation Oncology, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
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Abstract
Dose constraints are essential for performing dosimetry, especially for intensity modulation and for radiotherapy under stereotaxic conditions. We present the update of the recommendations of the French society of oncological radiotherapy for the use of these doses in classical current practice but also for reirradiation.
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Affiliation(s)
- G Noël
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France.
| | - D Antoni
- Département de radiothérapie-oncologie, Institut de cancérologie Strasbourg Europe (ICANS), 17, rue Albert-Calmette, BP 23025, 67033 Strasbourg, France
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Mathew JM, Mukherji A, Saxena SK, Vijayaraghavan N, Menon A, Sriharsha K, Rafi M. Change in dysphagia and laryngeal function after radical radiotherapy in laryngo pharyngeal malignancies - a prospective observational study. Rep Pract Oncol Radiother 2021; 26:655-663. [PMID: 34760301 DOI: 10.5603/rpor.a2021.0078] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2020] [Accepted: 02/28/2021] [Indexed: 12/25/2022] Open
Abstract
Background Intensity modulated radiotherapy (IMRT) has the perceived advantage of function preservation by reduction of toxicities in the treatment of laryngo-pharyngeal malignancies. The aim of the study was to assess changes in dysphagia from baseline (i.e. prior to start of treatment) at three and six months post treatment in patients with laryngo-pharyngeal malignancies treated with radical radiotherapy ± chemotherapy. Functional assessment of other structures involved in swallowing was also studied. Materials and methods 40 patients were sampled consecutively. 33 were available for final analysis. Dysphagia, laryngeal edema, xerostomia and voice of patients were assessed at baseline and at three and six months after treatment. Radiation was delivered with simultaneous integrated boost (SIB) using volumetric modulated radiation therapy (VMAT). Concurrent chemotherapy was three weekly cisplatin 100 mg/m2. Results Proportion of patients with dysphagia rose significantly from 45.5% before the start of treatment to 57.6% at three months and 60.6% at six months post treatment (p = 0.019). 67% patients received chemotherapy and addition of chemotherapy had a significant correlation with dysphagia (p = 0.05, r = -0.336). Severity of dysphagia at three and six months correlated significantly with the mean dose received by the superior constrictors (p = 0.003, r = 0.508 and p = 0.024, r = 0.391) and oral cavity (p = 0.001, r = 0.558 and p = 0.003, r = 0.501). There was a significant worsening in laryngeal edema at three and six months post treatment (p < 0.01) when compared to the pre-treatment examination findings with 60.6% of patients having grade two edema at six months. Significant fall in the mean spoken fundamental frequency from baseline was seen at 6 months (p = 0.04), mean fall was 21.3 Hz (95% CI: 1.5-41 Hz) with significant increase in roughness of voice post treatment (p = 0.01). Conclusion There was progressive worsening in dysphagia, laryngeal edema and voice in laryngo-pharyngeal malignancies post radical radiotherapy ± chemotherapy.
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Affiliation(s)
- John M Mathew
- Department of Radiation Oncology, JIPMER, Pondicherry, India
| | | | | | | | - Abhilash Menon
- Department of Radiation Oncology, JIPMER, Pondicherry, India
| | | | - Malu Rafi
- Department of Radiation Oncology, Regional Cancer Centre, Thiruvananthapuram, India
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Tonneau M, Matta R, Lals S, Mirabel X, Crop F, Lacornerie T, Pasquier D, Escande A, Liem X. [Radiotherapy for patients with early-stage glottic squamous cell carcinoma of the larynx: Interest of hypofractionation?]. Cancer Radiother 2021; 25:801-810. [PMID: 33931299 DOI: 10.1016/j.canrad.2021.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2021] [Revised: 04/07/2021] [Accepted: 04/07/2021] [Indexed: 11/15/2022]
Abstract
Hypofractionated radiotherapy of early-stage squamous cell carcinoma of the glottic larynx is a promising treatment option. This can be divided into radiotherapy with moderate hypofractionation (up to 2.5Gy per fraction), more intense hypofractionation (between 2.5 and 4.5Gy per fraction) and stereotactic radiotherapy (above 4.5Gy per fraction). Most studies evaluating moderate hypofractionation show a local control rate between 85 and 95%. Acute laryngeal toxicity is superior to conventional treatment, but only for grades 1 and 2, with no significant difference reported for severe toxicity. Stereotactic radiotherapy in this pathology is also an emerging entity, but some authors have reported significant toxicity. There are currently no standardized guidelines for treatment and management regimen. We conducted a systemic review of published prospective and retrospective trials to evaluate efficacy, toxicity, and discuss future directions.
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Affiliation(s)
- M Tonneau
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Centre de recherche du centre hospitalier universitaire de Montréal (CRCHUM), QC, Canada
| | - R Matta
- Université de Lille, université Henri-Warembourg, 59000 Lille, France
| | - S Lals
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Mirabel
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - F Crop
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - T Lacornerie
- Service de physique médicale, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - D Pasquier
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France; Université de Lille, université Henri-Warembourg, 59000 Lille, France; Centre de recherche en informatique, signal et automatique de Lille (Cristal), UMR 9189, 59000 Lille, France
| | - A Escande
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France
| | - X Liem
- Département universitaire de radiothérapie, centre Oscar-Lambret, 3, rue Frédéric-Combemale, 59000 Lille, France.
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Bahig H, Rosenthal DI, Nguyen-Tan FP, Fuller DC, Yuan Y, Hutcheson KA, Christopoulos A, Nichols AC, Fung K, Ballivy O, Filion E, Ng SP, Lambert L, Dorth J, Hu KS, Palma D. Vocal-cord Only vs. Complete Laryngeal radiation (VOCAL): a randomized multicentric Bayesian phase II trial. BMC Cancer 2021; 21:446. [PMID: 33888069 PMCID: PMC8061218 DOI: 10.1186/s12885-021-08195-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2020] [Accepted: 04/14/2021] [Indexed: 02/03/2023] Open
Abstract
BACKGROUND Radiotherapy, along with laser surgery, is considered a standard treatment option for patients with early glottic squamous cell cancer (SCC). Historically, patients have received complete larynx radiotherapy (CL-RT) due to fear of swallowing and respiratory laryngeal motion and this remains the standard approach in many academic institutions. Local control (LC) rates with CL-RT have been excellent, however this treatment can carry significant toxicities include adverse voice and swallowing outcomes, along with increased long-term risk of cerebrovascular morbidity. A recent retrospective study reported improved voice quality and similar local control outcomes with focused vocal cord radiotherapy (VC-RT) compared to CL-RT. There is currently no prospective evidence on the safety of VC-RT. The primary objective of this Bayesian Phase II trial is to compare the LC of VC-RT to that of CL-RT in patients with T1N0 glottic SCC. METHODS One hundred and fifty-five patients with T1a-b N0 SCC of the true vocal cords that are n ot candidate or declined laser surgery, will be randomized in a 1:3 ratio the control arm (CL-RT) and the experimental arm (VC-RT). Randomisation will be stratified by tumor stage (T1a/T1b) and by site (each site will be allowed to select one preferred radiation dose regimen, to be used in both arms). CL-RT volumes will correspond to the conventional RT volumes, with the planning target volume extending from the top of thyroid cartilage lamina superiorly to the bottom of the cricoid inferiorly. VC-RT volumes will include the involved vocal cord(s) and a margin accounting for respiration and set-up uncertainty. The primary endpoint will be LC at 2-years, while secondary endpoints will include patient-reported outcomes (voice impairment, dysphagia and symptom burden), acute and late toxicity radiation-induced toxicity, overall survival, progression free survival, as well as an optional component of acoustic and objective measures of voice analysis using the Consensus Auditory-Perceptual Evaluation of Voice. DISCUSSION This study would constitute the first prospective evidence on the efficacy and safety of VC-RT in early glottic cancer. If positive, this study would result in the adoption of VC-RT as standard approach in early glottic cancer. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT03759431 Registration date: November 30, 2018.
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Affiliation(s)
- Houda Bahig
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David I. Rosenthal
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Félix-Phuc Nguyen-Tan
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - David C. Fuller
- grid.240145.60000 0001 2291 4776Radiation Oncology Department, University of Texas MD Anderson Cancer Center, 1515 Holcombe, Houston, TX 77030 USA
| | - Ying Yuan
- grid.240145.60000 0001 2291 4776Biostatistics Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Katherine A. Hutcheson
- grid.240145.60000 0001 2291 4776Head and Neck Surgery Department, University of Texas MD Anderson Cancer Center, Houston, USA
| | - Apostolos Christopoulos
- grid.410559.c0000 0001 0743 2111Head and Neck Surgery Department, Centre Hospitalier de l’Université de Montréal, Montreal, Canada
| | - Anthony C. Nichols
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Kevin Fung
- grid.39381.300000 0004 1936 8884Department of Otolaryngology - Head and Neck Surgery, Western University, London, Ontario Canada
| | - Olivier Ballivy
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Edith Filion
- grid.410559.c0000 0001 0743 2111Radiation Oncology Department, Centre Hospitalier de l’Université de Montréal, 1051 Sanguinet, Montreal, QC H2X 3E4 Canada
| | - Sweet Ping Ng
- grid.1055.10000000403978434Radiation Oncology Department, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Louise Lambert
- Radiation Oncology Department, Centre Intégré de Cancérologie de Laval, Laval, Canada
| | - Jennifer Dorth
- grid.67105.350000 0001 2164 3847Radiation Oncology Department, Case Western Reserve University, Cleveland, USA
| | - Kenneth S. Hu
- Radiation Oncology Department, NYU Langone Health, Newyork, USA
| | - David Palma
- grid.39381.300000 0004 1936 8884Radiation Oncology Department, Western University, London, Ontario Canada
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14
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Sanguineti G, Pellini R, Vidiri A, Marzi S, D'Urso P, Terrenato I, Farneti A, Fuga V, Ungania S, Landoni V. Stereotactic body radiotherapy for T1 glottic cancer: dosimetric data in 27 consecutive patients. TUMORI JOURNAL 2021; 107:514-524. [PMID: 33821713 DOI: 10.1177/03008916211000440] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM Because the clinical feasibility of stereotactic body radiotherapy (SBRT) for early glottic cancer (T1) is controversial, we report dosimetric results in 27 consecutive patients from a prospective phase I and II study that started in 2017. METHODS In our approach, only the parts of the true vocal cord containing cancer and those immediately adjacent are planned to be treated to 36 Gy and 30 Gy, respectively, in 3 fractions. Several dosimetric metrics for both target volumes and organs at risk were extracted from individual plans and results were compared to those achieved by other authors in a similar setting. RESULTS Proper coverage was reached at planning in 2/3 of planning treatment volume 30 Gy, but only 4 planning treatment volume 36 Gy; conversely, the maximum dose objective was met for most of the patients on either arytenoid cartilage, but this was not the case for 51.9% and 96.3% of cricoid and thyroid cartilages, respectively. Our dosimetric results are similar to if not better than those achieved by others. CONCLUSION SBRT in 3 fractions for T1 glottic lesions is dosimetrically challenging. Clinical validation is awaited.
