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Chow JCH, Ho JCS, Cheung KM, Johnson D, Ip BYM, Beitler JJ, Strojan P, Mäkitie AA, Eisbruch A, Ng SP, Nuyts S, Mendenhall WM, Babighian S, Ferlito A. Neurological complications of modern radiotherapy for head and neck cancer. Radiother Oncol 2024; 194:110200. [PMID: 38438018 DOI: 10.1016/j.radonc.2024.110200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/21/2024] [Accepted: 02/29/2024] [Indexed: 03/06/2024]
Abstract
Radiotherapy is one of the mainstay treatment modalities for the management of non-metastatic head and neck cancer (HNC). Notable improvements in treatment outcomes have been observed in the recent decades. Modern radiotherapy techniques, such as intensity-modulated radiotherapy and charged particle therapy, have significantly improved tumor target conformity and enabled better preservation of normal structures. However, because of the intricate anatomy of the head and neck region, multiple critical neurological structures such as the brain, brainstem, spinal cord, cranial nerves, nerve plexuses, autonomic pathways, brain vasculature, and neurosensory organs, are variably irradiated during treatment, particularly when tumor targets are in close proximity. Consequently, a diverse spectrum of late neurological sequelae may manifest in HNC survivors. These neurological complications commonly result in irreversible symptoms, impair patients' quality of life, and contribute to a substantial proportion of non-cancer deaths. Although the relationship between radiation dose and toxicity has not been fully elucidated for all complications, appropriate application of dosimetric constraints during radiotherapy planning may reduce their incidence. Vigilant surveillance during the course of survivorship also enables early detection and intervention. This article endeavors to provide a comprehensive review of the various neurological complications of modern radiotherapy for HNC, summarize the current incidence data, discuss methods to minimize their risks during radiotherapy planning, and highlight potential strategies for managing these debilitating toxicities.
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Affiliation(s)
- James C H Chow
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region.
| | - Jason C S Ho
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - Ka Man Cheung
- Department of Clinical Oncology, Queen Elizabeth Hospital, Hong Kong Special Administrative Region
| | - David Johnson
- Department of Clinical Oncology, Prince of Wales Hospital, Hong Kong Special Administrative Region
| | - Bonaventure Y M Ip
- Division of Neurology, Department of Medicine and Therapeutics, The Chinese University of Hong Kong, Hong Kong Special Administrative Region; Li Ka Shing Institute of Health Sciences, Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong Special Administrative Region
| | - Jonathan J Beitler
- Harold Alfond Center for Cancer Care, Maine General Hospital, Augusta, ME, USA
| | - Primož Strojan
- Department of Radiation Oncology, Institute of Oncology, Ljubljana, Slovenia
| | - Antti A Mäkitie
- Department of Otorhinolaryngology, Head and Neck Surgery, Research Program in Systems Oncology, Faculty of Medicine, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Avraham Eisbruch
- Department of Radiation Oncology, University of Michigan Medicine, Ann Arbor, MI, USA
| | - Sweet Ping Ng
- Department of Radiation Oncology, Olivia Newton-John Cancer Centre, Austin Health, Melbourne, Australia
| | - Sandra Nuyts
- Department of Radiation Oncology, Leuven Cancer Institute, University Hospitals Leuven, KU Leuven - University of Leuven, Leuven, Belgium; Laboratory of Experimental Radiotherapy, Department of Oncology, University of Leuven, Leuven, Belgium
| | - William M Mendenhall
- Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Silvia Babighian
- Department of Ophthalmology, Ospedale Sant'Antonio, Azienda Ospedaliera, Padova, Italy
| | - Alfio Ferlito
- Coordinator of the International Head and Neck Scientific Group, Padua, Italy
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Shekouhi R, Gerhold C, Chim H. The role of surgery in the management of radiation-induced brachial plexopathy: a systematic review. J Hand Surg Eur Vol 2024; 49:490-498. [PMID: 37684017 DOI: 10.1177/17531934231197794] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/10/2023]
Abstract
This systematic literature review of the clinical characteristics of radiation-induced brachial plexopathy and outcomes after intervention includes 30 trials with 611 patients. The mean radiation dose to the brachial plexus was 56 Gy, and the mean duration of radiation was 4 weeks. The mean time from radiation to the onset of symptoms was 35 months. The most commonly reported symptom was sensory loss (n = 323, 62%), followed by motor deficits (n = 294, 56%) and neuropathic pain (n = 284, 54%). In total, 65 (56%) patients had panplexus involvement and 51 (44%) patients had partial plexus involvement. The most common surgical procedure was neurolysis with flap coverage (n = 108, 6%), followed by neurolysis alone (n = 71, 30%). Of the 237 patients who underwent surgery, 125 (53%) reported an improvement in pain. Motor and sensory deficits were improved in 46 (19%) and 39 (16%) patients, respectively, suggesting that surgery is beneficial in relieving pain, but not as beneficial in restoring motor and sensory function.
