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Nguyen NP, Kim L, Thariat J, Baumert BG, Mazibuko T, Gorobets O, Vinh-Hung V, Giap H, Mehmood T, Vincent F, Chi A, Basu T, Loganadane G, Mohammadianpanah M, Karlsson U, Oboite E, Oboite J, Ali A, Page BR. Immunotherapy and Modern Radiotherapy Technique for Older Patients with Locally Advanced Head and Neck Cancer: A Proposed Paradigm by the International Geriatric Radiotherapy Group. Cancers (Basel) 2022; 14:5285. [PMID: 36358703 PMCID: PMC9654379 DOI: 10.3390/cancers14215285] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 10/19/2022] [Accepted: 10/20/2022] [Indexed: 10/29/2023] Open
Abstract
The standard of care for locally advanced head and neck cancer is concurrent chemoradiation or postoperative irradiation with or without chemotherapy. Surgery may not be an option for older patients (70 years old or above) due to multiple co-morbidities and frailty. Additionally, the standard chemotherapy of cisplatin may not be ideal for those patients due to oto- and nephrotoxicity. Though carboplatin is a reasonable alternative for cisplatin in patients with a pre-existing hearing deficit or renal dysfunction, its efficacy may be inferior to cisplatin for head and neck cancer. In addition, concurrent chemoradiation is frequently associated with grade 3-4 mucositis and hematologic toxicity leading to poor tolerance among older cancer patients. Thus, a new algorithm needs to be developed to provide optimal local control while minimizing toxicity for this vulnerable group of patients. Recently, immunotherapy with check point inhibitors (CPI) has attracted much attention due to the high prevalence of program death-ligand 1 (PD-L1) in head and neck cancer. In patients with recurrent or metastatic head and neck cancer refractory to cisplatin-based chemotherapy, CPI has proven to be superior to conventional chemotherapy for salvage. Those with a high PD-L1 expression defined as 50% or above or a high tumor proportion score (TPS) may have an excellent response to CPI. This selected group of patients may be candidates for CPI combined with modern radiotherapy techniques, such as intensity-modulated image-guided radiotherapy (IM-IGRT), volumetric arc therapy (VMAT) or proton therapy if available, which allow for the sparing of critical structures, such as the salivary glands, oral cavity, cochlea, larynx and pharyngeal muscles, to improve the patients' quality of life. In addition, normal organs that are frequently sensitive to immunotherapy, such as the thyroid and lungs, are spared with modern radiotherapy techniques. In fit or carefully selected frail patients, a hypofractionated schedule may be considered to reduce the need for daily transportation. We propose a protocol combining CPI and modern radiotherapy techniques for older patients with locally advanced head and neck cancer who are not eligible for cisplatin-based chemotherapy and have a high TPS. Prospective studies should be performed to verify this hypothesis.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Lyndon Kim
- Department of Neurology, Division of Neuro-Oncology, Mount Sinai Hospital, New York, NY 10029, USA
| | | | - Brigitta G Baumert
- Institute of Radiation Oncology, Cantonal Hospital Graubuenden, 7000 Chur, Switzerland
| | - Thandeka Mazibuko
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Olena Gorobets
- Department of Maxillofacial Surgery, Centre Hospitalier Universitaire de Martinique, 97213 Le Lamentin Martinique, France
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Centre Hospitalier de la Polynesie Francaise, 98716 Pirae, Tahiti, French Polynesia
| | - Huan Giap
- Department of Radiation Oncology, Medical University of South Carolina, Charleston, SC 29425, USA
| | - Tahir Mehmood
- Department of Radiation Oncology, Northampton General Hospital, Northampton NN1 5BD, UK
| | - Felix Vincent
- Department of Surgery, Southern Regional Health System-Lawrenceburg, Lawrenceburg, TN 38464, USA
| | - Alexander Chi
- Department of Radiation Oncology, Beijing Chest Hospital, Beijing 101149, China
| | - Trinanjan Basu
- Department of Radiation Oncology, HCG Cancer Center Borivali, and HCG ICS, Mumbai, Maharashtra 400092, India
| | | | | | - Ulf Karlsson
- International Geriatric Radiotherapy Group, Department of Radiation Oncology, Washington, DC 20001, USA
| | - Eromosele Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Joan Oboite
