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Iyizoba-Ebozue Z, Fleming JC, Prestwich RJD, Thomson DJ. Management of sinonasal cancers: Survey of UK practice and literature overview. Eur J Surg Oncol 2021; 48:32-43. [PMID: 34840009 DOI: 10.1016/j.ejso.2021.11.124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 10/31/2021] [Accepted: 11/16/2021] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION Sinonasal malignancy is a rare and heterogenous disease, with limited evidence to guide management. This report summarises the findings of a UK survey and expert workshop discussion which took place to inform design of a proposed UK trial to assess proton beam therapy versus intensity-modulated radiation therapy. METHOD A multidisciplinary working group constructed an online survey to assess current approaches within the UK to surgical and non-surgical practice. Head and neck clinical oncologists, ear nose and throat (ENT) and oral-maxillofacial (OMF) surgeons were invited to participate in the 42-question survey in September 2020. The Royal College of Radiologists Consensus model was adopted in establishing categories to indicate strength of response. An expert panel conducted a virtual workshop in November 2020 to discuss areas of disagreement. RESULTS A survey was sent to 140 UK-based clinicians with 63 responses (45% response rate) from 30 centres, representing a broad geographical spread. Participants comprised 35 clinical oncologists (56%) and 29 surgeons (44%; 20 ENT and 9 OMF surgeons). There were variations in preferred sequence and combination of treatment modalities for locally advanced maxillary squamous cell carcinoma and sinonasal undifferentiated carcinoma. There was discordant surgical management of the orbit, dura, and neck. There was lack of consensus for radiotherapy in post-operative dose fractionation, target volume delineation, use of multiple dose levels and treatment planning approach to organs-at-risk. CONCLUSION There was wide variation across UK centres in the management of sinonasal carcinomas. There is need to standardise UK practice and develop an evidence base for treatment.
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Affiliation(s)
| | - Jason C Fleming
- Liverpool Head & Neck Centre, Department of Molecular and Clinical Cancer Medicine, The University of Liverpool Cancer Research Centre, Liverpool
| | | | - David J Thomson
- The Christie NHS Foundation Trust, Manchester and Division of Cancer Sciences, University of Manchester, UK.
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Precision Postoperative Radiotherapy in Sinonasal Carcinomas after Endonasal Endoscopic Surgery. Cancers (Basel) 2021; 13:cancers13194802. [PMID: 34638287 PMCID: PMC8508309 DOI: 10.3390/cancers13194802] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 09/15/2021] [Accepted: 09/18/2021] [Indexed: 11/19/2022] Open
Abstract
Simple Summary Sinonasal cancers are rare and heterogeneous tumors, mainly carcinomas, with essentially local evolution and a severe vital and functional prognosis. These tumors are more and more being treated in first intent by a mini-morbid endoscopic approach rather than open surgery as the cornerstone of curative treatment. Adjuvant radiotherapy remains necessary owing to non-optimal local control. This article describes the requirements of radiotherapy to ensure adequate delays, the potential of postoperative radiotherapy to increase local and distant disease control and to decrease morbidity further after mini morbid surgery and dose painting techniques, and reviews the criteria that lead to the choice of one technique over another. Abstract Radiotherapy plays an important role in the treatment of sinonasal cancer, mainly in the adjuvant setting after surgical resection. Many technological approaches have been described, including intensity-modulated radiotherapy, concomitant chemoradiotherapy, charged particle therapy or combined approaches. The choice is based on general criteria related to the oncological results and morbidity of each technique and their availability, as well as specific criteria related to the tumor (tumor extensions, pathology and quality of margins). The aims of this review are: (i) to provide an overview of the radiotherapy techniques available for the management of sinonasal malignant tumors and (ii) to describe the constraints and opportunities of radiotherapy owing to the recent developments of endonasal endoscopic surgery. The indication and morbidity of the different techniques will be discussed based on a critical literature review.