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Affiliation(s)
- Ramin Shekouhi
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Cameron Gerhold
- College of Medicine, Florida State University College of Medicine, Tallahassee, FL, USA
| | - Harvey Chim
- Division of Plastic & Reconstructive Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
- Lilian S. Wells Department of Neurosurgery, University of Florida College of Medicine, Gainesville, FL, USA
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Kudoh T, Haga A, Kudoh K, Takahashi A, Sasaki M, Kudo Y, Ikushima H, Miyamoto Y. Radiomics analysis of [ 18F]-fluoro-2-deoxyglucose positron emission tomography for the prediction of cervical lymph node metastasis in tongue squamous cell carcinoma. Oral Radiol 2023; 39:41-50. [PMID: 35254609 DOI: 10.1007/s11282-022-00600-7] [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: 12/12/2021] [Accepted: 02/10/2022] [Indexed: 01/07/2023]
Abstract
OBJECTIVES This study aimed to create a predictive model for cervical lymph node metastasis (CLNM) in patients with tongue squamous cell carcinoma (SCC) based on radiomics features detected by [18F]-fluoro-2-deoxyglucose (18F-FDG) positron emission tomography (PET). METHODS A total of 40 patients with tongue SCC who underwent 18F-FDG PET imaging during their first medical examination were enrolled. During the follow-up period (mean 28 months), 20 patients had CLNM, including six with late CLNM, whereas the remaining 20 patients did not have CLNM. Radiomics features were extracted from 18F-FDG PET images of all patients irrespective of metal artifact, and clinicopathological factors were obtained from the medical records. Late CLNM was defined as the CLNM that occurred after major treatment. The least absolute shrinkage and selection operator (LASSO) model was used for radiomics feature selection and sequential data fitting. The receiver operating characteristic curve analysis was used to assess the predictive performance of the 18F-FDG PET-based model and clinicopathological factors model (CFM) for CLNM. RESULTS Six radiomics features were selected from LASSO analysis. The average values of the area under the curve (AUC), accuracy, sensitivity, and specificity of radiomics analysis for predicting CLNM from 18F-FDG PET images were 0.79, 0.68, 0.65, and 0.70, respectively. In contrast, those of the CFM were 0.54, 0.60, 0.60, and 0.60, respectively. The 18F-FDG PET-based model showed significantly higher AUC than that of the CFM. CONCLUSIONS The 18F-FDG PET-based model has better potential for diagnosing CLNM and predicting late CLNM in patients with tongue SCC than the CFM.
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Affiliation(s)
- Takaharu Kudoh
- Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan.
| | - Akihiro Haga
- Department of Medical Image Informatics, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Keiko Kudoh
- Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Akira Takahashi
- Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Motoharu Sasaki
- Department of Therapeutic Radiology, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Yasusei Kudo
- Department of Oral Bioscience, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Hitoshi Ikushima
- Department of Therapeutic Radiology, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
| | - Youji Miyamoto
- Department of Oral Surgery, Tokushima University Graduate School of Biomedical Sciences, Kuramoto-cho, Tokushima, Japan
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Kim H, Jung J, Jung H, Jeong J, Lee D, Jeong HW, Lee Y. Comparison of Jaw Mode and Field Width for Left-Breast Cancer Using TomoDirect Three-Dimensional Conformal Radiation Therapy: A Phantom Study. Healthcare (Basel) 2022; 10:healthcare10122431. [PMID: 36553955 PMCID: PMC9777817 DOI: 10.3390/healthcare10122431] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Revised: 11/24/2022] [Accepted: 11/30/2022] [Indexed: 12/03/2022] Open
Abstract
It is very important to use effective parameters in the treatment plan of breast cancer patients in TomoDirect (TD)-three-dimensional conformal radiation therapy (TD-3DCRT). The objective of this study was to compare the radiation treatment plans to the parameters (jaw width and jaw mode) of TD-3DCRT for left-breast cancer. This study was conducted using the phantom, the jaw mode (fixed and dynamic) and field width (2.5 cm and 5.0 cm) were controlled to compare the TD-3DCRT treatment plans. There was small difference in the conformity index (CI) and homogeneity index (HI) values for target according to the jaw mode for each field width. As a result of observation in terms of dose, treatment time and unnecessary damage to surrounding normal organs could be minimized when dynamic jaw with a field width of 5.0 cm was used. In conclusion, we verified that the use of dynamic jaws and 5.0 cm field width was effective in left-breast cancer radiotherapy plan using TD-3DCRT.