- Department of Radiation Oncology, Howard University, 2041 Georgia Ave NW, Washington, DC 20060, USA
| | - Ahmed Ali
- Department of Hematology Oncology, Howard University, Washington, DC 20059, USA
| | - Brandi R Page
- Department of Radiation Oncology, Johns Hopkins University, Baltimore, MD 21093, USA
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Basic Properties of a New Polymer Gel for 3D-Dosimetry at High Dose-Rates Typical for FFF Irradiation Based on Dithiothreitol and Methacrylic Acid (MAGADIT): Sensitivity, Range, Reproducibility, Accuracy, Dose Rate Effect and Impact of Oxygen Scavenger. Polymers (Basel) 2019; 11:polym11101717. [PMID: 31635117 PMCID: PMC6835276 DOI: 10.3390/polym11101717] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2019] [Revised: 09/27/2019] [Accepted: 10/10/2019] [Indexed: 12/18/2022] Open
Abstract
The photon induced radical-initiated polymerization in polymer gels can be used for high-resolution tissue equivalent dosimeters in quality control of radiation therapy. The dose (D) distribution in radiation therapy can be measured as a change of the physical measurement parameter T2 using T2-weighted magnetic resonance imaging. The detection by T2 is relying on the local change of the molecular mobility due to local polymerization initiated by radicals generated by the ionizing radiation. The dosimetric signals R2 = 1/T2 of many of the current polymer gels are dose-rate dependent, which reduces the reliability of the gel for clinical use. A novel gel dosimeter, based on methacrylic acid, gelatin and the newly added dithiothreitol (MAGADIT) as an oxygen-scavenger was analyzed for basic properties, such as sensitivity, reproducibility, accuracy and dose-rate dependence. Dithiothreitol features no toxic classification with a difference to THPC and offers a stronger negative redox-potential than ascorbic acid. Polymer gels with three different concentration levels of dithiothreitol were irradiated with a preclinical research X-ray unit and MR-scanned (T2) for quantitative dosimetry after calibration. The polymer gel with the lowest concentration of the oxygen scavenger was about factor 3 more sensitive to dose as compared to the gel with the highest concentration. The dose sensitivity (α = ∆R2/∆D) of MAGADIT gels was significantly dependent on the applied dose rate D˙ (≈48% reduction between D˙ = 0.6 Gy/min and D˙ = 4 Gy/min). However, this undesirable dose-rate effect reduced between 4–8 Gy/min (≈23%) and almost disappeared in the high dose-rate range (8 ≤ D˙≤ 12 Gy/min) used in flattening-filter-free (FFF) irradiations. The dose response varied for different samples within one manufacturing batch within 3%–6% (reproducibility). The accuracy ranged between 3.5% and 7.9%. The impact of the dose rate on the spatial integrity is demonstrated in the example of a linear accelerator (LINAC) small sized 5 × 10 mm2 10 MV photon field. For MAGADIT the maximum shift in the flanks in this field is limited to about 0.8 mm at a FFF dose rate of 15 Gy/min. Dose rate sensitive polymer gels likely perform better at high dose rates; MAGADIT exhibits a slightly improved performance compared to the reference normoxic polymer gel methacrylic and ascorbic acid in gelatin initiated by copper (MAGIC) using ascorbic acid.
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Comparison of three and four-field radiotherapy technique and the effect of laryngeal shield on vocal and spinal cord radiation dose in radiotherapy of non-laryngeal head and neck tumors. POLISH JOURNAL OF MEDICAL PHYSICS AND ENGINEERING 2018. [DOI: 10.2478/pjmpe-2018-0004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Introduction: Due to the effect of radiation on both the tumor and the surrounding normal tissues, the side effects of radiation in normal tissues are expected. One of the important complications in the head and neck radiotherapy is the doses reached to the larynx and spinal cord of patients with non-laryngeal head and neck tumors.
Materials and Methods: In this study, CT scan images of 25 patients with non-laryngeal tumors including; lymph nodes, tongue, oropharynx and nasopharynx were used. A three-field and a four-field treatment planning with and without laryngeal shield in 3D CRT technique were planned for each patient. Subsequently, the values of Dmin, Dmean, Dmax and Dose Volume Histogram from the treatment planning system and NTCP values of spinal cord and larynx were calculated with BIOPLAN and MATLAB software for all patients.