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Affiliation(s)
- Giuseppe Sanguineti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Raul Pellini
- Department of Head and Neck Surgery, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Antonello Vidiri
- Department of Radiology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Simona Marzi
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Pasqualina D'Urso
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Irene Terrenato
- Department of Statistics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Alessia Farneti
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valentina Fuga
- Department of Radiation Oncology, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Sara Ungania
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
| | - Valeria Landoni
- Department of Physics, IRCCS Regina Elena National Cancer Institute, Rome, Italy
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15
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Jeans C, Brown B, Ward EC, Vertigan AE. Lymphoedema after head and neck cancer treatment: an overview for clinical practice. Br J Community Nurs 2021; 26:S24-S29. [PMID: 33797943 DOI: 10.12968/bjcn.2021.26.sup4.s24] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Lymphoedema is a disorder of the lymphatic system that presents as an atypical swelling and accumulation of protein-rich fluid within the interstitial spaces. Head and neck lymphoedema (HNL) is highly prevalent in patients who have been treated for head and neck cancer (HNC) and may manifest externally on the face and neck; internally within the oral cavity, pharynx or larynx; or as a combination of both. HNL is known to contribute to a wide range of physical, functional and psychological issues, and presents several unique challenges in terms of its management. This review article provides an overview of HNL for clinicians and aims to improve awareness of this condition and the impact it has on patients.
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Affiliation(s)
- Claire Jeans
- Speech Pathologist, Speech Pathology Department, Calvary Mater Hospital Newcastle, New South Wales Australia; PhD candidate, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia
| | - Bena Brown
- Senior Research Fellow, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Queensland, Australia
| | - Elizabeth C Ward
- Professor, School of Health and Rehabilitation Sciences, University of Queensland, Queensland, Australia; Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Queensland, Australia
| | - Anne E Vertigan
- Speech Pathology Manager, Speech Pathology Department, John Hunter Hospital and Belmont Hospital, New South Wales, Australia; Conjoint Associate Professor School of Medicine and Public Health, The University of Newcastle, New South Wales, Australia; Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, New South Wales, Australia
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16
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Mattioli F, Fermi M, Molinari G, Capriotti V, Melegari G, Bertolini F, D'Angelo E, Tirelli G, Presutti L. pT3 N0 Laryngeal Squamous Cell Carcinoma: Oncologic Outcomes and Prognostic Factors of Surgically Treated Patients. Laryngoscope 2021; 131:2262-2268. [PMID: 33755212 PMCID: PMC8518991 DOI: 10.1002/lary.29528] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2020] [Revised: 02/17/2021] [Accepted: 03/15/2021] [Indexed: 12/30/2022]
Abstract
Objectives/Hypothesis To assess the disease control, survival rates, and prognostic factors of exclusive surgical treatment for patients with pT3 N0 laryngeal squamous cell carcinoma (LSCC). Study Design Multicentric retrospective cohort study. Methods Multicentric retrospective case series of previously untreated patients with pT3 R0N0 LSCC, who received exclusive surgery between 2011 and 2019. Tumor location; subsite involvement; grading; and lymphatic, vascular, and perineural invasion were reported. Overall survival (OS), disease‐specific survival (DSS), and disease‐free survival (DFS) were measured. Results Fifty‐four patients (mean age 67.1; male sex 83.3%; mean follow‐up period 37 months) underwent total laryngectomy (48.1%) or partial laryngectomy (51.9%). Ipsilateral or bilateral neck dissection was performed in 46 (85.2%) cases. Perineural invasion was more frequent in case of supraglottic involvement than glottic involvement (85.7% vs. 14.3%, P = .03). Five (9.3%) patients experienced recurrence (3 local recurrences, 1 nodal recurrence, 1 distant recurrence). Rate of recurrence differed between glottic (0%), supraglottic (80%), and transglottic (20%) tumors (P = .01), with a lower risk yielded by glottic involvement (odds ratio [OR], 0.05, 95% confidence interval [95% CI], 0.01–0.56, P = .01). A higher risk was recorded in case of perineural invasion (OR, 66.0, 95% CI, 1.41–3085.3, P = .03). The OS, DSS, and DFS were 79.6%, 96.3%, and 90.7%, without differences regarding the type of surgery. The DFS was lower in case of supraglottic involvement when compared to purely glottic LSCC (83.9% vs. 100%, P = 0.02). Conclusions Exclusive surgery is a safe option for patients with pT3 R0N0 LSCC. Adjuvant treatments or closer follow‐up monitoring might be considered in case of supraglottic involvement or perineural invasion. Level of Evidence 4 Laryngoscope, 131:2262–2268, 2021
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Affiliation(s)
- Francesco Mattioli
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Matteo Fermi
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Giulia Molinari
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Vincenzo Capriotti
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Gabriele Melegari
- Anesthesiology and Reanimation Department, University Hospital of Modena, Modena, Italy
| | - Federica Bertolini
- Department of Oncology and Hematology, University Hospital of Modena, Modena, Italy
| | - Elisa D'Angelo
- Radiation Oncology Unit, University Hospital of Modena, Modena, Italy
| | - Giancarlo Tirelli
- Department of Otorhinolaryngology and Head and Neck Surgery, University of Trieste, Cattinara Hospital, Trieste, Italy
| | - Livio Presutti
- Otorhinolaryngology Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
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17
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Franzese C, Fogliata A, Loi M, Badalamenti M, Franceschini D, Comito T, Cozzi L, Reggiori G, Tomatis S, Scorsetti M. Dosimetric impact of volumetric modulated arc therapy for nasopharyngeal cancer treatment. ACTA ACUST UNITED AC 2021; 26:101-110. [PMID: 34046220 DOI: 10.5603/rpor.a2021.0017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2020] [Accepted: 12/21/2020] [Indexed: 11/25/2022]
Abstract
Background The purpose of the study was to evaluate the toxicity and outcome of nasopharyngeal carcinoma patients treated using 3-dimensional conformal radiotherapy (3DCRT) or volumetric modulated arc therapy (VMAT) technique. Materials and methods 68 patients treated between 2006 and 2018 were retrospectively analysed. Since 2009 patients received 3DCRT with 50/70 Gy to the elective/boost volumes in 35 fractions; from then, VMAT with simultaneous integrated boost (SIB) with 54.45/69.96 Gy in 33, or 54/66 Gy in 30 fractions. Induction chemotherapy was administered in 74% of the patients, concomitant cisplatinum in 87%. Acute and late toxicity data, progression-free survival PSF and overall survival OS, and toxicity correlations with dose metrics were reported. Results With a median follow-up of 64 months, complete remission at the last evaluation was in 68% of the patients, while 28% and 9% had locoregional relapse and distant disease, respectively. The 5- and 10-year progression free survival (PFS) rates were 62.7 ± 6.5% and 53.2 ± 8.7%, respectively. The 5- and 10-year OS rates were 78.9 ± 5.5% and 61.4 ± 9.2%, respectively. At the multivariate Cox analysis TNM stage (p = 0.02) and concomitant chemotherapy (p = 0.01) resulted significant for PFS, concomitant chemotherapy (p = 0.04) for OS.Improvements in acute toxicity were presented for VMAT patients due to its ability to spare OARs. Odds ratio (OR) for acute salivary toxicity, between VMAT and 3DCRT, was 4.67 (p = 0.02). Dosimetrically, salivary toxicity correlated with mean parotid dose (p = 0.05), dysphagia with laryngeal (p = 0.04) and mean oral cavity (p = 0.06) doses, when dose-volume histograms (DVHs) are corrected for fractionation. Conclusion This study is a proof of a significant benefit of the VMAT technique compared with 3DCRT in terms of side effects in nasopharynx patients, and adds dosimetric correlations.