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Affiliation(s)
- Haneul Kim
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Jaehong Jung
- Department of Radiation Oncology, College of Medicine, Soonchunhyang University Bucheon Hospital, 170, Jomaruro, Bucheon-si 14584, Republic of Korea
| | - Hyunseo Jung
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Jibeom Jeong
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Dohwa Lee
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
| | - Hyun-Woo Jeong
- Department of Biomedical Engineering, Eulji University, 553, Sanseong-daero, Sujeong-gu, Seongnam-si 13135, Republic of Korea
- Correspondence: (H.-W.J.); (Y.L.); Tel.: +82-31-740-7135 (H.-W.J.); +82-32-820-4362 (Y.L.)
| | - Youngjin Lee
- Department of Radiological Science, College of Health Science, Gachon University, 191, Hambakmoero, Yeonsu-gu, Incheon 21936, Republic of Korea
- Correspondence: (H.-W.J.); (Y.L.); Tel.: +82-31-740-7135 (H.-W.J.); +82-32-820-4362 (Y.L.)
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Azzam P, Mroueh M, Francis M, Daher AA, Zeidan YH. Radiation-induced neuropathies in head and neck cancer: prevention and treatment modalities. Ecancermedicalscience 2020; 14:1133. [PMID: 33281925 PMCID: PMC7685771 DOI: 10.3332/ecancer.2020.1133] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2020] [Indexed: 12/24/2022] Open
Abstract
Head and neck cancer (HNC) is the sixth most common human malignancy with a global incidence of 650,000 cases per year. Radiotherapy (RT) is commonly used as an effective therapy to treat tumours as a definitive or adjuvant treatment. Despite the substantial advances in RT contouring and dosage delivery, patients suffer from various radiation-induced complications, among which are toxicities to the nervous tissues in the head and neck area. Radiation-mediated neuropathies manifest as a result of increased oxidative stress-mediated apoptosis, neuroinflammation and altered cellular function in the nervous tissues. Eventually, molecular damage results in the formation of fibrotic tissues leading to susceptible loss of function of numerous neuronal substructures. Neuropathic sequelae following irradiation in the head and neck area include sensorineural hearing loss, alterations in taste and smell functions along with brachial plexopathy, and cranial nerves palsies. Numerous management options are available to relieve radiation-associated neurotoxicities notwithstanding treatment alternatives that remain restricted with limited benefits. In the scope of this review, we discuss the use of variable management and therapeutic modalities to palliate common radiation-induced neuropathies in head and neck cancers.