Results: Statistical results showed that mean values of doses of larynx in both three and four-field methods were significantly different between with and without shield groups. Comparison of absorbed dose didn’t show any difference between the three and four field methods (P>0.05). Using Shield, just the mean and minimum doses of spinal cord decreased in both three and four fields. The NTCP of the spinal cord and larynx by three and four-field methods with shield in the LKB and EUD models significantly are less than that of the three and four fields without shields, and in the four-field method NTCP of larynx is less than three radiation field.
Conclusion: The results of this study indicate that there is no significant difference in doses reached to larynx and spinal cord between the treatments techniques, but laryngeal shield reduce dose and NTCP values in larynx considerably.
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Tiong A, Lao L, MacKean J, Goonetilleke M, Kron T. Faculty of Radiation Oncology Position Paper on the use of Image-Guided Radiation Therapy. J Med Imaging Radiat Oncol 2016; 60:772-780. [PMID: 27122102 DOI: 10.1111/1754-9485.12463] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2015] [Accepted: 03/17/2016] [Indexed: 12/26/2022]
Abstract
The development of technology such as intensity-modulated radiotherapy (IMRT), volumetric arc therapy (VMAT) and stereotactic ablative body radiotherapy (SABR) has resulted in highly conformal radiotherapy treatments. While such technology has allowed for improved dose delivery, it has also meant that improved accuracy in the treatment room is required. Image-guided radiotherapy (IGRT), the use of imaging prior to or during treatment delivery, has been shown to improve the accuracy of treatment delivery and in some circumstances, clinical outcomes. Allied with the adoption of highly conformal treatments, there is a need for stringent quality assurance processes in a multidisciplinary environment. In 2015, the Royal Australian and New Zealand College of Radiologist (RANZCR) updated its position paper on IGRT. The draft document was distributed through the membership of the Faculty of Radiation Oncology (FRO) for review and the final version was endorsed by the board of FRO. This article describes issues that radiotherapy departments throughout Australia and New Zealand should consider. It outlines the role of IGRT and reviews current clinical evidence supporting the benefit of IGRT in genitourinary, head and neck, and lung cancers. It also highlights important international publications which provide guidance on implementation and quality assurances for IGRT. A set of key recommendations are provided to guide safe and effective IGRT implementation and practice in the Australian and New Zealander context.
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Affiliation(s)
- Albert Tiong
- Department of Radiation Oncology, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia
| | - Louis Lao
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand.,Auckland Radiation Oncology, Auckland, New Zealand.,University of Auckland, Auckland, New Zealand
| | - James MacKean
- Genesis Cancer Care Queensland, Brisbane, Queensland, Australia
| | - Madhavi Goonetilleke
- Department of Radiation Oncology, Townsville Cancer Centre, Townsville, Queensland, Australia
| | - Tomas Kron
- Department of Medical Physics, Peter MacCallum Cancer Centre, Melbourne, Victoria, Australia.,Sir Peter MacCallum Department of Oncology, University of Melbourne, Parkville, Australia
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Bahig H, Fortin B, Alizadeh M, Lambert L, Filion E, Guertin L, Ayad T, Christopoulos A, Bissada E, Soulières D, Gaba Idiamey F, Nguyen-Tan PF. Predictive factors of survival and treatment tolerance in older patients treated with chemotherapy and radiotherapy for locally advanced head and neck cancer. Oral Oncol 2015; 51:521-8. [DOI: 10.1016/j.oraloncology.2015.02.097] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Revised: 02/17/2015] [Accepted: 02/19/2015] [Indexed: 10/23/2022]
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Góra J, Kuess P, Stock M, Andrzejewski P, Knäusl B, Paskeviciute B, Altorjai G, Georg D. ART for head and neck patients: On the difference between VMAT and IMPT. Acta Oncol 2015; 54:1166-74. [PMID: 25850583 DOI: 10.3109/0284186x.2015.1028590] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