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Affiliation(s)
- Ciro Franzese
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
| | - Antonella Fogliata
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Mauro Loi
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Marco Badalamenti
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Davide Franceschini
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Tiziana Comito
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Luca Cozzi
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
| | - Giacomo Reggiori
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Stefano Tomatis
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy
| | - Marta Scorsetti
- Humanitas Clinical and Research Hospital IRCCS, Radiotherapy Dept, Milan-Rozzano, Italy.,Humanitas University, Biomedical Science Dept, Milan-Rozzano, Italy
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18
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Ursino S, Giuliano A, Martino FD, Cocuzza P, Molinari A, Stefanelli A, Giusti P, Aringhieri G, Morganti R, Neri E, Traino C, Paiar F. Incorporating dose-volume histogram parameters of swallowing organs at risk in a videofluoroscopy-based predictive model of radiation-induced dysphagia after head and neck cancer intensity-modulated radiation therapy. Strahlenther Onkol 2020; 197:209-218. [PMID: 33034672 PMCID: PMC7892680 DOI: 10.1007/s00066-020-01697-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/18/2020] [Indexed: 11/25/2022]
Abstract
Purpose To develop a videofluoroscopy-based predictive model of radiation-induced dysphagia (RID) by incorporating DVH parameters of swallowing organs at risk (SWOARs) in a machine learning analysis. Methods Videofluoroscopy (VF) was performed to assess the penetration-aspiration score (P/A) at baseline and at 6 and 12 months after RT. An RID predictive model was developed using dose to nine SWOARs and P/A-VF data at 6 and 12 months after treatment. A total of 72 dosimetric features for each patient were extracted from DVH and analyzed with linear support vector machine classification (SVC), logistic regression classification (LRC), and random forest classification (RFC). Results 38 patients were evaluable. The relevance of SWOARs DVH features emerged both at 6 months (AUC 0.82 with SVC; 0.80 with LRC; and 0.83 with RFC) and at 12 months (AUC 0.85 with SVC; 0.82 with LRC; and 0.94 with RFC). The SWOARs and the corresponding features with the highest relevance at 6 months resulted as the base of tongue (V65 and Dmean), the superior (Dmean) and medium constrictor muscle (V45, V55; V65; Dmp; Dmean; Dmax and Dmin), and the parotid glands (Dmean and Dmp). On the contrary, the features with the highest relevance at 12 months were the medium (V55; Dmin and Dmean) and inferior constrictor muscles (V55, V65 Dmin and Dmax), the glottis (V55 and Dmax), the cricopharyngeal muscle (Dmax), and the cervical esophagus (Dmax). Conclusion We trained and cross-validated an RID predictive model with high discriminative ability at both 6 and 12 months after RT. We expect to improve the predictive power of this model by enlarging the number of training datasets.
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Affiliation(s)
- Stefano Ursino
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy.
| | - Alessia Giuliano
- Department of Physics, S. Luca Hospital, Via Guglielmo Lippi Francesconi 556, 55100, Lucca, Italy
| | - Fabio Di Martino
- Department of Physics, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Paola Cocuzza
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Alessandro Molinari
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
- Department of Radiation Oncology, Ecomedica Institute of Clinical Research, Via Cherubini 2/4, 50053, Empoli, Italy
| | - Antonio Stefanelli
- Department of Radiation Oncology, University Hospital Cona, Via Aldo Moro 8, 44124, Ferrara, Italy
| | - Patrizia Giusti
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Giacomo Aringhieri
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Riccardo Morganti
- Department of Clinical and Experimental Medicine, Section of Statistics, Via Roma 55, 56100, Pisa, Italy
| | - Emanuele Neri
- Department of Radiology, University Hospital S. Chiara/Cisanello, Via Roma 55/Via Paradisa 2, 56100, Pisa, Italy
| | - Claudio Traino
- Department of Physics, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
| | - Fabiola Paiar
- Department of Radiation Oncology, University Hospital S. Chiara, Via Roma 55, 56100, Pisa, Italy
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19
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Lapeyre M, Biau J, Miroir J, Moreau J, Gleyzolle B, Brun L, Racadot S, Graff-Cailleaud P. [Concurrent chemoradiotherapy for head neck cancers. Should organs at risk dose constraints be revisited ?]. Cancer Radiother 2020; 24:586-593. [PMID: 32861607 DOI: 10.1016/j.canrad.2020.07.004] [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] [Received: 06/14/2020] [Revised: 07/02/2020] [Accepted: 07/08/2020] [Indexed: 01/16/2023]
Abstract
Concurrent chemoradiotherapy improves the outcome of locally advanced head and neck cancers and the current reference chemotherapy is cisplatin. These results are obtained at the cost of increased toxicities. To limit the risk of toxicity, organ at riskdose constraints have been established starting with 2D radiotherapy, then 3D radiotherapy and intensity-modulated radiotherapy. Regarding grade ≥3 acute toxicities, the scientific literature attests that concurrent chemoradiotherapy significantly increases risks of mucositis and dysphagia. Constraints applied to the oral mucosa volume excluding the planning target volume, the pharyngeal constrictor muscles and the larynx limit this adverse impact. Regarding late toxicity, concurrent chemoradiotherapy increases significantly the risk of postoperative neck fibrosis and hearing loss. However, for some organs at risk, concurrent chemotherapy appears to increase late radiation induced effect, even though the results are less marked (brachial plexus, mandible, pharyngeal constrictor muscles, parotid gland). This additional adverse impact of concomitant chemotherapy may be notable only when organs at risk receive less than their usual dose thresholds and this would be vanished when those thresholds are exceeded as seems to be the situation for the parotid glands. Until the availability of more robust data, it seems appropriate to apply the principle of delivering dose to organs at risk as low as reasonably achievable.
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Affiliation(s)
- M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France.
| | - J Biau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Miroir
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - J Moreau
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - B Gleyzolle
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - L Brun
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 5026, 63011 Clermont-Ferrand Cedex 1, France
| | - S Racadot
- Département de radiothérapie, centre Léon-Bérard, 28, rue Laennec, 69008 Lyon, France
| | - P Graff-Cailleaud
- Département de radiothérapie, institut universitaire du cancer de Toulouse, 1, avenue Irene Joliot-Curie, 31100 Toulouse, France
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20
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Jeans C, Brown B, Ward EC, Vertigan AE, Pigott AE, Nixon JL, Wratten C. Comparing the prevalence, location, and severity of head and neck lymphedema after postoperative radiotherapy for oral cavity cancers and definitive chemoradiotherapy for oropharyngeal, laryngeal, and hypopharyngeal cancers. Head Neck 2020; 42:3364-3374. [PMID: 32735033 DOI: 10.1002/hed.26394] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2019] [Revised: 05/01/2020] [Accepted: 07/09/2020] [Indexed: 01/28/2023] Open
Abstract
BACKGROUND This study aimed to examine the prevalence, location, and severity of chronic internal, external, and combined head and neck lymphedema (HNL) in patients with head and neck (HNC) who were treated with definitive chemoradiotherapy (CRT) or postoperative radiotherapy (PORT). METHODS Sixty-two participants between 1 and 3 years post-treatment were recruited. Internal HNL was rated with Patterson's Scale. External HNL was graded with the MD Anderson Cancer Center Lymphedema Rating Scale. RESULTS Ninety-eight percent of participants presented with some form of chronic HNL. Sixty-one percent had internal HNL only, 35% had combined HNL, and 2% had external HNL only. Participants treated with PORT were more likely to experience combined HNL (69% vs 24%, P = .001), whereas those treated with CRT were more likely to have internal HNL only (74% vs 25%, P = .001). CONCLUSIONS Chronic HNL is highly prevalent following multimodal treatment, and differences in HNL presentations exist between treatment modalities.
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Affiliation(s)
- Claire Jeans
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Speech Pathology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
| | - Bena Brown
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Buranda, Brisbane, Queensland, Australia.,Speech Pathology Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Elizabeth C Ward
- Division of Speech Pathology, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Buranda, Brisbane, Queensland, Australia
| | - Anne E Vertigan
- Speech Pathology Department, John Hunter Hospital and Belmont Hospital, New Lambton Heights, New South Wales, Australia.,School of Medicine and Public Health, The University of Newcastle, Callaghan, New South Wales, Australia.,Centre for Asthma and Respiratory Disease, Hunter Medical Research Institute, New Lambton Heights, New South Wales, Australia
| | - Amanda E Pigott
- Centre for Functioning and Health Research, Metro South Health Services District, Queensland Health, Buranda, Brisbane, Queensland, Australia.,Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jodie L Nixon
- Division of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia.,Occupational Therapy Department, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Chris Wratten
- Radiation Oncology Department, Calvary Mater Newcastle, Waratah, New South Wales, Australia
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21
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Deng J, Wulff-Burchfield EM, Murphy BA. Late Soft Tissue Complications of Head and Neck Cancer Therapy: Lymphedema and Fibrosis. J Natl Cancer Inst Monogr 2020; 2019:5551348. [PMID: 31425591 DOI: 10.1093/jncimonographs/lgz005] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2019] [Revised: 02/13/2019] [Accepted: 04/01/2019] [Indexed: 02/07/2023] Open
Abstract
Head and neck cancer and its treatment result in soft tissue damage secondary to lymphedema and fibrosis. Lymphedema is the result of pathological accumulation of interstitial fluid in tissues. It is caused by the inability of the lymphatic system to transport lymph fluid from the tissues to the central circulatory system and is manifested clinically by tissue swelling. Fibrosis is defined as an overaccumulation of fibrotic tissues within the skin and soft tissues after a single or repetitive injury and is characterized by hardening of the soft tissues with associated loss of elasticity. Lymphedema and fibrosis are common yet overlooked late effects of head and neck cancer and its therapy. They may result in profound long-term symptom burden, loss of critical functions, and altered quality of life. The following review will discuss the current pathobiology, clinical manifestations, and future directions for research related to lymphedema and fibrosis.
