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Foote RL, Harmsen WS, Amundson AC, Carr AB, Gamez ME, Garces YI, Lester SC, Ma DJ, McGee LA, Moore EJ, Neben Wittich MA, Patel SH, Routman DM, Rwigema JCM, Van Abel KM, Yin LX, Muller OM, Shiraishi S. Mean Oral Cavity Organ-at-Risk Dose Predicts Opioid Use and Hospitalization during Radiotherapy for Patients with Head and Neck Tumors. Cancers (Basel) 2024; 16:349. [PMID: 38254837 PMCID: PMC10814074 DOI: 10.3390/cancers16020349] [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: 12/07/2023] [Revised: 01/04/2024] [Accepted: 01/10/2024] [Indexed: 01/24/2024] Open
Abstract
BACKGROUND Approximately 75% of all head and neck cancer patients are treated with radiotherapy (RT). RT to the oral cavity results in acute and late adverse events which can be severe and detrimental to a patient's quality of life and function. The purpose of this study was to explore associations between RT dose to a defined oral cavity organ-at-risk (OAR) avoidance structure, provider- and patient-reported outcomes (PROs), opioid use, and hospitalization. METHODS This was a retrospective analysis of prospectively obtained outcomes using multivariable modeling. The study included 196 patients treated with RT involving the oral cavity for a head and neck tumor. A defined oral cavity OAR avoidance structure was used in all patients for RT treatment planning. Validated PROs were collected prospectively. Opioid use and hospitalization were abstracted electronically from medical records. RESULTS Multivariable modeling revealed the mean dose to the oral cavity OAR was significantly associated with opioid use (p = 0.0082) and hospitalization (p = 0.0356) during and within 30 days of completing RT. CONCLUSIONS The findings of this study may be valuable in RT treatment planning for patients with tumors of the head and neck region to reduce the need for opioid use and hospitalization during treatment.
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Affiliation(s)
- Robert L. Foote
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - W. Scott Harmsen
- Department of Quantitative Health Sciences, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
| | - Adam C. Amundson
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Alan B. Carr
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Mauricio E. Gamez
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Yolanda I. Garces
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Scott C. Lester
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Daniel J. Ma
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Lisa A. McGee
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Eric J. Moore
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Michelle A. Neben Wittich
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Samir H. Patel
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - David M. Routman
- Department of Radiation Oncology, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.C.A.); (M.E.G.); (Y.I.G.); (S.C.L.); (D.J.M.); (M.A.N.W.); (D.M.R.)
| | - Jean-Claude M. Rwigema
- Department of Radiation Oncology, Mayo Clinic Arizona, 5777 E. Mayo Blvd., Phoenix, AZ 85054, USA; (L.A.M.); (S.H.P.); (J.-C.M.R.)
| | - Kathryn M. Van Abel
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Linda X. Yin
- Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (E.J.M.); (K.M.V.A.); (L.X.Y.)
| | - Olivia M. Muller
- Department of Dental Specialties, Division of Esthetic and Prosthetic Dentistry, Department of Advanced Prosthodontics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA; (A.B.C.); (O.M.M.)