UNLABELLED Anatomical changes in the head-and-neck (H&N) region during the course of treatment can cause deteriorated dose distributions. Different replanning strategies were investigated for volumetric modulated arc therapy (VMAT) and intensity-modulated proton therapy (IMPT). MATERIAL AND METHODS For six H&N patients two repeated computed tomography (CT) and magnetic resonance (MR) (CT1/MR1 at week 2 and CT2/MR2 at week 4) scans were acquired additionally to the initial planning CT/MR. Organs-at-risk (OARs) and three targets (CTV70Gy, CTV63Gy, CTV56Gy) were delineated on MRs and transferred to respective CT data set. Simultaneously integrated boost plans were created using VMAT (two arcs) and IMPT (four beams). To assess the need of replanning the initial VMAT and IMPT plans were recalculated on repeated CTs. Furthermore, VMAT and IMPT plans were replanned on the repeated CTs. A Demon algorithm was used for deformable registration of the repeated CTs with the initial CT and utilized for dose accumulation. Total dose estimations were performed to compare ART versus standard treatment strategies. RESULTS Dosimetric evaluation of recalculated plans on CT1 and CT2 showed increasing OAR doses for both, VMAT and IMPT. The target coverage of recalculated VMAT plans was considered acceptable in three cases, while for all IMPT plans it dropped. Adaptation of the treatment reduced D2% for brainstem by 6.7 Gy for VMAT and by 8 Gy for IMPT, for particular patients. These D2% reductions were reaching 9 Gy and 14 Gy for the spinal cord. ART improved target dose homogeneity, especially for protons, i.e. D2% decreased by up to 8 Gy while D98% increased by 1.2 Gy. CONCLUSION ART showed benefits for both modalities. However, as IMPT is more conformal, the magnitude of dosimetric changes was more pronounced compared to VMAT. Large anatomic variations had a severe impact on treatment plan quality for both VMAT and IMPT. ART is justified in those cases irrespective of treatment modalities.
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Affiliation(s)
- Joanna Góra
- a Department of Radiation Oncology , Medical University of Vienna/AKH Wien , Vienna , Austria
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Nguyen NP, Davis R, Bose SR, Dutta S, Vinh-Hung V, Chi A, Godinez J, Desai A, Woods W, Altdorfer G, D'Andrea M, Karlsson U, Vo RA, Sroka T. Potential applications of image-guided radiotherapy for radiation dose escalation in patients with early stage high-risk prostate cancer. Front Oncol 2015; 5:18. [PMID: 25699239 PMCID: PMC4313771 DOI: 10.3389/fonc.2015.00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2014] [Accepted: 01/15/2015] [Indexed: 01/21/2023] Open
Abstract
Patients with early stage high-risk prostate cancer (prostate specific antigen > 20, Gleason score > 7) are at high risk of recurrence following prostate cancer irradiation. Radiation dose escalation to the prostate may improve biochemical-free survival for these patients. However, high rectal and bladder dose with conventional three-dimensional conformal radiotherapy may lead to excessive gastrointestinal and genitourinary toxicity. Image-guided radiotherapy (IGRT), by virtue of combining the steep dose gradient of intensity-modulated radiotherapy and daily pretreatment imaging, may allow for radiation dose escalation and decreased treatment morbidity. Reduced treatment time is feasible with hypo-fractionated IGRT and it may improve patient quality of life.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Rick Davis
- Department of Radiation Oncology, Michael D. Wachtel Cancer Center , Oskosh, WI , USA
| | - Satya R Bose
- Department of Radiation Oncology, Howard University , Washington, DC , USA
| | - Suresh Dutta
- Department of Radiation Oncology, Medicine and Radiation Oncology PA , San Antonio, TX , USA
| | - Vincent Vinh-Hung
- Department of Radiation Oncology, Martinique University Hospital , Martinique , France
| | - Alexander Chi
- Department of Radiation Oncology, University of West Virginia , Morgantown, WV , USA
| | - Juan Godinez
- Department of Radiation Oncology, Rochester Radiation Oncology Group , Rochester, NY , USA
| | - Anand Desai
- Department of Radiation Oncology, Akron City Hospital , Akron, OH , USA
| | - William Woods
- Department of Radiation Oncology, Richard A. Henson Institute , Salisbury, ML , USA
| | - Gabor Altdorfer
- Department of Radiation Oncology, Camden Clark Cancer Center , Parkersburg, WV , USA
| | - Mark D'Andrea
- Department of Radiation Oncology, University Cancer Centers , Houston, TX , USA
| | - Ulf Karlsson
- Department of Radiation Oncology, Marshfield Clinic , Marshfield, WI , USA
| | - Richard A Vo
- University of Galveston School of Medicine , Galveston, TX , USA
| | - Thomas Sroka
- Department of Radiation Oncology, Geisel School of Medicine at Dartmouth, Dartmouth College , Hanover, NH , USA
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Abstract
Pharyngo-oesophageal stricture (PES) is a serious complication that occurs in up to a third of patients treated with external beam radiotherapy or combined chemoradiotherapy for head and neck cancer. This entity is under-reported and as a result, our understanding of the pathophysiology and prevention of this complication is restricted. This Review presents the knowledge so far on radiation-related and non-radiation-related risk factors for PES, including tumour stage and subsite, patient age, and comorbidities. The interventions to decrease this toxicity are discussed, including early detection of PES, initiation of an oral diet, and protection of swallowing structures from high-dose radiation. We discuss various treatment options, including swallowing exercises and manoeuvres, endoscopic dilatations, and for advanced cases, oesophageal reconstruction. Study of the subset of patients who develop this toxicity and early recognition and intervention of this pathological change in future trials will help to optimise treatment of these patients.