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Affiliation(s)
- Jie Deng
- School of Nursing, University of Pennsylvania, Philadelphia, PA
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22
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Chung SY, Lee CG. Feasibility of single vocal cord irradiation as a treatment strategy for T1a glottic cancer. Head Neck 2019; 42:854-859. [PMID: 31854475 DOI: 10.1002/hed.26052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2019] [Revised: 11/15/2019] [Accepted: 12/10/2019] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Generally, radiotherapy for patients with early glottic cancer includes treatment of the whole larynx. This study was conducted to evaluate the treatment outcomes and toxicity in patients who received single vocal cord irradiation (SVCI) for T1a classification glottic cancer. METHODS A total of 34 patients diagnosed with clinical T1aN0M0 classification squamous cell carcinoma of the glottis who received radiotherapy to the single vocal cord were included for analysis. RESULTS Median follow-up period was 41.3 months (range, 6.4-124.5 months). The 3-year and 5-year local control (LC) rates were both 96.8%. Grade 3 radiation dermatitis was observed as severe acute toxicity in two (6%) patients. No patients experienced any severe late toxicity events during follow-up. CONCLUSIONS SVCI showed good LC, low acute and late toxicities, and reasonable voice recovery. SVCI may be considered a feasible treatment strategy for patients with T1a glottic cancer.
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Affiliation(s)
- Seung Yeun Chung
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
| | - Chang Geol Lee
- Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University College of Medicine, Seoul, South Korea
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23
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Kang BH, Yu T, Kim JH, Park JM, Kim JI, Chung EJ, Kwon SK, Kim JH, Wu HG. Early Closure of a Phase 1 Clinical Trial for SABR in Early-Stage Glottic Cancer. Int J Radiat Oncol Biol Phys 2019; 105:104-109. [DOI: 10.1016/j.ijrobp.2019.03.011] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2019] [Revised: 03/03/2019] [Accepted: 03/06/2019] [Indexed: 01/29/2023]
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24
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LaVigne AW, Margalit DN, Rawal B, Puzanov M, Annino DJ, Goguen LA, Sher DJ, Schoenfeld JD, Chau NG, Lorch JH, Rabinowits G, Haddad RI, Tishler RB. IMRT‐based treatment of unknown primary malignancy of the head and neck: Outcomes and improved toxicity with decreased mucosal dose and larynx sparing. Head Neck 2019; 41:959-966. [DOI: 10.1002/hed.25531] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2018] [Revised: 07/26/2018] [Accepted: 09/28/2018] [Indexed: 12/12/2022] Open
Affiliation(s)
- Anna W. LaVigne
- Johns Hopkins University School of Medicine Baltimore Maryland
| | - Danielle N. Margalit
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Bhupendra Rawal
- Department of Biostatistics and Computational BiologyDana‐Farber Cancer Institute Boston Massachusetts
| | | | - Donald J. Annino
- Division of Otolaryngology, Department of SurgeryDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Laura A. Goguen
- Division of Otolaryngology, Department of SurgeryDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - David J. Sher
- Department of Radiation OncologyUT Southwestern Medical Center Dallas Texas
| | - Jonathan D. Schoenfeld
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
| | - Nicole G. Chau
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Jochen H. Lorch
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | | | - Robert I. Haddad
- Department of Medical OncologyDana‐Farber Cancer Institute Boston Massachusetts
| | - Roy B. Tishler
- Department of Radiation OncologyDana‐Farber Cancer Institute/Brigham and Women's Hospital Boston Massachusetts
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25
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de Veij Mestdagh PD, Janssen T, Lamers E, Carbaat C, Hamming-Vrieze O, Vogel WV, Sonke JJ, Al-Mamgani A. SPECT/CT-guided elective nodal irradiation for head and neck cancer: Estimation of clinical benefits using NTCP models. Radiother Oncol 2019; 130:18-24. [DOI: 10.1016/j.radonc.2018.07.023] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2018] [Revised: 07/17/2018] [Accepted: 07/23/2018] [Indexed: 11/16/2022]
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26
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Omitting the lower neck and sparing the glottic larynx in node-negative nasopharyngeal carcinoma was safe and feasible, and improved patient-reported voice outcomes. Clin Transl Oncol 2018; 21:781-789. [DOI: 10.1007/s12094-018-1988-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2018] [Accepted: 11/09/2018] [Indexed: 10/27/2022]
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27
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Yu T, Wee CW, Choi N, Wu HG, Kang HC, Park JM, Kim JI, Kim JH, Kwon TK, Chung EJ. Study design and early result of a phase I study of SABR for early-stage glottic cancer. Laryngoscope 2018; 128:2560-2565. [DOI: 10.1002/lary.27226] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 03/06/2018] [Accepted: 03/20/2018] [Indexed: 01/08/2023]
Affiliation(s)
- Tosol Yu
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Chan Woo Wee
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Noorie Choi
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hong-Gyun Wu
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Hyun-Cheol Kang
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jong Min Park
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jung-In Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Jin Ho Kim
- Institute of Radiation Medicine, Medical Research Center; Seoul National University; Seoul Republic of Korea
- Department of Radiation Oncology; Seoul National University College of Medicine; Seoul Republic of Korea
- Cancer Research Institution; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Tack-Kyun Kwon
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
| | - Eun-Jae Chung
- Department of Otorhinolaryngology-Head and Neck Surgery; Seoul National University College of Medicine; Seoul Republic of Korea
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28
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Lechien JR, Khalife M, Huet K, Fourneau AF, Delvaux V, Piccaluga M, Harmegnies B, Saussez S. Impact of Chemoradiation After Supra- or Infrahyoid Cancer on Aerodynamic, Subjective, and Objective Voice Assessments: A Multicenter Prospective Study. J Voice 2018; 32:257.e11-257.e19. [DOI: 10.1016/j.jvoice.2017.04.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2017] [Revised: 04/14/2017] [Accepted: 04/17/2017] [Indexed: 12/13/2022]
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29
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Alterio D, Ansarin M, Jereczek-Fossa BA, Zorzi S, Santoro L, Zerini D, Massaro M, Rondi E, Ferrario S, Piperno G, Rocca MC, Griseri M, Preda L, Chiesa F, Orecchia R. What is the price of functional surgical organ preservation in local-regionally advanced supraglottic cancer? Long-term outcome for partial laryngectomy followed by radiotherapy in 32 patients. TUMORI JOURNAL 2018; 99:667-75. [DOI: 10.1177/030089161309900605] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aims and background To achieve the goal of organ preservation, both a chemoradiotherapy and a conservative surgical approach can be proposed. The aim of the study was to review all patients treated in our Institute with conservative surgery and postoperative radiotherapy for locally advanced supraglottic tumor. Methods and study design A retrospective analysis of 32 patients treated between 2000 and 2010 was performed. Overall survival, disease-free survival and late laryngeal toxicity were evaluated. The impact of surgical procedures, radiotherapy characteristics and addition of chemotherapy on late laryngeal toxicity was studied. Results The median follow-up was 38 months. Overall survival and disease-free survival at 5 years were 73% and 66%, respectively. Three (9%) patients experienced local recurrence (after 22, 25 and 40 months, respectively) and were treated with total laryngectomy. The larynx preservation rate was 93%. Severe treatment-related late laryngeal toxicity (grade 3 and 4 laryngeal edema, laryngeal stenosis, presence of tracheotomy at last follow-up because of treatment-related toxicity, and the need for enteral nutrition) was experienced by 34% of patients. The functional larynx preservation rate was 81%. The statistically significant risk factors for severe late toxicity were: female gender, extension of the surgical procedure, removal of one arytenoid and association with concomitant chemotherapy. Conclusions We confirmed literature data on the feasibility and efficacy of a surgical organ preservation strategy. However, the high incidence of severe late toxicity requires further studies to improve patient selection and to reduce side effects.
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Affiliation(s)
- Daniela Alterio
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mohssen Ansarin
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | | | - Stefano Zorzi
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Luigi Santoro
- Department of Experimental Oncology, European Institute of Oncology, Milan
| | - Dario Zerini
- Division of Radiotherapy, European Institute of Oncology, Milan
| | - Mariangela Massaro
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Elena Rondi
- Department of Medical Physics, European Institute of Oncology, Milan
| | - Silvia Ferrario
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Gaia Piperno
- Division of Radiotherapy, European Institute of Oncology, Milan
| | | | - Mara Griseri
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
| | - Lorenzo Preda
- Division of Radiology, European Institute of Oncology, Milan
| | - Fausto Chiesa
- Department of Head and Neck Surgery, European Institute of Oncology, Milan
| | - Roberto Orecchia
- Division of Radiotherapy, European Institute of Oncology, Milan
- University of Milan, Milan
- National Center for Oncological Hadrontherapy, Pavia, Italy
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30
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Wopken K, Bijl HP, Langendijk JA. Prognostic factors for tube feeding dependence after curative (chemo-) radiation in head and neck cancer: A systematic review of literature. Radiother Oncol 2018; 126:56-67. [DOI: 10.1016/j.radonc.2017.08.022] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Revised: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/31/2022]
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31
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Alterio D, Gerardi MA, Cella L, Spoto R, Zurlo V, Sabbatini A, Fodor C, D'Avino V, Conson M, Valoriani F, Ciardo D, Pacelli R, Ferrari A, Maisonneuve P, Preda L, Bruschini R, Cossu Rocca M, Rondi E, Colangione S, Palma G, Dicuonzo S, Orecchia R, Sanguineti G, Jereczek-Fossa BA. Radiation-induced acute dysphagia : Prospective observational study on 42 head and neck cancer patients. Strahlenther Onkol 2017; 193:971-981. [PMID: 28884310 DOI: 10.1007/s00066-017-1206-x] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/05/2017] [Accepted: 08/17/2017] [Indexed: 11/24/2022]
Abstract
PURPOSE Acute toxicity in head and neck (H&N) cancer patients treated with definitive radiotherapy (RT) has a crucial role in compliance to treatments. The aim of this study was to correlate doses to swallowing-associated structures and acute dysphagia. METHODS We prospectively analyzed 42 H&N cancer patients treated with RT. Dysphagia (grade ≥ 3) and indication for percutaneous endoscopic gastrostomy (PEG) insertion were classified as acute toxicity. Ten swallowing-related structures were considered for the dosimetric analysis. The correlation between clinical information and the dose absorbed by the contoured structures was analyzed. Multivariate logistic regression method using resampling methods (bootstrapping) was applied to select model order and parameters for normal tissue complication probability (NTCP) modelling. RESULTS A strong multiple correlation between dosimetric parameters was found. A two-variable model was suggested as the optimal order by bootstrap method. The optimal model (Rs = 0.452, p < 0.001) includes V45 of the cervical esophagus (odds ratio [OR] = 1.016) and Dmean of the cricopharyngeal muscle (OR = 1.057). The model area under the curve was 0.82 (95% confidence interval 0.69-0.95). CONCLUSION Our results suggested that the absorbed dose to the cricopharyngeal muscle and cervical esophagus might play a relevant role in the development of acute RT-related dysphagia.