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Sharma MB, Jensen K, Amidi A, Eskildsen SF, Johansen J, Grau C. Late toxicity in the brain after radiotherapy for sinonasal cancer: Neurocognitive functioning, MRI of the brain and quality of life. Clin Transl Radiat Oncol 2020; 25:52-60. [PMID: 33024844 PMCID: PMC7530204 DOI: 10.1016/j.ctro.2020.09.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 08/31/2020] [Accepted: 09/07/2020] [Indexed: 12/12/2022] Open
Abstract
Compared with matched normative data, impaired cognitive function was substantial. Several correlations between radiation dose and cognitive impairment were present. Radiation-induced white matter hyperintensities were present in 2/27 participants. One participant displayed radiation-induced necrosis in the temporal lobe. The domains affecting quality of life the most were fatigue and quality of sleep.
Purpose The aim of the study was to evaluate neurocognitive late effects, structural alterations and associations between cognitive impairment and radiation doses as well as cerebral tissue damage after radiotherapy for sinonasal cancer. Furthermore, the aim was to report quality of life (QoL) and self-reported cognitive capacity. Materials and methods Recurrence-free patients previously treated with intensity-modulated radiotherapy with a curative intent were eligible for the study. Study examinations comprised comprehensive neurocognitive testing, MRI of the brain, and self-reported outcomes. Results A total of 27 patients were included. Median age was 67 years (range 47–83). The majority of test outcomes were below normative values in any degree, and 37% of the participants had clinically significant neurocognitive impairment when compared with normative data. Correlations between absorbed doses to specific substructures of the brain and neurocognitive outcomes were present for Wechsler’s Adult Intelligence Scale-digit span and Controlled Oral Word Association Test-S. Structural MRI revealed macroscopic abnormalities in three patients; infarction (n = 1), diffuse white matter intensities (n = 2) and necrosis (n = 1). In the analysis of atrophy of cerebral tissue, no correlations were present with neither radiation dose to cerebral substructures nor neurocognitive impairment. The global QoL of the cohort was 75. The most affected outcomes were ‘fatigue’, ‘insomnia’, and ‘drowsiness’. A total of 59% of participants reported significantly impaired quality of sleep. Self-reported cognitive function revealed that ‘memory’ was the most affected cognitive domain. For the domains of ‘memory’ and ‘language’, self-reported functioning was associated with objectively measured neurocognitive outcomes. Conclusion Cerebral toxicity after radiotherapy for sinonasal cancer was substantial. Clinically significant cognitive impairment was present in more than one third of the participants, and several dose–response associations were present. Furthermore, the presence of macroscopic radiation sequelae indicated considerable impact of radiotherapy on brain tissue.
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Affiliation(s)
- M B Sharma
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensen Boulevard 99, DK-8200 Aarhus N, Denmark
| | - K Jensen
- Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, B420, 8200 Aarhus N, Denmark
| | - A Amidi
- Unit for Psychooncology and Health Psychology, Department of Psychology, Aarhus University, Bartholins Allé 9, Build. 1351, 8000 Aarhus C, Denmark
| | - S F Eskildsen
- Center of Functionally Integrative Neuroscience, Aarhus University, Nørrebrogade 44, Build. 1A, 8000 Aarhus C, Denmark
| | - J Johansen
- Department of Oncology, Odense University Hospital, J.B. Winsløvs Vej 4, 5000 Odense, Denmark
| | - C Grau
- Department of Oncology, Aarhus University Hospital, Palle Juul Jensen Boulevard 99, DK-8200 Aarhus N, Denmark.,Danish Center for Particle Therapy, Aarhus University Hospital, Palle Juul Jensens Boulevard 99, B420, 8200 Aarhus N, Denmark
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Mohamed Ali A, Mathis T, Bensadoun RJ, Thariat J. Radiation induced optic neuropathy: Does treatment modality influence the risk? Bull Cancer 2019; 106:1160-1176. [PMID: 31757405 DOI: 10.1016/j.bulcan.2019.09.008] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2019] [Revised: 06/29/2019] [Accepted: 09/20/2019] [Indexed: 11/16/2022]
Abstract
Radiation induced optic neuropathy (RION) is a rare but disastrous complication of radiation therapy in treatment of periorbital tumors. The objective of this study is to investigate the incidence of RION in series of patients treated from peri orbital tumors by recent photon and proton irradiation modalities. We searched the Pub Med database for studies in periorbital tumors including base of skull, sinonasal, pituitary, nasopharyngeal tumors and craniopharyngioma treated with Intensity modulated radiotherapy (IMRT) and with proton beam therapy (PBT) between 1992 and 2017 excluding metastatic tumors, lymphomas, pediatric series, those treated mainly with chemotherapy, target therapy and those written in languages other than English and French. The result retrieved 421 articles that were revised by the panel. Fourteen articles with IMRT and 27 with PBT reported usable data for the review from which 31studies that had pointed to the doses to the optic nerve (ON) and/or optic chiasm (OC) and incidence of RION have been analyzed. We have found that the incidence of RION had been reported fairly in both modalities and many other factors related to the patient, tumor, and irradiation process interplay in its development. We have concluded that proper treatment planning, good selection of treatment modality, adherence to dose constraints applied to critical structures all along with regular oncological and ophthalmological follow up, control of co-morbidities and early intervention, could help reducing its magnitude.