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Affiliation(s)
- Patrick Azzam
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Manal Mroueh
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Marina Francis
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Alaa Abou Daher
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
| | - Youssef H Zeidan
- Department of Anatomy, Cell Biology and Physiology, Faculty of Medicine, American University of Beirut, Beirut 1107 2020, Lebanon
- Department of Radiation Oncology, American University of Beirut Medical Center, Beirut 1107 2020, Lebanon
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Yan M, Kong W, Kerr A, Brundage M. The radiation dose tolerance of the brachial plexus: A systematic review and meta-analysis. Clin Transl Radiat Oncol 2019; 18:23-31. [PMID: 31309161 PMCID: PMC6606964 DOI: 10.1016/j.ctro.2019.06.006] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2019] [Accepted: 06/12/2019] [Indexed: 12/25/2022] Open
Abstract
PURPOSE We performed a systematic review and meta-analysis of studies reporting the incidence of radiation induced brachial plexopathy (RIBP) and the associated radiotherapy doses to this structure. METHODS Databases were queried without language restriction for cohort studies reporting RIBP incidence and associated brachial plexus dose maximum dose (bpDmax). Studies specifying RIBP relative risk (RR) effect size were selected for meta-analysis. RRs for RIBP from each study were converted to a regression coefficient (β) and standard error corresponding to a continuous representation of bpDmax. The adjusted β from individual studies were combined using a random effects model and weighted by inverse variance (1/SE2). The trim and fill approach was used to assess publication bias. RESULTS We identified 25 studies that included 37 unique patient cohorts eligible for analysis. Seventeen cohorts experienced an RIBP incidence ≤5%, of which 6 cohorts exceeded conventional plexus constraints of 60 Gy for bpDmax. Five of the 6 cohorts were simulated with 3D-CT techniques. Meta-analysis of eligible studies demonstrated a significant increase in RIBP risk for each Gy increase in bpDmax (RR, 1.11; 95% CI 1.07-1.15). Results remained significant after adjustment for publication bias and when sensitivity analysis was performed. CONCLUSIONS Our results suggest that current brachial plexus constraints of 60-66 Gy are safe. Meta-analysis provides a log-linear model to quantify the association of brachial plexus dose and RIBP risk, and thus inform the therapeutic ratio for dose escalation. Further prospective studies reporting dosimetric data can better refine this model and inform brachial plexus constraint guidelines.
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Affiliation(s)
- Michael Yan
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Weidong Kong
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada
| | - Andrew Kerr
- Department of Medical Physics, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
| | - Michael Brundage
- Department of Radiation Oncology, Cancer Centre of Southeastern Ontario, Kingston, ON, Canada
- Division of Cancer Care and Epidemiology, Queen’s University Cancer Research Institute, Kingston, ON, Canada
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Chang EI, Rose MI, Rossi K, Elkwood AI. Microneurosurgical treatment options in peripheral nerve compression syndromes after chemotherapy and radiation treatment. J Surg Oncol 2018; 118:793-799. [PMID: 30261113 DOI: 10.1002/jso.25254] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2018] [Accepted: 09/05/2018] [Indexed: 12/25/2022]
Abstract
Chemotherapy-induced peripheral neuropathy and radiation-induced brachial plexopathy are extremely debilitating conditions which can occur after treatment of malignancy. Unfortunately, the diagnosis can be elusive, and this dilemma is further compounded by the lack of efficacious therapeutics to prevent the onset of neurotoxicity before initiating chemotherapy or radiation or to treat these sequelae after treatment. However, microsurgical nerve decompression can provide these patients with a viable option to treat this complication.
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Affiliation(s)
- Eric I Chang
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Michael I Rose
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Kristie Rossi
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
| | - Andrew I Elkwood
- The Institute for Advanced Reconstruction at The Plastic Surgery Center, Shrewsbury, New Jersey.,Center for Treatment of Paralysis and Reconstructive Nerve Surgery, Jersey Shore University Medical Center, Neptune, New Jersey
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Boisselier P, Racadot S, Thariat J, Graff P, Pointreau Y. Radiothérapie conformationnelle avec modulation d’intensité des cancers des voies aérodigestives supérieures. Dose de tolérance des tissus sains : moelle épinière et plexus brachial. Cancer Radiother 2016; 20:459-66. [DOI: 10.1016/j.canrad.2016.08.124] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2016] [Accepted: 08/03/2016] [Indexed: 12/25/2022]
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Grisold W, Grisold A, Löscher WN. Neuromuscular complications in cancer. J Neurol Sci 2016; 367:184-202. [PMID: 27423586 DOI: 10.1016/j.jns.2016.06.002] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2016] [Revised: 05/08/2016] [Accepted: 06/01/2016] [Indexed: 12/11/2022]
Abstract
Cancer is becoming a treatable and even often curable disease. The neuromuscular system can be affected by direct tumor invasion or metastasis, neuroendocrine, metabolic, dysimmune/inflammatory, infections and toxic as well as paraneoplastic conditions. Due to the nature of cancer treatment, which frequently is based on a DNA damaging mechanism, treatment related toxic side effects are frequent and the correct identification of the causative mechanism is necessary to initiate the proper treatment. The peripheral nervous system is conventionally divided into nerve roots, the proximal nerves and plexus, the peripheral nerves (mono- and polyneuropathies), the site of neuromuscular transmission and muscle. This review is based on the anatomic distribution of the peripheral nervous system, divided into cranial nerves (CN), motor neuron (MND), nerve roots, plexus, peripheral nerve, the neuromuscular junction and muscle. The various etiologies of neuromuscular complications - neoplastic, surgical and mechanic, toxic, metabolic, endocrine, and paraneoplastic/immune - are discussed separately for each part of the peripheral nervous system.