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Affiliation(s)
- D Alterio
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.
| | - M A Gerardi
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - L Cella
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - R Spoto
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - V Zurlo
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - A Sabbatini
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - C Fodor
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - V D'Avino
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - M Conson
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - F Valoriani
- Dietetic and Clinical Nutrition Unit, European Institute of Oncology, Milan, Italy
| | - D Ciardo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - R Pacelli
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy.,Department of Advanced Biomedical Sciences, Federico II University School of Medicine, Naples, Italy
| | - A Ferrari
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - P Maisonneuve
- Department of Epidemiology and Statistics, European Institute of Oncology, Milan, Italy
| | - L Preda
- Department of Radiology, European Institute of Oncology, Milan, Italy
| | - R Bruschini
- Division of Head and Neck Surgery, European Institute of Oncology, Milan, Italy
| | - M Cossu Rocca
- Division of Urogenital and Head and Neck Tumors, Department of Medical Oncology, European Institute of Oncology, Milan, Italy
| | - E Rondi
- Unit of Medical Physics, European Institute of Oncology, Milan, Italy
| | - S Colangione
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy
| | - G Palma
- Institute of Biostructures and Bioimaging, National Research Council (CNR), Naples, Italy
| | - S Dicuonzo
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
| | - R Orecchia
- Scientific Directorate, European Institute of Oncology, Milan, Italy
| | | | - B A Jereczek-Fossa
- Department of Radiotherapy, European Institute of Oncology, Via Ripamonti 435, 20141, Milan, Italy.,Department of Oncology and Hemato-oncology, University of Milan, Milan, Italy
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Bahig H, Nguyen-Tan PF, Filion É, Roberge D, Thanomsack P, de Guise J, Blais D, Doucet R, Létourneau-Guillon L, Lambert L. Larynx motion considerations in partial larynx volumetric modulated arc therapy for early glottic cancer. J Med Imaging Radiat Oncol 2017; 61:666-673. [PMID: 28557310 DOI: 10.1111/1754-9485.12612] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2016] [Accepted: 03/11/2017] [Indexed: 11/28/2022]
Abstract
INTRODUCTION To assess laryngeal motion in early glottic cancer in order to determine safe margins for partial larynx volumetric modulated arc therapy (PL-VMAT), and to quantify dosimetric advantages of PL-VMAT. METHODS This prospective study included T1-2N0 glottic cancers treated with whole larynx VMAT (WL-VMAT). Pre- and mid-treatment 4D-computed tomography (4D-CT) and dynamic magnetic resonance imaging (MRI) allowed for assessment of larynx swallowing and respiratory motion. For 10 patients with lateralized lesions, PL-VMAT plans were calculated using margins derived from 4D-CT analysis. RESULTS Twenty patients were accrued from 2014 to 2016. Mean amplitude of larynx swallowing excursion was 23 mm and 6 mm in the superior and anterior directions, respectively. Mean respiratory motion reached 4 mm and 2 mm in superior-inferior and antero-posterior directions, respectively. Pre-treatment 4D-CT analysis identified one patient with planning CT acquired during swallowing. Mid-treatment 4D-CT revealed larynx shift relative to vertebrae in 30% of cases. PL-VMAT allowed for significant reduction of mean doses to ipsilateral carotid, contralateral carotid, thyroid gland, contralateral arytenoid and larynx. Using 8 mm internal margin for PL-VMAT, swallowing resulted in clinical target volume excursion beyond 95% isodose line during ≤1.5% of total treatment time in all patients. CONCLUSION Although swallowing motion is rare, rapid and easily suppressed by patients, there is a risk of systematic miss-targeting if planning CT is acquired during swallowing. Larynx position shift relative to vertebrae occurs in 1/3 of patients over the course of radiotherapy. With soft-tissue image guidance and margins accounting for respiratory motion, PL-VMAT allows safe reduction of dose to organs at risk.
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Affiliation(s)
- Houda Bahig
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Phuc Félix Nguyen-Tan
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Édith Filion
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - David Roberge
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
| | - Pensavan Thanomsack
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | | | - Danis Blais
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Robert Doucet
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Laurent Létourneau-Guillon
- CHUM Research Center, Montreal, Quebec, Canada.,Radiology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada
| | - Louise Lambert
- Radiation Oncology Department, Centre Hospitalier de l'Université de Montréal, Montreal, Quebec, Canada.,CHUM Research Center, Montreal, Quebec, Canada
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[Head and neck intensity-modulated radiation therapy: Normal tissues dose constraints. Pharyngeal constrictor muscles and larynx]. Cancer Radiother 2016; 20:452-8. [PMID: 27599684 DOI: 10.1016/j.canrad.2016.06.004] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2016] [Accepted: 06/23/2016] [Indexed: 10/21/2022]
Abstract
Radio-induced pharyngolaryngeal chronic disorders may challenge the quality of life of head and neck cancer long survivors. Many anatomic structures have been identified as potentially impaired by irradiation and responsible for laryngeal edema, dysphonia and dysphagia. Some dose constraints might be plausible such as keeping the mean dose to the pharyngeal constrictor muscles under 50 to 55Gy, the mean dose to the supra-glottic larynx under 40 to 45Gy and, if feasible, the mean dose to the glottic larynx under 20Gy. A reduction of the dose delivered to the muscles of the floor of the mouth and the cervical esophagus would be beneficial as well. Nevertheless, the publications available do not provide an extensive enough level of proof. One should consider limiting as low as possible the dose delivered to these structures without compromising the quality of irradiation of the target tumor volumes.
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Noël G, Antoni D, Barillot I, Chauvet B. Délinéation des organes à risque et contraintes dosimétriques. Cancer Radiother 2016; 20 Suppl:S36-60. [DOI: 10.1016/j.canrad.2016.07.032] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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35
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Grade 3 radiation dermatitis in a patient with presumed latent actinic lichen planus. Adv Radiat Oncol 2016; 1:157-160. [PMID: 28740885 PMCID: PMC5514014 DOI: 10.1016/j.adro.2016.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/11/2016] [Accepted: 06/15/2016] [Indexed: 11/22/2022] Open
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36
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King SN, Dunlap NE, Tennant PA, Pitts T. Pathophysiology of Radiation-Induced Dysphagia in Head and Neck Cancer. Dysphagia 2016; 31:339-51. [PMID: 27098922 PMCID: PMC5340192 DOI: 10.1007/s00455-016-9710-1] [Citation(s) in RCA: 129] [Impact Index Per Article: 16.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2015] [Accepted: 04/08/2016] [Indexed: 11/25/2022]
Abstract
Oncologic treatments, such as curative radiotherapy and chemoradiation, for head and neck cancer can cause long-term swallowing impairments (dysphagia) that negatively impact quality of life. Radiation-induced dysphagia comprised a broad spectrum of structural, mechanical, and neurologic deficits. An understanding of the biomolecular effects of radiation on the time course of wound healing and underlying morphological tissue responses that precede radiation damage will improve options available for dysphagia treatment. The goal of this review is to discuss the pathophysiology of radiation-induced injury and elucidate areas that need further exploration.
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Affiliation(s)
- Suzanne N King
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA
| | - Neal E Dunlap
- Department of Radiation Oncology, University of Louisville, Louisville, USA
| | - Paul A Tennant
- Department of Otolaryngology-Head and Neck Surgery and Communicative Disorders, University of Louisville, Louisville, USA
| | - Teresa Pitts
- Department of Neurological Surgery, Kentucky Spinal Cord Injury Research Center, University of Louisville, 511 South Floyd St MDR 616, Louisville, KY, 40202, USA.