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Affiliation(s)
- Ali Mohamed Ali
- Sohag University, Sohag University Hospital, Department of Clinical Oncology, Sohag East, 82524 Sohag, Egypt
| | - Thibaud Mathis
- Croix-Rousse University Hospital, Department of Ophthalmology, 103, grande rue de la Croix-Rousse, Lyon, France; UMR-CNRS 5510, Mateis, Villeurbanne, Lyon, France
| | | | - Juliette Thariat
- Centre François-Baclesse/ARCHADE, Department of Radiation Oncology, 3, avenue General Harris, 14000 Caen, France; Unicaen - Normandie Université, laboratoire de physique corpusculaire IN2P3/ENSICAEN - UMR6534, boulevard du Marechal Juin, 14050 Caen, France
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Fatigue following radiation therapy in nasopharyngeal cancer survivors: A dosimetric analysis incorporating patient report and observer rating. Radiother Oncol 2019; 133:35-42. [PMID: 30935579 DOI: 10.1016/j.radonc.2018.12.023] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 12/19/2018] [Accepted: 12/21/2018] [Indexed: 01/13/2023]
Abstract
PURPOSE To explore for fatigue-related regions and the radiotherapy (RT) dose-fatigue relationship in nasopharyngeal cancer (NPC) survivors. METHODS Eighty disease-free NPC survivors completed the MD Anderson Symptom Inventory-Head and Neck module (MDASI-HN) after RT. Fatigue was evaluated by the MDASI-HN fatigue item (MDASI-HN-F) and Common Terminology Criteria for Adverse Events v3.0 (CTC-AE), between 6 and 36 months after RT to determine the presence of chronic fatigue. Skull base MRIs and planning CT/RT dose were retrievable for 56 patients. Dosimetric data were extracted for 10 MRI-defined potential fatigue at-risk structures (FARS): brainstem (BS), pituitary gland (PG), hypothalamus (HT), basal ganglia, internal capsule, pineal gland, sub-thalamic nuclei, thalamus, substantia nigra, and hippocampus (HC). Recursive partitioning analysis (RPA) was used to identify dose-volume effects associated with chronic fatigue. RESULTS 56 pts formed the cohort. Thirty patients (54%) reported any fatigue per MDASI-HN-F. Thirty-three pts (59%) had any fatigue by CTC-AE. The maximum point doses (Dmax) for PG, BS, HC, and HT were numerically higher in patients with fatigue. Dmax and Dmean of the PG were significantly higher in patients with chronic fatigue, p ≤ 0.01. A dose-volume threshold of PG V52 Gy ≥16% (LogWorth 2.4, AUC 0.7) was identified on RPA, and potential sensitivity to the PG doses was observed in younger patients (<53 years-old). CONCLUSION A dose-fatigue relationship was identified for the pituitary gland, both patient-reported and observer ratings. We recommend limiting the Dmax of PG to <54 Gy and V52 Gy to <16%, particularly in young NPC patients, during plan optimization when achievable.