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Affiliation(s)
- W Grisold
- Department of Neurology, Kaiser Franz Josef Hospital, Vienna, Austria.
| | - A Grisold
- Department of Neurology, Medical University of Vienna, Vienna, Austria
| | - W N Löscher
- Department of Neurology, Medical University of Innsbruck, Innsbruck, Austria
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Andrä C, Rauch J, Li M, Ganswindt U, Belka C, Saleh-Ebrahimi L, Ballhausen H, Nachbichler SB, Roeder F. Excellent local control and survival after postoperative or definitive radiation therapy for sarcomas of the head and neck. Radiat Oncol 2015; 10:140. [PMID: 26156022 PMCID: PMC4496934 DOI: 10.1186/s13014-015-0449-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 06/26/2015] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND To report our results with postoperative or definitive radiation therapy in head and neck sarcomas. METHODS We performed a retrospective analysis of 26 patients suffering from head and neck sarcomas, who received postoperative or definitive radiation therapy between 2003 and 2012. Median age was 64 years (19-88) and 69 % were male. Tumor locations were skull (including skin) in 31 %, paranasal sinus/orbita in 27 % and neck (including pharynx/larynx) in 42 %. Median tumor size was 4.6 cm (1-12 cm). 22 patients (85 %) presented in primary situation. Stage at presentation (UICC 7(th) for soft tissue sarcomas) was as follows: Ia:4 %, IIa:50 %, IIb:15 %, III:31 %. All except one patient suffered from high grade lesions (G2/3 FNCLCC), predominantly angiosarcoma (35 %), MFH (19 %) and synovial sarcoma (15 %). Surgery was performed in 21 pts (81 %), resulting in free margins in 10 (38 %), microscopically positive margins in 6 (23 %) and gross residual disease in 5 (19 %). Median dose to the primary tumor region was 66Gy (45-72Gy) in conventional fractionation, using 3D-CRT in 65 %, IMRT in 27 % and electrons in 8 %. 50 % of the patients also received sequential chemotherapy. RESULTS Median follow up was 39 months (8-136). We observed three local recurrences, transferring into estimated 3- and 5-year local control rates of 86 %. One additional patient failed distantly, resulting in 3- and 5-year freedom from treatment failure rates of 82 %. Four patients have deceased, transferring into 3- and 5-year overall survival rates of 88 % and 82 %, respectively. Only two of the four deaths were sarcoma related. Maximum acute toxicity (CTCAE 3.0) was grade 1 in 27 % of the patients, grade 2 in 50 % and grade 3 in 23 %. Severe acute toxicity was mainly represented by mucositis and dysphagia. Maximum late toxicity was grade 1 in 31 %, grade 2 in 15 % and grade 3 in 19 % of the patients. Severe late toxicity included skin ulceration (n = 1), dysphagia with persistent tube dependency (n = 1), persistent sinusitis (n = 1) and hearing loss (n = 2). CONCLUSION Excellent local control and overall survival rates can be achieved with postoperative or definitive radiation therapy with acceptable acute and late toxicities in patients suffering from sarcomas of the head and neck region.
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Affiliation(s)
- Claudia Andrä
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Josefine Rauch
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Minglun Li
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Ute Ganswindt
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Claus Belka
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Ladan Saleh-Ebrahimi
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Hendrik Ballhausen
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Silke Birgit Nachbichler
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany.
| | - Falk Roeder
- Department of Radiation Oncology, University Hospital of LMU Munich, Marchioninistr, 15 81377, Munich, Germany. .,Department of Molecular Radiation Oncology, German Cancer Research Center (DKFZ), Heidelberg, Germany.
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