| | - Satomi Shiraishi
- Division of Medical Physics, Mayo Clinic, 200 First St. SW, Rochester, MN 55905, USA;
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Paczona VR, Capala ME, Deák-Karancsi B, Borzási E, Együd Z, Végváry Z, Kelemen G, Kószó R, Ruskó L, Ferenczi L, Verduijn GM, Petit SF, Oláh J, Cserháti A, Wiesinger F, Hideghéty K. Magnetic Resonance Imaging-Based Delineation of Organs at Risk in the Head and Neck Region. Adv Radiat Oncol 2022; 8:101042. [PMID: 36636382 PMCID: PMC9830100 DOI: 10.1016/j.adro.2022.101042] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Accepted: 07/24/2022] [Indexed: 01/16/2023] Open
Abstract
Purpose The aim of this article is to establish a comprehensive contouring guideline for treatment planning using only magnetic resonance images through an up-to-date set of organs at risk (OARs), recommended organ boundaries, and relevant suggestions for the magnetic resonance imaging (MRI)-based delineation of OARs in the head and neck (H&N) region. Methods and Materials After a detailed review of the literature, MRI data were collected from the H&N region of healthy volunteers. OARs were delineated in the axial, coronal, and sagittal planes on T2-weighted sequences. Every contour defined was revised by 4 radiation oncologists and subsequently by 2 independent senior experts (H&N radiation oncologist and radiologist). After revision, the final structures were presented to the consortium partners. Results A definitive consensus was reached after multi-institutional review. On that basis, we provided a detailed anatomic and functional description and specific MRI characteristics of the OARs. Conclusions In the era of precision radiation therapy, the need for well-built, straightforward contouring guidelines is on the rise. Precise, uniform, delineation-based, automated OAR segmentation on MRI may lead to increased accuracy in terms of organ boundaries and analysis of dose-dependent sequelae for an adequate definition of normal tissue complication probability.
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Affiliation(s)
- Viktor R. Paczona
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,Corresponding author: Viktor R. Paczona, MD
| | | | | | - Emőke Borzási
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zsófia Együd
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Zoltán Végváry
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Gyöngyi Kelemen
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | - Renáta Kószó
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | | | | | - Judit Oláh
- Department of Oncotherapy, University of Szeged, Szeged, Hungary
| | | | | | - Katalin Hideghéty
- Department of Oncotherapy, University of Szeged, Szeged, Hungary,ELI-HU Non-Profit Ltd, Szeged, Hungary
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Khattar H, Kumar P, S N. Delineation of Oral Mucosa as a Pseudo-Organ-at-Risk May Lead to a Decrease in the Incidence of Oral Mucositis: A Dosimetric Analysis of Intensity-Modulated Radiation Therapy Plans in Head and Neck Cancers. Cureus 2022; 14:e23716. [PMID: 35505730 PMCID: PMC9056708 DOI: 10.7759/cureus.23716] [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] [Accepted: 03/31/2022] [Indexed: 11/19/2022] Open
Abstract
Introduction Oral mucositis is a common and potentially serious complication of radiation in head and neck cancer treatment. Severe mucositis causes pain, difficulty in chewing and swallowing that can cause treatment breaks and can cause treatment failures leading to local recurrence or a decrease in overall survival. The contouring of the planning target volume (PTV) and organ at risk (OAR) leaves some undefined regions on computed tomography imaging. The treatment planning system uses these regions as dumping sites for the dose in order to achieve the optimum plan. The present study was done to assess the dose going to these unspecified regions termed as pseudo-OARs and whether delineation of these structures and prescribing a dose constraint will reduce the dose to the oral mucosa without compromising the quality of the treatment plan. Methods Twenty patients of head and neck cancer were selected and were randomly placed in two arms. One was intensity-modulated radiation therapy (IMRT) arm I, which included the initial plans with which the patients were treated where the pseudo-OAR was not delineated and hence was not considered in the planning process. After giving treatment, the pseudo-OAR was delineated to see the dose dumped into the area outside the PTV. The other was IMRT arm II, where another virtual plan of the same patients of arm I was made wherein the delineation of the pseudo-OAR was done before planning and dose constraint prescribed. The pseudo-OAR consisted of anterior oral mucosa, part of mandible and maxilla, which was adjacent to the PTV in oropharynx and contralateral buccal mucosa patients. The dose constraint given to the pseudo-OAR was Dmean ≤30 Gy. Statistical significance was calculated by using a paired t-test. A p-value of <0.05 was considered as statistically significant. Results The dosimetric parameters of PTV were comparable in both the IMRT arms. The pre-specified objective was fulfilled with both the study arms. The dose homogeneity and conformity was also similar. The dosimetric parameters of other OARs were within the prescribed dose constraints. The Dmean value of the pseudo-OAR in arm I was 31.28 Gy ± 3.55 Gy and 7.87 Gy ± 9.11 Gy in arm II and the p-value was significant (p=0.001), whereas the Dmax in arm I was 61.82 Gy ± 5.91 Gy and 61.23 Gy ± 5.54 Gy in arm II (p=0.6). The dose to the pseudo-OAR in IMRT arm II was reduced drastically by 75%, which was statistically significant. Conclusion The delineation of oral mucosa as a pseudo-OAR should routinely be done. The dose constraints need to be optimized by clinical studies, which might probably decrease the incidence and severity of oral mucositis.