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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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Feasibility of tomotherapy-based image-guided radiotherapy for locally advanced oropharyngeal cancer. PLoS One 2013; 8:e60268. [PMID: 23555938 PMCID: PMC3610680 DOI: 10.1371/journal.pone.0060268] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2012] [Accepted: 02/25/2013] [Indexed: 11/19/2022] Open
Abstract
Purpose The study aims to assess the feasibility of tomotherapy-based image-guided (IGRT) radiotherapy for locally advanced oropharyngeal cancer. A retrospective review of 33 patients undergoing concurrent chemoradiation for locally advanced oropharyngeal cancers was conducted. Radiotherapy planning, treatment toxicity and loco-regional control were assessed. Results At a median follow-up of 32 months (6–47 months), no patient developed loco-regional recurrence. Two patients (6%) developed distant metastases. Grade 3–4 acute toxicity was respectively 72% and 25% for mucositis and gastrointestinal toxicity. Two patients (6%) had long-term dependence on tube feedings. Dose-volume histogram demonstrated excellent target volume coverage and low radiation dose to the organs at risk for complications. Conclusions and clinical relevance IGRT provides excellent loco-regional control but acute toxicity remains significant and needs to be addressed in future prospective trials. The feasibility of Tomotherapy to decrease radiation dose to the normal tissues merits further investigations.
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Feasibility of Tomotherapy-based image-guided radiotherapy to reduce aspiration risk in patients with non-laryngeal and non-pharyngeal head and neck cancer. PLoS One 2013; 8:e56290. [PMID: 23505414 PMCID: PMC3591427 DOI: 10.1371/journal.pone.0056290] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2012] [Accepted: 01/11/2013] [Indexed: 11/19/2022] Open
Abstract
PURPOSE The study aims to assess the feasibility of Tomotherapy-based image-guided radiotherapy (IGRT) to reduce the aspiration risk in patients with non-laryngeal and non-hypopharyngeal cancer. A retrospective review of 48 patients undergoing radiation for non-laryngeal and non-hypopharyngeal head and neck cancers was conducted. All patients had a modified barium swallow (MBS) prior to treatment, which was repeated one month following radiotherapy. Mean middle and inferior pharyngeal dose was recorded and correlated with the MBS results to determine aspiration risk. RESULTS Mean pharyngeal dose was 23.2 Gy for the whole group. Two patients (4.2%) developed trace aspiration following radiotherapy which resolved with swallowing therapy. At a median follow-up of 19 months (1-48 months), all patients were able to resume normal oral feeding without aspiration. CONCLUSION AND CLINICAL RELEVANCE IGRT may reduce the aspiration risk by decreasing the mean pharyngeal dose in the presence of large cervical lymph nodes. Further prospective studies with IGRT should be performed in patients with non-laryngeal and non-hypopharyngeal head and neck cancers to verify this hypothesis.
