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de Roest RH, van der Heijden M, W R Wesseling F, de Ruiter EJ, Heymans MW, Terhaard C, Vergeer MR, Buter J, Devriese LA, Paul de Boer J, Navran A, Hoeben A, Vens C, van den Brekel M, Brakenhoff RH, René Leemans C, Hoebers F. Disease outcome and associated factors after definitive platinum based chemoradiotherapy for advanced stage HPV-negative head and neck cancer. Radiother Oncol 2022; 175:112-121. [PMID: 35973619 DOI: 10.1016/j.radonc.2022.08.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2022] [Revised: 08/05/2022] [Accepted: 08/09/2022] [Indexed: 11/26/2022]
Abstract
BACKGROUND Definitive concomitant cisplatin-based chemoradiotherapy (CRT) is the current gold standard for most patients with advanced stage head and neck squamous cell carcinoma (HNSCC) of the pharynx and larynx. Since previous meta-analysis on CRT outcomes in HNSCC have been reported, advances have been made in radiotherapy techniques and clinical management, while HPV-status has been identified as a strong confounding prognostic factor in oropharyngeal cancer. Here, we present real-world outcome data from a large multicenter cohort of HPV-negative advanced stage HNSCC treated with CRT using contemporary IMRT-based techniques. METHOD Retrospective data were collected from a multicenter cohort of 513 patients treated with definitive concurrent platinum-based CRT with curative intent between January 2009 and August 2017. Only patients with HPV-negative advanced stage (III-IV) HNSCC were included. A prognostic model for outcome was developed based on clinical parameters and compared to TNM. RESULTS Nearly half of the 513 patients (49%) had an oropharyngeal tumor, often locally advanced (73.3% T3-T4b) and with involvement of the regional lymph nodes (84%). Most patients (84%) received cisplatin as single agent. 66% received the planned number of cycles and 75% reached a cumulative cisplatin dose of ≥200 mg/m2. Locoregional control was achieved in 324 (63%) patients during follow-up, and no association with tumor sites was observed (p = 0.48). Overall survival at 5 year follow-up was 47%, with a better survival for laryngeal cancer (p = 0.02) compared to other sites. A model with clinical variables (gender, high pre-treatment weight loss, N2c/N3-stage and <200 mg/m2 dose of cisplatin) provided a noticeably stronger association with overall survival than TNM-staging (C- index 0.68 vs 0.55). Simultaneous Integrated Boosting (SIB) significantly outperformed Sequential Boosting (SEQ) to reduce the development of distant metastasis (SEQ vs SIB: OR 1.91 (1.11 - 3.26; p = 0.02). CONCLUSION Despite advances in clinical management, more than a third of patients with HPV-negative HNSCC do not complete CRT treatment protocols due to cisplatin toxicity. A model that consists of clinical variables and treatment parameters including cisplatin dose provided the strongest association with overall survival. Since cisplatin toxicity is a major obstacle in completing definitive CRT, the development of alternative and less toxic radiosensitizers is therefore warranted to improve treatment results. The association of RT-boost technique with distant metastasis is an important finding and requires further study.