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Klarić Sever E, Tarle A, Vukelja J, Soče M, Grego T. Direct Induced Effects of Standard and Modified Radiotherapy Protocol on Surface Structure of Hard Dental Tissue. Acta Stomatol Croat 2022; 55:334-345. [PMID: 35001929 PMCID: PMC8734449 DOI: 10.15644/asc55/4/1] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2021] [Accepted: 10/20/2021] [Indexed: 12/24/2022] Open
Abstract
Introduction Radiotherapy is used to treat neo plasmatic lesions and the common side effects of this process are pain, swelling and sensitivity of mucous membranes in domain of radiation, reduced salivation, caries, and periodontal disease and, in total, low life quality. The purpose of this research was to estimate the outcome of direct irradiation on physical and surface characteristics of hard dental tissues. Materials and methods Twenty, caries free third molars were involved in the research. Prior to different submission protocols, tooth halves were randomly assigned to subject and control groups by using a draw method. The first group (n=20) was submitted to conventional irradiation protocol (2 Gy for 35 days), second group (n=20) was submitted to one powerful, exploratory dose of 70 Gy. Each sample served as its own control. Radiation was performed with a linear accelerator radiotherapy unit. The surface microhardness and roughness were measured at the beginning (initially), and upon completion of irradiation procedure. The average change in microhardness and roughness after different treatments was compared by t-test for independent samples. Normality was tested by the Shapiro-Wilk test. Results Significant differences were found after the standard radiation protocol and the exploratory dose of 70 Gy, with decreased mean microhardness and increased mean roughness (p<0.001) of both hard dental tissues. Enamel and dentin surface microhardness and roughness did not vary notably with regards to different irradiation protocols. Conclusion Head and neck conventional irradiation protocol leads to possible breakdown of enamel and dentin with reduced microhardness and increased surface roughness regardless of used irradiation protocol.
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Affiliation(s)
- Eva Klarić Sever
- Department of Endodontics and Restorative Dental Medicine, School of Dental Medicine Zagreb
| | | | - Josipa Vukelja
- PhD student, School of Dental Medicine, University of Zagreb, Croatia
| | - Majana Soče
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb
| | - Timor Grego
- Department of Oncology, Radiotherapy Unit, University Hospital Centre Zagreb, Zagreb
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Klarić Sever E, Tarle A, Soče M, Grego T. Direct Radiotherapy-Induced Effects on Dental Hard Tissue in Combination With Bleaching Procedure. FRONTIERS IN DENTAL MEDICINE 2021. [DOI: 10.3389/fdmed.2021.714400] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/09/2022] Open
Abstract
Introduction: The aim of this study was to evaluate the effects of radiation and tooth bleaching on the physical and morphological properties of enamel and dentin on permanent teeth.Materials and Methods: Eighty fresh, non-carious third molars were used in this study. Before cutting the crown in half, the teeth samples were randomly allocated to treatment and control groups by using a lottery method. The first group (n = 20) underwent standard radiation protocol (2 Gy/fraction/day, 5 days/week) with bleaching treatment afterward using 16% carbamide peroxide gel, the second group (n = 20) underwent standard radiation protocol with afterward bleaching treatment using 38% hydrogen peroxide, the third group (n = 20) underwent a short, one strong, experimental dose of 70 Gy with afterward bleaching treatment using 16% carbamide peroxide gel, and the fourth group (n = 20) underwent one strong, experimental dose of 70 Gy with afterward bleaching treatment using 38% hydrogen peroxide gel. Groups 5–8 (n = 20) served as control as they underwent only bleaching treatment. Vickers microhardness and surface roughness were performed before (initial) and after irradiation and before bleaching or after only bleaching. The effects of irradiation and bleaching on microhardness (or roughness) of enamel and dentin were analyzed in the repeated-measures ANOVA model.Results: Enamel microhardness after experimental single 70-Gy irradiation or after standard radiation protocol and bleaching with 16 or 38% gel was not statistically significant from microhardness in the control group (p > 0.05). There was a statistically significantly greater reduction in the average microhardness of enamel and dentin during bleaching with 38% gel compared to 16% for both radiation protocols (p < 0.001). After experimental 70-Gy irradiation and bleaching, a 16% statistically significant increase in surface roughness was found for enamel (p = 0.006) and dentin (p = 0.018), while this was not recorded for 38% gel. There was a statistically significantly greater increase in the average roughness of enamel and dentin during bleaching with 38% gel compared to 16% (p < 0.001) for both radiation protocols.Conclusions: Directly induced radiation leads to potential damage of hard dental tissues, which can be further damaged by additional bleaching. If teeth whitening is necessary after irradiation, it is suggested to use lower concentrations of whitening gels.