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Yan Y, Yadav P, Bassetti M, Du K, Saenz D, Harari P, Paliwal BR. Dosimetric differences in flattened and flattening filter-free beam treatment plans. J Med Phys 2016; 41:92-9. [PMID: 27217620 PMCID: PMC4871009 DOI: 10.4103/0971-6203.181636] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
This study investigated the dosimetric differences in treatment plans from flattened and flattening filter-free (FFF) beams from the TrueBeam System. A total of 104 treatment plans with static (sliding window) intensity-modulated radiotherapy beams and volumetric-modulated arc therapy (VMAT) beams were generated for 15 patients involving three cancer sites. In general, the FFF beam provides similar target coverage as the flattened beam with improved dose sparing to organ-at-risk (OAR). Among all three cancer sites, the head and neck showed more important differences between the flattened beam and FFF beam. The maximum reduction of the FFF beam in the mean dose reached up to 2.82 Gy for larynx in head and neck case. Compared to the 6 MV flattened beam, the 10 MV FFF beam provided improved dose sparing to certain OARs, especially for VMAT cases. Thus, 10 MV FFF beam could be used to improve the treatment plan.
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Affiliation(s)
- Yue Yan
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
| | - Poonam Yadav
- Department of Human Oncology, University of Wisconsin, Madison, USA; Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Michael Bassetti
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Kaifang Du
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Daniel Saenz
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
| | - Paul Harari
- Riverview Cancer Center, University of Wisconsin, Wisconsin Rapids, Wisconsin, USA
| | - Bhudatt R Paliwal
- Department of Medical Physics, University of Wisconsin, Madison, USA; Department of Human Oncology, University of Wisconsin, Madison, USA
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Single cannula versus double cannula tracheostomy tubes in major oral and oropharyngeal resections. The Journal of Laryngology & Otology 2015; 130:388-92. [PMID: 26707289 DOI: 10.1017/s0022215115003412] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To compare the outcomes of two types of tracheostomy tubes used in major head and neck surgery. METHODS A retrospective study was conducted of prospectively collected data. The post-operative safety and adequacy of a single cannula tracheostomy tube was compared to a double cannula tracheostomy tube in patients undergoing tracheostomy during major oral and oropharyngeal resections. RESULTS Out of 46 patients with the single cannula tube, 7 (15 per cent) experienced significant obstruction warranting immediate tube removal, while another 9 (20 per cent) needed a change of tube or tube re-insertion for continued airway protection. In contrast, out of 50 patients with the double cannula tube, the corresponding numbers were 0 (p = 0.004) and 1 (2 per cent; p = 0.007) respectively. CONCLUSION Insertion of a double cannula (instead of a single cannula) tracheostomy tube in the course of major oral and oropharyngeal resections offers better airway protection during the post-operative period.
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Franzese C, Fogliata A, Clerici E, Franceschini D, Villa E, D'Agostino G, Navarria P, Mancosu P, Tomatis S, Cozzi L, Scorsetti M. Toxicity profile and early clinical outcome for advanced head and neck cancer patients treated with simultaneous integrated boost and volumetric modulated arc therapy. Radiat Oncol 2015; 10:224. [PMID: 26545871 PMCID: PMC4636817 DOI: 10.1186/s13014-015-0535-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2015] [Accepted: 11/02/2015] [Indexed: 01/09/2023] Open
Abstract
Background Shortening the overall treatment time without increasing acute reactions is one of the major aims in radiotherapy for head and neck cancer (HNC). Volumetric modulated arc therapy (VMAT) with Simultaneous Integrated Boost (SIB) showed improvements in outcome and pattern of toxicity. Patients with stage III-IV HNC treated with VMAT-SIB have been analysed, and doses were correlated to limiting structures and toxicity. Methods One hundred two patients treated from December 2008 to August 2014 were analysed. Patients were treated with VMAT (RapidArc) and SIB in 33 fractions for a total dose of 69.96 and 54.45Gy, respectively. For organs at risk, D1/3 V, D1/2 V, D2/3 V, the mean dose, VD with D = 10,20,30,40,50,70 Gy were analysed. For targets, D98%, D2%, and V95%, V107%, conformity and homogeneity indexes were calculated. Toxicity was graded according to CTCAE3. Results Oral cavity V30Gy, V40Gy, and V70Gy, were found correlated with mucosal toxicity grading. Concerning salivary glands, significant was only D2/3V for one of the two parotids. Almost all analysed parameters of the inferior constrictor muscle were significant while no correlations were found for middle and superior constrictors. With median follow-up of 19 months, Overall Survival (OS) at 3 and 5 years was 83 % ± 4 % and 73 % ± 10 %. Mean OS was 51 ± 3 months. Disease Free Survival (DFS) at 3 and 5 years was 71 % ± 7 %, and 34 % ± 16 %. Mean DFS was 43 ± 3 months. Conclusions RapidArc technology and SIB with 1.65 and 2.12Gy/fraction for 33 fractions showed a good toxicity profile and encouraging trend for OS and DFS for patients with stage III-IV HNC.
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Affiliation(s)
- Ciro Franzese
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Antonella Fogliata
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Elena Clerici
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Davide Franceschini
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Elisa Villa
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Giuseppe D'Agostino
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Piera Navarria
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Pietro Mancosu
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Stefano Tomatis
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Luca Cozzi
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
| | - Marta Scorsetti
- Radiotherapy and Radiosurgery Department, Humanitas Research Hospital, Milan, Rozzano, 20089, Italy.
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Christianen MEMC, Verdonck-de Leeuw IM, Doornaert P, Chouvalova O, Steenbakkers RJHM, Koken PW, Leemans CR, Oosting SF, Roodenburg JLN, van der Laan BFAM, Slotman BJ, Bijl HP, Langendijk JA. Patterns of long-term swallowing dysfunction after definitive radiotherapy or chemoradiation. Radiother Oncol 2015; 117:139-44. [PMID: 26320608 DOI: 10.1016/j.radonc.2015.07.042] [Citation(s) in RCA: 61] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2015] [Revised: 07/27/2015] [Accepted: 07/29/2015] [Indexed: 11/28/2022]
Abstract
OBJECTIVES To identify patterns of long-term, radiation-induced swallowing dysfunction after definitive radiotherapy with or without chemotherapy (RT or CHRT) and to determine which factors may explain these patterns over time. MATERIAL AND METHODS The study population consisted of 238 consecutive head and neck cancer patients treated with RT or CHRT. The primary endpoint was ⩾grade 2 swallowing dysfunction at 6, 12, 18 and 24months after treatment. Cluster analysis was used to identify different patterns over time. The differences between the mean dose to the swallowing organs at risk for each pattern were determined by using dose maps. RESULTS The cluster analysis revealed five patterns of swallowing dysfunction: low persistent, intermediate persistent, severe persistent, transient and progressive. Patients with high dose to the upper pharyngeal, laryngeal and lower pharyngeal region had the highest risk of severe persistent swallowing dysfunction. Transient problems mainly occurred after high dose to the laryngeal and lower pharyngeal regions, combined with moderate dose to the upper pharyngeal region. The progressive pattern was mainly seen after moderate dose to the upper pharyngeal region. CONCLUSIONS Various patterns of swallowing dysfunction after definitive RT or CHRT can be identified over time. This could reflect different underlying biological processes.
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Affiliation(s)
- Miranda E M C Christianen
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Irma M Verdonck-de Leeuw
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Patricia Doornaert
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - Olga Chouvalova
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Roel J H M Steenbakkers
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Phil W Koken
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - C René Leemans
- Department of Otolaryngology-Head and Neck Surgery, VU University Medical Center Amsterdam, The Netherlands
| | - Sjoukje F Oosting
- Department of Medical Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Jan L N Roodenburg
- Department of Oral and Maxillofacial Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Bernard F A M van der Laan
- Department of Otolaryngology-Head and Neck Surgery, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Ben J Slotman
- Department of Radiation Oncology, VU University Medical Center Amsterdam, The Netherlands
| | - Hendrik P Bijl
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands
| | - Johannes A Langendijk
- Department of Radiation Oncology, University of Groningen, University Medical Center Groningen, The Netherlands.
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Abstract
Laryngeal function after oncologic treatment is a key aspect and focus of interest in the contemporary management of head and neck cancers. Although historically the treatment of most locally advanced laryngeal cancers has been total laryngectomy, recent innovations in radiation therapy and combined chemotherapy and radiation therapy have shown that organ and function preservation can be achieved with good oncologic outcomes. Technical improvements, along with better understanding of tumor biology and dose tolerance of critical organs involved in speech and swallowing function, have paved the way for better outcomes. This article reviews in comprehensive detail the recent data of laryngeal function after radiotherapy.
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Al-Mamgani A, Kwa SLS, Tans L, Moring M, Fransen D, Mehilal R, Verduijn GM, Baatenburg de Jong RJ, Heijmen BJM, Levendag PC. Single Vocal Cord Irradiation: Image Guided Intensity Modulated Hypofractionated Radiation Therapy for T1a Glottic Cancer: Early Clinical Results. Int J Radiat Oncol Biol Phys 2015; 93:337-43. [PMID: 26264629 DOI: 10.1016/j.ijrobp.2015.06.016] [Citation(s) in RCA: 37] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2015] [Revised: 06/05/2015] [Accepted: 06/08/2015] [Indexed: 01/30/2023]
Abstract
PURPOSE To report, from a retrospective analysis of prospectively collected data, on the feasibility, outcome, toxicity, and voice-handicap index (VHI) of patients with T1a glottic cancer treated by a novel intensity modulated radiation therapy technique developed at our institution to treat only the involved vocal cord: single vocal cord irradiation (SVCI). METHODS AND MATERIALS Thirty patients with T1a glottic cancer were treated by means of SVCI. Dose prescription was set to 16 × 3.63 Gy (total dose 58.08 Gy). The clinical target volume was the entire vocal cord. Setup verification was done by means of an online correction protocol using cone beam computed tomography. Data for voice quality assessment were collected prospectively at baseline, end of treatment, and 4, 6, and 12 weeks and 6, 12, and 18 months after treatment using VHI questionnaires. RESULTS After a median follow-up of 30 months (range, 7-50 months), the 2-year local control and overall survival rates were 100% and 90% because no single local recurrence was reported and 3 patients died because of comorbidity. All patients have completed the intended treatment schedule; no treatment interruptions and no grade 3 acute toxicity were reported. Grade 2 acute dermatitis or dysphagia was reported in only 5 patients (17%). No serious late toxicity was reported; only 1 patient developed temporary grade 2 laryngeal edema, and responded to a short-course of corticosteroid. The VHI improved significantly, from 33.5 at baseline to 9.5 and 10 at 6 weeks and 18 months, respectively (P<.001). The control group, treated to the whole larynx, had comparable local control rates (92.2% vs 100%, P=.24) but more acute toxicity (66% vs 17%, P<.0001) and higher VHI scores (23.8 and 16.7 at 6 weeks and 18 months, respectively, P<.0001). CONCLUSION Single vocal cord irradiation is feasible and resulted in maximal local control rate at 2 years. The deterioration in VHI scores was slight and temporary and subsequently improved to normal levels. Long-term follow-up is needed to consolidate these promising results.