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Affiliation(s)
- Reinout H de Roest
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, The Netherlands
| | - Martijn van der Heijden
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Frederik W R Wesseling
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Emma J de Ruiter
- Department of Pathology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Martijn W Heymans
- Department of Epidemiology and Data Science, Amsterdam UMC, Location VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Chris Terhaard
- Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Marije R Vergeer
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Radiation Oncology, Amsterdam, The Netherlands
| | - Jan Buter
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Oncology, Amsterdam, The Netherlands
| | - Lot A Devriese
- Department of Medical Oncology, Division of Imaging and Oncology, University Medical Center Utrecht and Utrecht University, The Netherlands
| | - Jan Paul de Boer
- Department of Medical Oncology, The Netherlands Cancer Institute, Amsterdam, The Netherlands
| | - Arash Navran
- Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Ann Hoeben
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands; Division of Medical Oncology, Department of Internal Medicine, Maastricht University Medical Center+, GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Conchita Vens
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Division of Cell Biology, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Radiation Oncology, The Netherlands Cancer Institute, Amsterdam, the Netherlands
| | - Michiel van den Brekel
- Department of Head and Neck Oncology and Surgery, The Netherlands Cancer Institute, Amsterdam, The Netherlands; Department of Oral and Maxillofacial Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Ruud H Brakenhoff
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, The Netherlands
| | - C René Leemans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Otolaryngology / Head and Neck Surgery, Cancer Center Amsterdam, The Netherlands
| | - Frank Hoebers
- Department of Radiation Oncology (MAASTRO), GROW - School for Oncology and Developmental Biology, Maastricht University Medical Center, Maastricht, The Netherlands
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Rakesh A, Goyal J, Soni S, Abhilasha, Rastogi K. A comparative study of planning and dosimetry in locally advanced head-and-neck cancer: sequential versus simultaneous integrated boost methods in intensity-modulated radiotherapy. JOURNAL OF RADIATION AND CANCER RESEARCH 2022. [DOI: 10.4103/jrcr.jrcr_46_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Hsieh CH, Shueng PW, Wang LY, Liao LJ, Lo WC, Yeh HP, Chou HL, Wu LJ. Single-Institute Clinical Experiences Using Whole-Field Simultaneous Integrated Boost (SIB) Intensity-Modulated Radiotherapy (IMRT) and Sequential IMRT in Postoperative Patients With Oral Cavity Cancer (OCC). Cancer Control 2021; 27:1073274820904702. [PMID: 33047615 PMCID: PMC7791442 DOI: 10.1177/1073274820904702] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
This study aimed to review clinical experiences using whole-field simultaneous
integrated boost (SIB) intensity-modulated radiotherapy (IMRT) and sequential
IMRT in postoperative patients with oral cavity cancer (OCC). From November 2006
to December 2014, a total of 182 postoperative patients with OCC who underwent
either SIB-IMRT (n = 63) or sequential IMRT (n = 119) were enrolled
retrospectively and matched randomly according to multiple risk factors by a
computer. The differences were well balanced after patient matching
(P = .38). The median follow-up time was 65 months. For
patients treated with the SIB technique and the sequential technique, the
respective mortality rates were 36.8% and 20.0% (P = .04). The
primary recurrence rates were 26.3% and 10.0% (P = .02),
respectively. The respective marginal failure rates were 26.7% and 16.7%. A
multivariate logistic regression analysis showed that patients who received the
SIB technique had a 2.74 times higher risk of death than those who received the
sequential technique (95% confidence interval = 1.10-6.79, P =
.03). Sequential IMRT provided a significantly lower dose to the esophagus (5.2
Gy, P = .02) and trachea (4.6 Gy, P = .03)
than SIB-IMRT. For patients with locally advanced OCC, postoperative sequential
IMRT may overcome an unpredictable geographic miss, potentially with a lower
marginal failure rate in the primary area. Patients treated by sequential IMRT
show equal overall survival benefits to those treated by SIB-IMRT and a lower
mortality rate than those treated by SIB-IMRT. Additionally, a reduced dose to
the esophagus and trachea compared to sequential IMRT was noted.