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Outcome and toxicity of intensity-modulated radiotherapy with simultaneous integrated boost in patients with pharyngo-laryngeal cancer. Clin Transl Oncol 2018; 21:881-890. [PMID: 30506131 DOI: 10.1007/s12094-018-1995-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Accepted: 11/17/2018] [Indexed: 12/26/2022]
Abstract
PURPOSE The present work aims at evaluating intensity-modulated radiation therapy with simultaneous integrated boost (IMRT-SIB) in squamous cell carcinomas (SCC) of the larynx and hypopharynx. METHODS/PATIENTS We performed a single institutional retrospective analysis on 116 pharyngo (29%)-laryngeal (71%) SCC patients (93% male) treated with IMRT-SIB to 66-69.96 Gy in 33 fractions between 2008 and 2016. Those who underwent surgery (54%) received adjuvant radiation of 66 Gy at 2 Gy/fraction to the surgical bed. 16 patients (14%) were treated for a local recurrence after prior surgery. High-risk lymph node regions received 59.4 Gy at 1.8 Gy/fraction and low risk regions 54.12 Gy at 1.64 Gy/fraction. The median age was 60 years and 95% of patients had an ECOG performance status 0-2. Most had advanced stage disease (III 22%, IV 74%). Chemotherapy was delivered in 74% of cases. RESULTS Median follow-up was 32 months. Two and three-year overall survival for all patients was 87% and 82%, respectively. There were 28 (24%) locoregional recurrences and 19 (16%) distant failures. Grade 3 mucositis, dermatitis, and xerostomy were observed in 12%, 10%, and 3%, respectively. A longer IMRT-SIB overall treatment time was associated with a higher risk of mortality (HR 1.09, CI 1.01-1.17, P = 0.02). Postoperative IMRT-SIB associated with a significantly lower risk of any recurrence (HR 0.34, CI 0.18-0.64, P = 0.001) and higher local control (HR 0.06, CI 0.01-0.24, P < 0.01). Additionally, it associated with a lower risk of mucositis (P = 0.029) compared with definitive radio (chemo) therapy. CONCLUSIONS IMRT-SIB is a safe and feasible radiation treatment technique for pharyngo-laryngeal SCC patients with a tolerable acute toxicity profile.
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Cristaudo A, Hickman M, Fong C, Sanghera P, Hartley A. Assessing Novel Drugs and Radiation Technology in the Chemoradiation of Oropharyngeal Cancer. MEDICINES (BASEL, SWITZERLAND) 2018; 5:E65. [PMID: 29954154 PMCID: PMC6163293 DOI: 10.3390/medicines5030065] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Revised: 06/21/2018] [Accepted: 06/25/2018] [Indexed: 01/21/2023]
Abstract
Integrating immunotherapy, proton therapy and biological dose escalation into the definitive chemoradiation of oropharyngeal cancer poses several challenges. Reliable and reproducible data must be obtained in a timely fashion. However, despite recent international radiotherapy contouring guidelines, controversy persists as to the applicability of such guidelines to all cases. Similarly, a lack of consensus exists concerning both the definition of the organ at risk for oral mucositis and the most appropriate endpoint to measure for this critical toxicity. Finally, the correlation between early markers of efficacy such as complete response on PET CT following treatment and subsequent survival needs elucidation for biological subsets of oropharyngeal cancer.