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Affiliation(s)
- Abrahim Al-Mamgani
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands.
| | - Stefan L S Kwa
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa Tans
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael Moring
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennie Fransen
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robert Mehilal
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Gerda M Verduijn
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Rob J Baatenburg de Jong
- Department of Otolaryngology and Head and Neck Surgery - Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ben J M Heijmen
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter C Levendag
- Department of Radiation Oncology - Erasmus MC Cancer Institute, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Merlotti A, Alterio D, Vigna-Taglianti R, Muraglia A, Lastrucci L, Manzo R, Gambaro G, Caspiani O, Miccichè F, Deodato F, Pergolizzi S, Franco P, Corvò R, Russi EG, Sanguineti G. Technical guidelines for head and neck cancer IMRT on behalf of the Italian association of radiation oncology - head and neck working group. Radiat Oncol 2014; 9:264. [PMID: 25544268 PMCID: PMC4316652 DOI: 10.1186/s13014-014-0264-9] [Citation(s) in RCA: 79] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Accepted: 11/17/2014] [Indexed: 12/25/2022] Open
Abstract
Performing intensity-modulated radiotherapy (IMRT) on head and neck cancer patients (HNCPs) requires robust training and experience. Thus, in 2011, the Head and Neck Cancer Working Group (HNCWG) of the Italian Association of Radiation Oncology (AIRO) organized a study group with the aim to run a literature review to outline clinical practice recommendations, to suggest technical solutions and to advise target volumes and doses selection for head and neck cancer IMRT. The main purpose was therefore to standardize the technical approach of radiation oncologists in this context. The following paper describes the results of this working group. Volumes, techniques/strategies and dosage were summarized for each head-and-neck site and subsite according to international guidelines or after reaching a consensus in case of weak literature evidence.
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Affiliation(s)
- Anna Merlotti
- Radioterapia AO Ospedale di Circolo-Busto Arsizio (VA), Piazzale Professor G. Solaro, 3, 21052, Busto Arsizio, VA, Italy.
| | | | | | | | | | - Roberto Manzo
- Radioterapia Azienda Ospedaliera ASL Napoli 1-Napoli, Napoli, Italy.
| | | | - Orietta Caspiani
- Radioterapia Ospedale Fatebenefratelli, Isola Tiberina-Roma, Roma, Italy.
| | | | - Francesco Deodato
- Radioterapia Università Cattolica del S. Cuore -Campobasso, Roma, Italy.
| | - Stefano Pergolizzi
- Dipartimento SBIMOF Sezione di Scienze Radiologiche, Università di Messina, Piazza Pugliatti Salvatore, 1, 98122, Messina, ME, Italy.
| | - Pierfrancesco Franco
- Dipartimento di Oncologia, Radioterapia Oncologica, Università di Torino, Turin, Italy.
| | - Renzo Corvò
- Oncologia Radioterapica, IRCS S. Martino-IST- Istituto Nazionale per la Ricerca sul Cancro, Università Genova, Genova, Italy.
| | - Elvio G Russi
- Radioterapia Az. Ospedaliera S. Croce e Carle-Cuneo, via M. Coppino 26 12100, Cuneo, Italy.
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Broggi S, Perna L, Bonsignore F, Rinaldin G, Fiorino C, Chiara A, Frigerio C, Butti I, Sangalli G, Dell'Oca I, Di Muzio N, Cattaneo GM, Declich F. Static and rotational intensity modulated techniques for head-neck cancer radiotherapy: A planning comparison. Phys Med 2014; 30:973-9. [DOI: 10.1016/j.ejmp.2014.07.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Revised: 07/09/2014] [Accepted: 07/12/2014] [Indexed: 10/24/2022] Open
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Kraaijenga SAC, van der Molen L, Jacobi I, Hamming-Vrieze O, Hilgers FJM, van den Brekel MWM. Prospective clinical study on long-term swallowing function and voice quality in advanced head and neck cancer patients treated with concurrent chemoradiotherapy and preventive swallowing exercises. Eur Arch Otorhinolaryngol 2014; 272:3521-31. [PMID: 25381096 DOI: 10.1007/s00405-014-3379-6] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2014] [Accepted: 10/25/2014] [Indexed: 11/30/2022]
Abstract
Concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer (HNC) is associated with substantial early and late side effects, most notably regarding swallowing function, but also regarding voice quality and quality of life (QoL). Despite increased awareness/knowledge on acute dysphagia in HNC survivors, long-term (i.e., beyond 5 years) prospectively collected data on objective and subjective treatment-induced functional outcomes (and their impact on QoL) still are scarce. The objective of this study was the assessment of long-term CCRT-induced results on swallowing function and voice quality in advanced HNC patients. The study was conducted as a randomized controlled trial on preventive swallowing rehabilitation (2006-2008) in a tertiary comprehensive HNC center with twenty-two disease-free and evaluable HNC patients as participants. Multidimensional assessment of functional sequels was performed with videofluoroscopy, mouth opening measurements, Functional Oral Intake Scale, acoustic voice parameters, and (study specific, SWAL-QoL, and VHI) questionnaires. Outcome measures at 6 years post-treatment were compared with results at baseline and at 2 years post-treatment. At a mean follow-up of 6.1 years most initial tumor-, and treatment-related problems remained similarly low to those observed after 2 years follow-up, except increased xerostomia (68%) and increased (mild) pain (32%). Acoustic voice analysis showed less voicedness, increased fundamental frequency, and more vocal effort for the tumors located below the hyoid bone (n = 12), without recovery to baseline values. Patients' subjective vocal function (VHI score) was good. Functional swallowing and voice problems at 6 years post-treatment are minimal in this patient cohort, originating from preventive and continued post-treatment rehabilitation programs.
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Affiliation(s)
- Sophie A C Kraaijenga
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Lisette van der Molen
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Irene Jacobi
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Olga Hamming-Vrieze
- Department of Radiation Oncology, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands
| | - Frans J M Hilgers
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands.,Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands
| | - Michiel W M van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Plesmanlaan 121, 1066 CX, Amsterdam, The Netherlands. .,Institute of Phonetic Sciences, University of Amsterdam, Spuistraat 210, 1012 VT, Amsterdam, The Netherlands. .,Department of Oral and Maxillofacial Surgery, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands.
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Anderson NJ, Wada M, Schneider-Kolsky M, Rolfo M, Joon DL, Khoo V. Dose-volume response in acute dysphagia toxicity: Validating QUANTEC recommendations into clinical practice for head and neck radiotherapy. Acta Oncol 2014; 53:1305-11. [PMID: 24980044 DOI: 10.3109/0284186x.2014.933874] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
PURPOSE To determine the validity of QUANTEC recommendations in predicting acute dysphagia using intensity-modulated head and neck radiotherapy. MATERIAL AND METHODS Seventy-six consecutive patients with locally advanced squamous cell carcinoma (SCC) of the head and neck +/- systemic therapy were analyzed. Multiple dose parameters for the larynx (V50Gy, Dmean and Dmax) were recorded. Acute dysphagia toxicity was prospectively scored in all treatment weeks (week 1-6 or 1-7) using CTCAEv3 by three blinded investigators. QUANTEC larynx recommendations (V50Gy < 27%, Dmean < 44 Gy, Dmean < 40 Gy, Dmax < 66 Gy) were used to group the cohort (i.e. V50Gy < 27% vs. V50Gy > 27%). The proportion of patients with Grade 3 dysphagia was compared within each group. RESULTS There was a significant reduction in the incidence of grade 3 toxicity in the V50Gy < or > 27% group at week 5 (14.3% vs. 45.2%, p = 0.01) and 6 (25.9% vs. 65.9%, p < 0.01). A significant reduction at week 5 (14.7% vs. 50.0, p = 0.02) and 6 (32.4% vs. 67.6%, p = 0.01) was seen in Dmean < 44 Gy when compared to Dmean > 44 Gy. Dmean < 40 Gy also delivered a significant reduction at week 5 (5.6% vs. 42.3%, p < 0.01) and week 6 (23.5% vs. 59.3%, p = 0.01). A significant toxicity reduction at treatment week 6 (28.0% vs. 63.0%, p = 0 < 01) was seen from Dmax < 66 Gy to Dmax > 66 Gy. V50Gy > 27% (p < 0.01), Dmean > 40 Gy (p = 0.01) and Dmax > 66 Gy (p < 0.01) were also predictors of Grade 3 dysphagia when analyzed with multiple clinical risk factors. CONCLUSIONS QUANTEC late toxicity recommendations for dose to larynx during IMRT are a useful predictor for acute dysphagia toxicity in this patient cohort. Furthermore, this included chemoradiotherapy regimes and post-operative radiotherapy patients, allowing for prophylactic implementation of supportive care measures.