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Affiliation(s)
- Chen-Hsi Hsieh
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China).,Institute of Traditional Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Pei-Wei Shueng
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Faculty of Medicine, School of Medicine, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Li-Ying Wang
- Physical Therapy Center, National Taiwan University Hospital, Taipei, Taiwan, R.O.C. (Republic of China).,School and Graduate Institute of Physical Therapy, College of Medicine, National Taiwan University, Taipei, Taiwan, R.O.C. (Republic of China)
| | - Li-Jen Liao
- Department of Otolaryngology, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, R.O.C. (Republic of China)
| | - Wu-Chia Lo
- Department of Electrical Engineering, Yuan Ze University, Taoyuan, Taiwan, R.O.C. (Republic of China)
| | - Hsin-Pei Yeh
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China)
| | - Hsiu-Ling Chou
- Department of Nursing, Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China).,School of Nursing, National Yang-Ming University, Taipei, Taiwan, R.O.C. (Republic of China).,Department of Nursing, Oriental Institute of Technology, New Taipei City, Taiwan, R.O.C. (Republic of China)
| | - Le-Jung Wu
- Division of Radiation Oncology, Department of Radiology, 46608Far Eastern Memorial Hospital, New Taipei City, Taiwan, R.O.C. (Republic of China)
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Pigorsch SU, Kampfer S, Oechsner M, Mayinger MC, Mozes P, Devecka M, Kessel KK, Combs SE, Wilkens JJ. Report on planning comparison of VMAT, IMRT and helical tomotherapy for the ESCALOX-trial pre-study. Radiat Oncol 2020; 15:253. [PMID: 33138837 PMCID: PMC7607845 DOI: 10.1186/s13014-020-01693-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 10/21/2020] [Indexed: 12/12/2022] Open
Abstract
Background The ESCALOX trial was designed as a multicenter, randomized prospective dose escalation study for head and neck cancer. Therefore, feasibility of treatment planning via different treatment planning systems (TPS) and radiotherapy (RT) techniques is essential. We hypothesized the comparability of dose distributions for simultaneous integrated boost (SIB) volumes respecting the constraints by different TPS and RT techniques. Methods CT data sets of the first six patients (all male, mean age: 61.3 years) of the pre-study (up to 77 Gy) were used for comparison of IMRT, VMAT, and helical tomotherapy (HT). Oropharynx was the primary tumor location. Normalization of the three step SIB (77 Gy, 70 Gy, 56 Gy) was D95% = 77 Gy. Coverage (CVF), healthy tissue conformity index (HTCI), conformation number (CN), and dose homogeneity (HI) were compared for PTVs and conformation index (COIN) for parotids. Results All RT techniques achieved good coverage. For SIB77Gy, CVF was best for IMRT and VMAT, HT achieved highest CN followed by VMAT and IMRT. HT reached good HTCI value, and HI compared to both other techniques. For SIB70Gy, CVF was best by IMRT. HTCI favored HT, consequently CN as well. HI was slightly better for HT. For SIB56Gy, CVF resulted comparably. Conformity favors VMAT as seen by HTCI and CN. Dmean of ipsilateral and contralateral parotids favor HT. Conclusion Different TPS for dose escalation reliably achieved high plan quality. Despite the very good results of HT planning for coverage, conformity, and homogeneity, the TPS also achieved acceptable results for IMRT and VMAT. Trial registration ClinicalTrials.gov Identifier: NCT 01212354, EudraCT-No.: 2010-021139-15. ARO: ARO 14-01
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Affiliation(s)
- Steffi U Pigorsch
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany.
| | - Severin Kampfer
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Markus Oechsner
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michael C Mayinger
- Department of Radiation Oncology, University Hospital Zurich, Rämistrasse 100, Zurich, Switzerland
| | - Petra Mozes
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Michal Devecka
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Kerstin K Kessel
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
| | - Stephanie E Combs
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany.,Institute of Radiation Medicine (IRM), Helmholtz Zentrum München, Ingolstädter Landstraße 1, Neuherberg, Germany
| | - Jan J Wilkens
- Department of Radiation Oncology, Technical University of Munich (TUM), School of Medicine, Klinikum Rechts Der Isar, Ismaninger Straße 22, 81675, Munich, Germany
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Kuo YH, Liang JA, Wang TC, Juan CJ, Li CC, Chien CR. Comparative effectiveness of simultaneous integrated boost vs sequential intensity-modulated radiotherapy for oropharyngeal or hypopharyngeal cancer patients: A population-based propensity score-matched analysis. Medicine (Baltimore) 2019; 98:e18474. [PMID: 31861029 PMCID: PMC6940180 DOI: 10.1097/md.0000000000018474] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