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Affiliation(s)
- Agostino Cristaudo
- Department of Radiation Oncology, University of Pisa, 56100 Pisa PI, Italy.
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Mitchell Hickman
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Charles Fong
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Paul Sanghera
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
| | - Andrew Hartley
- Hall-Edwards Radiotherapy Research Group, Queen Elizabeth Hospital, Birmingham B15 2TH, UK.
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Radiotherapy alters the composition, structural and mechanical properties of root dentin in vitro. Clin Oral Investig 2018; 22:2871-2878. [DOI: 10.1007/s00784-018-2373-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Accepted: 01/29/2018] [Indexed: 10/18/2022]
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Hawkins PG, Kadam AS, Jackson WC, Eisbruch A. Organ-Sparing in Radiotherapy for Head-and-Neck Cancer: Improving Quality of Life. Semin Radiat Oncol 2018; 28:46-52. [DOI: 10.1016/j.semradonc.2017.08.002] [Citation(s) in RCA: 30] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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Macann A, Fauzi F, Simpson J, Sasso G, Krawitz H, Fraser-Browne C, Manitz J, Raith A. Humidification mitigates acute mucosal toxicity during radiotherapy when factoring volumetric parameters. Trans Tasman Radiation Oncology Group (TROG) RadioHUM 07.03 substudy. Oral Oncol 2017; 75:75-80. [PMID: 29224827 DOI: 10.1016/j.oraloncology.2017.10.021] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Revised: 10/11/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
PURPOSE/OBJECTIVE(S) To model in a subset of patients from TROG 07.03 managed at a single site the association between domiciliary based humidification use and mucositis symptom burden during radiotherapy (RT) for head and neck cancer (HNC) when factoring in volumetric radiotherapy parameters derived from tumour and normal tissue regions of interest. MATERIALS/METHODS From June 2008 through June 2011, 210 patients with HNC receiving RT were randomised to either a control arm or humidification using the Fisher & Paykel Healthcare MR880 humidifier. This subset analysis involves patients recruited from Auckland City Hospital treated with a prescribed dose of ≥70 Gy. Regression models included control variables for Planning Target Volume 70 GY (PTV70Gy); Equivalent Uniform Dose (EUD) MOIST and TSV (surrogates of total mucosal and total swallowing volumes respectively). RESULTS The analysis included 39 patients (humidification 20, control 19). There was a significant odds reduction in CTCAE v3.0 functional mucositis score of 0.29 associated with the use of humidification (p<.001). Within the parameters of the model therefore, the risk of a humidification patient being scored as experiencing a one-step increase in functional mucositis was 3.45 times lower (1/0.29) than for control patients. A control patient was 4.17 times more likely to receive an unfavourable nutritional mode score (p<.001). The risk of being admitted to hospital decreased by a factor of 11.11 for humidification patients (p=.013). CONCLUSION The results support the hypothesis that humidification can help mitigate mucositis symptom burden. Radiotherapy dosimetric parameters assist in the evaluation of toxicity interventions.
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Affiliation(s)
- A Macann
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand.