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Nguyen NP, Vock J, Chi A, Ewell L, Vos P, Mills M, Khan R, Almeida F, Davis R, Betz M, Jang S, Gelumbauskas S, Vo RP, Vinh-Hung V. Effectiveness of intensity-modulated and image-guided radiotherapy to spare the mandible from excessive radiation. Oral Oncol 2012; 48:653-7. [DOI: 10.1016/j.oraloncology.2012.01.016] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2012] [Revised: 01/24/2012] [Accepted: 01/25/2012] [Indexed: 11/28/2022]
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Nguyen NP, Vock J, Vinh-Hung V, Almeida F, Ewell L, Betz M, Jang S, Vo RA, Dutta S, Godinez J, Karlsson U, Chi A. Effectiveness of prophylactic retropharyngeal lymph node irradiation in patients with locally advanced head and neck cancer. BMC Cancer 2012; 12:253. [PMID: 22708791 PMCID: PMC3489531 DOI: 10.1186/1471-2407-12-253] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2011] [Accepted: 05/28/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The aim of the study is to assess the effectiveness of intensity-modulated radiotherapy (IMRT) or image-guided radiotherapy (IGRT) for the prevention of retropharyngeal nodal recurrences in locally advanced head and neck cancer. METHODS A retrospective review of 76 patients with head and neck cancer undergoing concurrent chemoradiation or postoperative radiotherapy with IMRT or IGRT who were at risk for retropharyngeal nodal recurrences because of anatomic site (hypopharynx, nasopharynx, oropharynx) and/or the presence of nodal metastases was undertaken.The prevalence of retropharyngeal nodal recurrences was assessed on follow-up positron emission tomography (PET)-CT scans. RESULTS At a median follow-up of 22 months (4-53 months), no patient developed retropharyngeal nodal recurrences. CONCLUSION Prophylactic irradiation of retropharyngeal lymph nodes with IMRT or IGRT provides effective regional control for individuals at risk for recurrence in these nodes.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, USA.
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Nguyen N, Vock J, Chi A, Vinh-Hung V, Dutta S, Ewell L, Jang S, Betz M, Almeida F, Miller M, Davis R, Sroka T, Vo R, Karlsson U, Vos P. Impact of intensity-modulated and image-guided radiotherapy on elderly patients undergoing chemoradiation for locally advanced head and neck cancer. Strahlenther Onkol 2012; 188:677-83. [DOI: 10.1007/s00066-012-0125-0] [Citation(s) in RCA: 45] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2012] [Accepted: 03/27/2012] [Indexed: 12/22/2022]
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Cmelak AJ. Current issues in combined modality therapy in locally advanced head and neck cancer. Crit Rev Oncol Hematol 2012; 84:261-73. [PMID: 22595517 DOI: 10.1016/j.critrevonc.2012.04.004] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2011] [Revised: 04/05/2012] [Accepted: 04/13/2012] [Indexed: 02/08/2023] Open
Abstract
Curative treatment for patients with locally advanced squamous cell carcinomas of the head and neck (SCCHN) is complex and multidisciplinary. Our understanding of the optimal management of this disease has improved over the years, incorporating refined surgical approaches, better radiotherapy delivery methods, and greater use of systemic therapies. Investigation into shifting epidemiology patterns has uncovered two biologically and clinically distinct diseases: the smoking-related entity and the increasingly common malignancy associated with human papilloma virus (HPV). Prognosis favors the latter, driving newer investigations into dose de-intensification to limit toxicities in patients with HPV-driven disease, and alternatively intensifying treatment to improve tumor control in those with a significant smoking history. In this review, I describe the most recent progress in the multi-modal integration of radiotherapy and chemoradiotherapy, and the role of targeted agents and personalized therapy, and conclude with a discussion of the relevance of these innovations with respect to HPV tumor status.
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Affiliation(s)
- Anthony J Cmelak
- Department of Radiation Oncology, Vanderbilt Ingram Cancer Center, Nashville, TN 37232-5671, USA.