There were 2 common radiotherapy dose fractionation strategies in head-and-neck cancer patients (such as oropharyngeal cancer [OPC] or hypopharyngeal cancer [HPC]) treated with radiotherapy: intensity-modulated radiotherapy using simultaneous integrated boost (IMRT-SIB) and sequential IMRT (IMRT-SEQ). There is a lack of high-level clinical evidence to compare IMRT-SIB vs IMRT-SEQ specifically for OPC or HPC patients. The present study investigated the survival outcomes of OPC or HPC patients receiving definite concurrent chemoradiotherapy (CCRT) with either IMRT-SIB or IMRT-SEQ via a population-based propensity score (PS)-based analysis.The localized stage OPC or HPC patients diagnosed between 2011 and 2015 were identified based on the Health and Welfare Data Science Center database in Taiwan. These patients received definitive CCRT with either IMRT-SIB or IMRT-SEQ. We constructed a PS-matched cohort (1:1 for IMRT-SIB vs IMRT-SEQ) to balance observable potential confounders. We compared the hazard ratio (HR) of death between IMRT-SIB and IMRT-SEQ during the entire follow-up period. We also evaluated other disease outcome or subgroups.Our study population constituted 200 patients with well balance in observed covariables. The HR of death when IMRT-SIB was compared to IMRT-SEQ was 1.23 (95% confidence interval 0.84-1.80, P = .29). The results were similar for other disease outcome or subgroups.We found the survival outcome might be comparable for those treated with IMRT-SIB vs those treated with IMRT-SEQ.
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Affiliation(s)
- Yao-Hung Kuo
- Department of Radiation Oncology, E-Da Hospital
- College of Medicine, I-Shou University, Kaohsiung
| | - Ji-An Liang
- Department of Radiation Oncology, China Medical University Hospital, Taichung
- School of Medicine, College of Medicine, China Medical University
| | | | - Chun-Jung Juan
- Department of Medical Imaging, China Medical University Hsinchu Hospital, Hsinchu
- Department of Radiology, School of Medicine, College of Medicine, China Medical University, Taichung
| | - Chia-Chin Li
- Department of Radiation Oncology, China Medical University Hospital, Taichung
| | - Chun-Ru Chien
- Department of Radiation Oncology, China Medical University Hospital, Taichung
- School of Medicine, College of Medicine, China Medical University
- Department of Radiation Oncology, China Medical University Hsinchu Hospital, Hsinchu, Taiwan
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Clinical outcome and toxicity after simultaneous integrated boost IMRT in head and neck squamous cell cancer patients. Oral Oncol 2019; 98:132-140. [DOI: 10.1016/j.oraloncology.2019.09.012] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2019] [Revised: 09/06/2019] [Accepted: 09/13/2019] [Indexed: 12/17/2022]
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Jiang L, Zhang Y, Yang Z, Liang F, Wu J, Wang R. A comparison of clinical outcomes between simultaneous integrated boost (SIB) versus sequential boost (SEQ) intensity modulated radiation therapy (IMRT) for head and neck cancer: A meta-analysis. Medicine (Baltimore) 2019; 98:e16942. [PMID: 31441887 PMCID: PMC6716705 DOI: 10.1097/md.0000000000016942] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND The optimal intensity modulated radiation therapy (IMRT) technique for head and neck cancer (HNC) has not been determined yet. The present study aimed to compare the clinical outcomes of the simultaneous integrated boost (SIB)-IMRT versus the sequential boost (SEQ)-IMRT in HNC. METHODS A meta-analysis of 7 studies involving a total of 1049 patients was carried out to compare the treatment outcomes together with severe acute adverse effects of the SIB-IMRT versus the SEQ-IMRT in HNC patients. RESULTS Comparison of the SIB-IMRT and SEQ-IMRT showed no significant difference in the measurement of overall survival (OS) (hazard ratio [HR] 0.94; 95% confidence inerval [CI], 0.70-1.27; P = .71), progression free survival (PFS) (HR 1.03; 95% CI, 0.82-1.30; P = .79), locoregional recurrence free survival (LRFS) (HR 0.98; 95% CI, 0.65-1.47; P = .91), and distance metastasis free survival (DMFS) (HR 0.87; 95% CI, 0.50-1.53; P = .63). Moreover, there were no significant differences in adverse effect occurrence between the SIB-IMRT and SEQ-IMRT groups. CONCLUSION SIB-IMRT and SEQ-IMRT can provide comparable outcomes in the treatment of patients afflicted by HNC. Both IMRT techniques were found to carry a similar risk of severe acute adverse effect. SIB-IMRT may have advantages due to its convenience and short-course of treatment; however, the optimum fractionation and prescribed dose remained unclear. Furthermore, both IMRT techniques can be advocated as the technique of choice for HNC. Treatment plan should be individualized for patients.