| | - F Fauzi
- Faculty of Information Science and Technology, Universiti Kebangsaan Malaysia, Bangi, Malaysia
| | - J Simpson
- Department of Medical Physics, Newcastle Mater Hospital, Newcastle, Australia
| | - G Sasso
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - H Krawitz
- Department of Radiation Oncology, Auckland City Hospital, Auckland, New Zealand
| | - C Fraser-Browne
- Oncology Research Centre, Auckland City Hospital, Auckland, New Zealand
| | - J Manitz
- Centre for Statistics, University of Göttingen, Göttingen, Germany
| | - A Raith
- Department of Engineering Science, University of Auckland, Auckland, New Zealand
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Abstract
Nasapharyngeal carcinoma is a rare disease. Oftenly, the diagnostic is made for advanced disease. Localized tumors, T1 or T2 NO observed a good prognosis and are locally controlled in more than 90 % of the cases by radiotherapy alone. The standard treatment of locally advanced disease is combined chemoradiation. A special vigilance of fast decrease of the volume of the pathological lymph nodes, sometimes associated to loss of weight might indicate an adaptive dosimetric revision. The treatment of recurrent disease is of great importance. Surgical indications are limited but should be discussed in multidisciplinary tumor board when possible. Surgical nodal sampling has to be proposed for nodal recurrence as well as reirradiation, which could be indicated according to the technical issues.
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Mendez LC, Moraes FY, Poon I, Marta GN. The management of head and neck tumors with high technology radiation therapy. Expert Rev Anticancer Ther 2015; 16:99-110. [PMID: 26568146 DOI: 10.1586/14737140.2016.1121111] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Squamous cell carcinoma is responsible for 90% of the head and neck cancers affecting over 600,000 people worldwide. Radiation therapy, surgery and chemotherapy are the most important treatment modalities in head and neck squamous cell carcinoma. The aim of this review is to summarize the recent innovations in head and neck radiation therapy, which intends to appreciate the cutting-edge intensity-modulated radiation therapy strategies to mitigate long-term toxicities and evaluate promising technologies in the field as adaptive treatment, dose painting and proton therapy.
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Affiliation(s)
- Lucas Castro Mendez
- a Service of Radiation Oncology , Hospital Israelita Albert Einstein and Instituto de Radiologia (INRAD) - Faculdade de Medicina da Universidade de São Paulo (FMUSP) , São Paulo , Brazil
| | - Fabio Ynoe Moraes
- b Department of Radiation Oncology , Hospital Sírio-Libanes , São Paulo , Brazil.,c Service of Radiotherapy , Instituto de Radiologia (INRAD) - Faculdade de Medicina da Universidade de São Paulo (University of São Paulo - FMUSP) , São Paulo , Brazil
| | - Ian Poon
- d Department of Radiation Oncology , Sunnybrook Odette Cancer Centre - University of Toronto , Toronto , Canada
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Abstract
OBJECTIVES To assess whether sparing neck-level IB in target delineation of node-positive (N+) oropharyngeal carcinoma (OPC) can improve xerostomia outcomes without compromising locoregional control (LRC). METHODS A total of 125 N+ OPC patients with a median age of 57 years underwent chemoradiation between May 2010 and December 2011. A total of 74% of patients had T1-T2 disease, 26% T3-T4, 16% N1, 8% N2A, 48% N2B, 28% N2C; 53% base of tongue, 41% tonsil, and 6% other. Patients were divided into those who had target delineation sparing of bilateral level IB (the spared cohort) versus no sparing (the treated cohort). Sparing of contralateral high-level II nodes was also performed more consistently in the spared cohort. A prospective xerostomia questionnaire (patient reported) was given at each patient follow-up visit to this cohort of patients to assess late xerostomia. Clinical assessment (observer rated) at each patient follow-up visit was also recorded. RESULTS The 2-year LRC for the spared and treated cohorts was 97.5% and 93.8%, respectively (median follow-up, 23.2 mo). No locoregional failures occurred outside of treatment fields. The spared cohort experienced significant benefits in patient-reported xerostomia summary scores (P=0.021) and observer-rated xerostomia scores (P=0.006). In addition, there were significant reductions in mean doses to the ipsilateral submandibular gland (63.9 vs. 70.5 Gy; P<0.001), contralateral submandibular gland (45.0 vs. 56.2 Gy; P<0.001), oral cavity (35.9 vs. 45.2 Gy; P<0.001), and contralateral parotid gland (20.0 vs. 24.4 Gy; P<0.001). CONCLUSIONS Target delineation sparing of bilateral level IB nodes in N+ OPC reduced mean doses to salivary organs without compromising LRC. Patients with reduced target volumes had better patient-reported xerostomia outcomes.