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Nguyen NP, Vos P, Vinh-Hung V, Ceizyk M, Smith-Raymond L, Stevie M, Slane B, Chi A, Desai A, Krafft SP, Jang S, Hamilton R, Karlsson U, Abraham D. Feasibility of image-guided radiotherapy based on helical tomotherapy to reduce contralateral parotid dose in head and neck cancer. BMC Cancer 2012; 12:175. [PMID: 22578076 PMCID: PMC3411401 DOI: 10.1186/1471-2407-12-175] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2011] [Accepted: 05/11/2012] [Indexed: 12/02/2022] Open
Abstract
Background To evaluate the feasibility of image-guided radiotherapy based on helical Tomotherapy to spare the contralateral parotid gland in head and neck cancer patients with unilateral or no neck node metastases. Methods A retrospective review of 52 patients undergoing radiotherapy for head and neck cancers with image guidance based on daily megavoltage CT imaging with helical tomotherapy was performed. Results Mean contralateral parotid dose and the volume of the contralateral parotid receiving 40 Gy or more were compared between radiotherapy plans with significant constraint (SC) of less than 20 Gy on parotid dose (23 patients) and the conventional constraint (CC) of 26 Gy (29 patients). All patients had PTV coverage of at least 95% to the contralateral elective neck nodes. Mean contralateral parotid dose was, respectively, 14.1 Gy and 24.7 Gy for the SC and CC plans (p < 0.0001). The volume of contralateral parotid receiving 40 Gy or more was respectively 5.3% and 18.2% (p < 0.0001) Conclusion Tomotherapy for head and neck cancer minimized radiotherapy dose to the contralateral parotid gland in patients undergoing elective node irradiation without sacrificing target coverage.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ 85724, USA.
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Nguyen NP, Abraham D, Desai A, Betz M, Davis R, Sroka T, Chi A, Gelumbauskas S, Ceizyk M, Smith-Raymond L, Stevie M, Jang S, Hamilton R, Vinh-Hung V. Impact of image-guided radiotherapy to reduce laryngeal edema following treatment for non-laryngeal and non-hypopharyngeal head and neck cancers. Oral Oncol 2011; 47:900-4. [DOI: 10.1016/j.oraloncology.2011.06.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2011] [Revised: 06/03/2011] [Accepted: 06/03/2011] [Indexed: 11/29/2022]
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Nguyen NP, Krafft SP, Vos P, Vinh-Hung V, Ceizyk M, Jang S, Desai A, Abraham D, Ewell L, Watchman C, Hamilton R, Jo BH, Karlsson U, Smith-Raymond L. Feasibility of tomotherapy for Graves' ophthalmopathy: Dosimetry comparison with conventional radiotherapy. Strahlenther Onkol 2011; 187:568-74. [PMID: 21713392 DOI: 10.1007/s00066-011-2220-z] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2010] [Accepted: 03/18/2011] [Indexed: 11/25/2022]
Abstract
PURPOSE To compare the dosimetry of tomotherapy and the conventional half-beam technique (HBT) or non-split beam technique (NSBT) for target coverage and radiation dose to the lacrimal glands and lens. PATIENTS AND METHODS A retrospective review of 7 patients with Graves' ophthalmopathy who had radiotherapy because of disease progression on high steroid dose is reported: 3 patients were treated with tomotherapy and 4 patients with HBT. RESULTS Compared to HBT, tomotherapy may provide better target coverage and significant reduction of radiation dose to the lacrimal glands and a higher dose to the lens. The NSBT improved target coverage but resulted in significantly higher doses to the lens and lacrimal glands. CONCLUSION Tomotherapy may provide better coverage of the target volume and may be more effective in reducing severe exophthalmos compared to the conventional radiotherapy technique.
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Affiliation(s)
- Nam P Nguyen
- Department of Radiation Oncology, University of Arizona, Tucson, AZ, USA.
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Nguyen NP, Smith-Raymond L, Vinh-Hung V, Sloan D, Davis R, Vos P, Abraham D, Stevie M, Krafft SP, Ly BH, Ries T, Karlsson U, Ceizyk M. Feasibility of Tomotherapy to spare the cochlea from excessive radiation in head and neck cancer. Oral Oncol 2011; 47:414-9. [DOI: 10.1016/j.oraloncology.2011.03.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2010] [Revised: 03/10/2011] [Accepted: 03/10/2011] [Indexed: 11/27/2022]
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Nguyen NP, Ceizyk M, Almeida F, Chi A, Betz M, Modarresifar H, Sroka T, Cohen D, Jang S, Abraham D, Stevie M, Smith-Raymond L, Krafft S, Vinh-Hung V. Effectiveness of Image-Guided Radiotherapy for Locally Advanced Rectal Cancer. Ann Surg Oncol 2010; 18:380-5. [DOI: 10.1245/s10434-010-1329-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Indexed: 11/18/2022]
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