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Organ preservation in rectal cancer - Challenges and future strategies. Clin Transl Radiat Oncol 2017; 3:9-15. [PMID: 29658007 PMCID: PMC5893528 DOI: 10.1016/j.ctro.2017.02.002] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2017] [Accepted: 02/16/2017] [Indexed: 12/14/2022] Open
Abstract
Neoadjuvant radiochemotherapy with subsequent total mesorectal excision is the standard of care for locally advanced rectal cancer. While this multimodal strategy has decreased local recurrences rates below 5%, long-term morbidities are considerable in terms of urinary, sexual or bowel functioning. At the same time approximately 10–20% of patients have no evidence of residual tumour in their surgical specimen. Pioneering studies from Brazil have suggested that surgery can safely be omitted in carefully selected patients with a clinical complete response after radiochemotherapy. Although confirmatory studies showed similar results, challenges in terms of optimizing radiochemotherapy for organ-preservation, appropriate selection of patients for non-operative management and the safety of this approach remain. The present review will summarize the current data on organ-preservation in rectal cancer and discuss the challenges that need to be addressed in future trials.
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mARC Treatment of Hypopharynx Carcinoma with Flat and Flattening-Filter-Free Beam Energies - A Planning Study. PLoS One 2016; 11:e0164616. [PMID: 27741272 PMCID: PMC5065169 DOI: 10.1371/journal.pone.0164616] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Accepted: 09/22/2016] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND The recently implemented mARC-rotation-technique is capable to deliver high dose rate bursts. For the case of hypopharynx cancer plans we evaluate whether the mARC can achieve an advantage in treatment time in comparison to IMRT. These plans consider two arcs with flat and flattening filter free (FFF) beam energies. MATERIALS AND METHODS For 8 hypopharynx-cancer patients step-and-shoot-IMRT and mARC plans were created retrospectively using flat and FFF beam energy. The comparison of the plan scenarios considered measures of quality for PTV coverage and sparing of organs at risk. All plans were irradiated on an anthromorphic phantom equipped with thermoluminescent dosimeters to measure scattered dose and treatment times. RESULTS A visual comparison of the dose distribution did not show a marked preference for either technique or energy. The statistical evaluation yielded significant differences in favor of the mARC technique and the FFF energy. Scattered dose could be decreased markedly by the use of the mARC technique. Treatment times could be reduced up to 3 minutes with the use of mARC in comparison to IMRT. The high dose rate energy results in another time advantage of about 1 minute. CONCLUSIONS All four plan scenarios yielded equally good quality plans. A combination of the mARC technique with FFF 7 MV high dose rate resulted in a decrease of treatment times from about 9 minutes to 5-6 minutes in comparison to 6 MV IMRT.
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Unilateral and bilateral neck SIB for head and neck cancer patients : Intensity-modulated proton therapy, tomotherapy, and RapidArc. Strahlenther Onkol 2016; 192:232-9. [PMID: 26852243 DOI: 10.1007/s00066-016-0945-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2015] [Accepted: 01/14/2016] [Indexed: 12/22/2022]
Abstract
AIM To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer. PATIENTS AND METHODS A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared. RESULTS All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001-1.1 Gy) than both rotational techniques did (parotid gland: 6-10 Gy; submandibular gland: 15-20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory. CONCLUSION For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ-at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level.
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