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Affiliation(s)
- Nigel J Anderson
- Department of Radiation Oncology, Austin Health, Heidelberg Heights , Victoria , Australia
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Vainshtein JM, Griffith KA, Feng FY, Vineberg KA, Chepeha DB, Eisbruch A. Patient-reported voice and speech outcomes after whole-neck intensity modulated radiation therapy and chemotherapy for oropharyngeal cancer: prospective longitudinal study. Int J Radiat Oncol Biol Phys 2014; 89:973-980. [PMID: 24803039 DOI: 10.1016/j.ijrobp.2014.03.013] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/09/2014] [Accepted: 03/07/2014] [Indexed: 10/25/2022]
Abstract
PURPOSE To describe voice and speech quality changes and their predictors in patients with locally advanced oropharyngeal cancer treated on prospective clinical studies of organ-preserving chemotherapy-intensity modulated radiation therapy (chemo-IMRT). METHODS AND MATERIALS Ninety-one patients with stage III/IV oropharyngeal cancer were treated on 2 consecutive prospective studies of definitive chemoradiation using whole-field IMRT from 2003 to 2011. Patient-reported voice and speech quality were longitudinally assessed from before treatment through 24 months using the Communication Domain of the Head and Neck Quality of Life (HNQOL-C) instrument and the Speech question of the University of Washington Quality of Life (UWQOL-S) instrument, respectively. Factors associated with patient-reported voice quality worsening from baseline and speech impairment were assessed. RESULTS Voice quality decreased maximally at 1 month, with 68% and 41% of patients reporting worse HNQOL-C and UWQOL-S scores compared with before treatment, and improved thereafter, recovering to baseline by 12-18 months on average. In contrast, observer-rated larynx toxicity was rare (7% at 3 months; 5% at 6 months). Among patients with mean glottic larynx (GL) dose ≤20 Gy, >20-30 Gy, >30-40 Gy, >40-50 Gy, and >50 Gy, 10%, 32%, 25%, 30%, and 63%, respectively, reported worse voice quality at 12 months compared with before treatment (P=.011). Results for speech impairment were similar. Glottic larynx dose, N stage, neck dissection, oral cavity dose, and time since chemo-IMRT were univariately associated with either voice worsening or speech impairment. On multivariate analysis, mean GL dose remained independently predictive for both voice quality worsening (8.1%/Gy) and speech impairment (4.3%/Gy). CONCLUSIONS Voice quality worsening and speech impairment after chemo-IMRT for locally advanced oropharyngeal cancer were frequently reported by patients, underrecognized by clinicians, and independently associated with GL dose. These findings support reducing mean GL dose to as low as reasonably achievable, aiming at ≤20 Gy when the larynx is not a target.
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Affiliation(s)
| | - Kent A Griffith
- Center for Cancer Biostatistics, University of Michigan School of Public Health, Ann Arbor, Michigan
| | - Felix Y Feng
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Karen A Vineberg
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan
| | - Douglas B Chepeha
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor, Michigan
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan, Ann Arbor, Michigan.
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Sanguineti G, Ricchetti F, McNutt T, Wu B, Fiorino C. Dosimetric predictors of dysphonia after intensity-modulated radiotherapy for oropharyngeal carcinoma. Clin Oncol (R Coll Radiol) 2013; 26:32-8. [PMID: 23992739 DOI: 10.1016/j.clon.2013.08.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2012] [Revised: 05/13/2013] [Accepted: 06/20/2013] [Indexed: 11/30/2022]
Abstract
AIMS To investigate dosimetric predictors of voice changes after whole-field intensity-modulated radiotherapy (IMRT). MATERIALS AND METHODS Patients treated with whole-field IMRT for oropharyngeal/unknown primary tumours were selected for the present retrospective study having grossly uninvolved larynx at the time of radiotherapy and at least one follow-up visit. Voice changes were prospectively scored at each follow-up examination according to the Common Terminology Criteria for Adverse Events (CTCAE) v3.0 scale and self-reported by two items (HN4 and HN10) of the Functional Assessment of Cancer Therapy-Head and Neck Scale (FACT-HN) questionnaire. Predictors of toxicity were investigated at logistic regression, including various patient and tumour characteristics, as well as individual dosimetric data. RESULTS With a median follow-up of 18 months (range 3-46 months), peak CTCAE dysphonia was graded as 2 in 13 patients (10.5%), whereas 45 patients (36.3%) reported peak grade 0-1 voice changes according to FACT-HN4. Communication (FACT-HN10) was barely affected. At multivariate analysis, the mean laryngeal dose was an independent predictor of both grade 2 CTCAE dysphonia (odds ratio = 1.10, 95% confidence interval 1.01-1.20, P = 0.025) and grade 0-1 FACT-HN4 voice changes (odds ratio = 1.11, 95% confidence interval 1.04-1.18, P = 0.001). Further stratification optimised by a receiver operating characteristic (ROC) analysis showed that, to minimise the risk of grade 0-1 FACT-HN4 voice changes, the mean dose to the larynx has to be kept ≤ 49.4 Gy. CONCLUSION Voice changes after whole-field IMRT are common, but mild, and are strictly correlated to the dose received by the uninvolved larynx; in order to minimise the risk of side-effects, the mean dose to the larynx should be kept ≤ 50 Gy.
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Affiliation(s)
- G Sanguineti
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA.
| | - F Ricchetti
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - T McNutt
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - B Wu
- Radiation Oncology, Johns Hopkins University, Baltimore, MD, USA
| | - C Fiorino
- Physics, Ospedale San Raffaele, Milano, Italy
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Kandula S, Zhu X, Garden AS, Gillin M, Rosenthal DI, Ang KK, Mohan R, Amin MV, Garcia JA, Wu R, Sahoo N, Frank SJ. Spot-scanning beam proton therapy vs intensity-modulated radiation therapy for ipsilateral head and neck malignancies: a treatment planning comparison. Med Dosim 2013; 38:390-4. [PMID: 23916884 DOI: 10.1016/j.meddos.2013.05.001] [Citation(s) in RCA: 77] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2012] [Revised: 02/24/2013] [Accepted: 05/01/2013] [Indexed: 11/13/2022]
Abstract
Radiation therapy for head and neck malignancies can have side effects that impede quality of life. Theoretically, proton therapy can reduce treatment-related morbidity by minimizing the dose to critical normal tissues. We evaluated the feasibility of spot-scanning proton therapy for head and neck malignancies and compared dosimetry between those plans and intensity-modulated radiation therapy (IMRT) plans. Plans from 5 patients who had undergone IMRT for primary tumors of the head and neck were used for planning proton therapy. Both sets of plans were prepared using computed tomography (CT) scans with the goals of achieving 100% of the prescribed dose to the clinical target volume (CTV) and 95% to the planning TV (PTV) while maximizing conformity to the PTV. Dose-volume histograms were generated and compared, as were conformity indexes (CIs) to the PTVs and mean doses to the organs at risk (OARs). Both modalities in all cases achieved 100% of the dose to the CTV and 95% to the PTV. Mean PTV CIs were comparable (0.371 IMRT, 0.374 protons, p = 0.953). Mean doses were significantly lower in the proton plans to the contralateral submandibular (638.7 cGy IMRT, 4.3 cGy protons, p = 0.002) and parotid (533.3 cGy IMRT, 48.5 cGy protons, p = 0.003) glands; oral cavity (1760.4 cGy IMRT, 458.9 cGy protons, p = 0.003); spinal cord (2112.4 cGy IMRT, 249.2 cGy protons, p = 0.002); and brainstem (1553.52 cGy IMRT, 166.2 cGy protons, p = 0.005). Proton plans also produced lower maximum doses to the spinal cord (3692.1 cGy IMRT, 2014.8 cGy protons, p = 0.034) and brainstem (3412.1 cGy IMRT, 1387.6 cGy protons, p = 0.005). Normal tissue V10, V30, and V50 values were also significantly lower in the proton plans. We conclude that spot-scanning proton therapy can significantly reduce the integral dose to head and neck critical structures. Prospective studies are underway to determine if this reduced dose translates to improved quality of life.
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Affiliation(s)
- Shravan Kandula
- Department of Radiation Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
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Nguyen NP, Kratz S, Lemanski C, Vock J, Vinh-Hung V, Olena Gorobets, Chi A, Almeida F, Betz M, Khan R, Godinez J, Karlsson U, Ampil F. Image-guided radiotherapy for locally advanced head and neck cancer. Front Oncol 2013; 3:172. [PMID: 23847763 PMCID: PMC3703525 DOI: 10.3389/fonc.2013.00172] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Accepted: 06/17/2013] [Indexed: 12/11/2022] Open
Abstract
Treatment of locally advanced head and neck cancer remains a challenge because of the head and neck complex anatomy and the tumor invasion to the adjacent organs and/or metastases to the cervical nodes. Postoperative irradiation or concurrent chemoradiation may lead to damage of radiosensitive structures such as the salivary glands, mandible, cochlea, larynx, and pharyngeal muscles. Xerostomia, osteoradionecrosis, deafness, hoarseness of the voice, dysphagia, and aspiration remain serious complications of head and neck irradiation and impair patient quality of life. Intensity-modulated and image-guided radiotherapy by virtue of steep dose gradient and daily imaging may allow for decreased radiation of the organs at risk for complication while preserving loco-regional control.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona , Tucson, AZ , USA
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