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CT-based delineation of organs at risk in the head and neck region: DAHANCA, EORTC, GORTEC, HKNPCSG, NCIC CTG, NCRI, NRG Oncology and TROG consensus guidelines. Radiother Oncol 2015; 117:83-90. [PMID: 26277855 DOI: 10.1016/j.radonc.2015.07.041] [Citation(s) in RCA: 390] [Impact Index Per Article: 43.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2015] [Accepted: 07/29/2015] [Indexed: 12/25/2022]
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Thomson DJ, Teo BKK, Ong A, Ang KW, Kirk M, Ahn PH, Lukens JN, Swisher-McClure S, Liptrot T, Solberg TD, Slevin NJ, Lin A. The Impact of Anatomic Change on Pencil Beam Scanning in the Treatment of Oropharynx Cancer. Int J Part Ther 2015. [DOI: 10.14338/ijpt-15-00002.1] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- David J. Thomson
- The Christie NHS Foundation Trust, Manchester, United Kingdom
- University of Manchester, Institute of Cancer Sciences, Manchester, United Kingdom
| | - Boon-Keng Kevin Teo
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Ashley Ong
- National Cancer Centre Singapore, Singapore
| | | | - Maura Kirk
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Peter H. Ahn
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - John N. Lukens
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Tom Liptrot
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Timothy D. Solberg
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Nick J. Slevin
- The Christie NHS Foundation Trust, Manchester, United Kingdom
| | - Alexander Lin
- Department of Radiation Oncology, University of Pennsylvania, Philadelphia, PA, USA
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Thomson D, Boylan C, Liptrot T, Aitkenhead A, Lee L, Yap B, Sykes A, Rowbottom C, Slevin N. Evaluation of an automatic segmentation algorithm for definition of head and neck organs at risk. Radiat Oncol 2014; 9:173. [PMID: 25086641 PMCID: PMC4123306 DOI: 10.1186/1748-717x-9-173] [Citation(s) in RCA: 54] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2014] [Accepted: 07/21/2014] [Indexed: 11/10/2022] Open
Abstract
Background The accurate definition of organs at risk (OARs) is required to fully exploit the benefits of intensity-modulated radiotherapy (IMRT) for head and neck cancer. However, manual delineation is time-consuming and there is considerable inter-observer variability. This is pertinent as function-sparing and adaptive IMRT have increased the number and frequency of delineation of OARs. We evaluated accuracy and potential time-saving of Smart Probabilistic Image Contouring Engine (SPICE) automatic segmentation to define OARs for salivary-, swallowing- and cochlea-sparing IMRT. Methods Five clinicians recorded the time to delineate five organs at risk (parotid glands, submandibular glands, larynx, pharyngeal constrictor muscles and cochleae) for each of 10 CT scans. SPICE was then used to define these structures. The acceptability of SPICE contours was initially determined by visual inspection and the total time to modify them recorded per scan. The Simultaneous Truth and Performance Level Estimation (STAPLE) algorithm created a reference standard from all clinician contours. Clinician, SPICE and modified contours were compared against STAPLE by the Dice similarity coefficient (DSC) and mean/maximum distance to agreement (DTA). Results For all investigated structures, SPICE contours were less accurate than manual contours. However, for parotid/submandibular glands they were acceptable (median DSC: 0.79/0.80; mean, maximum DTA: 1.5 mm, 14.8 mm/0.6 mm, 5.7 mm). Modified SPICE contours were also less accurate than manual contours. The utilisation of SPICE did not result in time-saving/improve efficiency. Conclusions Improvements in accuracy of automatic segmentation for head and neck OARs would be worthwhile and are required before its routine clinical implementation.
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Affiliation(s)
| | | | | | | | | | | | | | | | - Nicholas Slevin
- Department of Clinical Oncology, The Christie NHS Foundation Trust, Wilmslow Road, Manchester M20 4BX, UK.
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