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Gooi Z, Fakhry C, Goldenberg D, Richmon J, Kiess AP. AHNS Series: Do you know your guidelines?Principles of radiation therapy for head and neck cancer: A review of the National Comprehensive Cancer Network guidelines. Head Neck 2016; 38:987-92. [DOI: 10.1002/hed.24448] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/02/2016] [Indexed: 01/02/2023] Open
Affiliation(s)
- Zhen Gooi
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Carole Fakhry
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - David Goldenberg
- Department of Surgery, Division of Otolaryngology-Head and Neck Surgery; The Pennsylvania State University, College of Medicine; Hershey Pennsylvania
| | - Jeremy Richmon
- Department of Otolaryngology-Head and Neck Surgery; Johns Hopkins University; Baltimore Maryland
| | - Ana P. Kiess
- Department of Radiation Oncology and Molecular Radiation Sciences; Johns Hopkins University; Baltimore Maryland
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Giaj-Levra N, Sciascia S, Fiorentino A, Fersino S, Mazzola R, Ricchetti F, Roccatello D, Alongi F. Radiotherapy in patients with connective tissue diseases. Lancet Oncol 2016; 17:e109-e117. [DOI: 10.1016/s1470-2045(15)00417-9] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2015] [Revised: 09/30/2015] [Accepted: 10/12/2015] [Indexed: 01/21/2023]
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Lu JY, Zheng J, Zhang WZ, Huang BT. Flattening Filter-Free Beams in Intensity-Modulated Radiotherapy and Volumetric Modulated Arc Therapy for Sinonasal Cancer. PLoS One 2016; 11:e0146604. [PMID: 26734731 PMCID: PMC4703390 DOI: 10.1371/journal.pone.0146604] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2015] [Accepted: 12/18/2015] [Indexed: 02/05/2023] Open
Abstract
PURPOSE To evaluate the dosimetric impacts of flattening filter-free (FFF) beams in intensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT) for sinonasal cancer. METHODS For fourteen cases, IMRT and VMAT planning was performed using 6-MV photon beams with both conventional flattened and FFF modes. The four types of plans were compared in terms of target dose homogeneity and conformity, organ-at-risk (OAR) sparing, number of monitor units (MUs) per fraction, treatment time and pure beam-on time. RESULTS FFF beams led to comparable target dose homogeneity, conformity, increased number of MUs and lower doses to the spinal cord, brainstem and normal tissue, compared with flattened beams in both IMRT and VMAT. FFF beams in IMRT resulted in improvements by up to 5.4% for sparing of the contralateral optic structures, with shortened treatment time by 9.5%. However, FFF beams provided comparable overall OAR sparing and treatment time in VMAT. With FFF mode, VMAT yielded inferior homogeneity and superior conformity compared with IMRT, with comparable overall OAR sparing and significantly shorter treatment time. CONCLUSIONS Using FFF beams in IMRT and VMAT is feasible for the treatment of sinonasal cancer. Our results suggest that the delivery mode of FFF beams may play an encouraging role with better sparing of contralateral optic OARs and treatment efficiency in IMRT, but yield comparable results in VMAT.
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Affiliation(s)
- Jia-Yang Lu
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Jing Zheng
- Department of Laboratory, Shantou Central Hospital, Affiliated Shantou Hospital of Sun Yat-sen University, Shantou, Guangdong, China
| | - Wu-Zhe Zhang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
| | - Bao-Tian Huang
- Department of Radiation Oncology, Cancer Hospital of Shantou University Medical College, Shantou, Guangdong, China
- * E-mail:
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Gray ST, Sadow PM, Lin DT, Sedaghat AR. Endoscopic sinus surgery for chronic rhinosinusitis in patients previously treated for sinonasal malignancy. Laryngoscope 2015; 126:304-15. [PMID: 26309057 DOI: 10.1002/lary.25435] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/01/2015] [Indexed: 02/03/2023]
Abstract
OBJECTIVES/HYPOTHESIS Patients with a history of sinonasal malignancy can develop chronic rhinosinusitis (CRS) as a consequence of their oncologic treatment. Some patients will fail medical management and require endoscopic sinus surgery (ESS). This study reviews the use of ESS in the management of CRS in patients previously treated for sinonasal malignancy. STUDY DESIGN Retrospective review. METHODS All patients with a history of sinonasal malignancy who developed CRS and underwent ESS were reviewed. Preoperative and postoperative imaging and symptoms were collected. Major complications (bleeding, orbital injury, and cerebrospinal fluid leak) and minor complications (adhesion formation) and postoperative healing were reviewed. RESULTS Eighteen patients were identified. All patients presented with symptoms of CRS and sinonasal crusting. Additionally, five patients presented with recurrent facial cellulitis, and six patients had mucoceles. No major complications were encountered. Postoperatively, all patients reported a subjective improvement in their sinonasal symptoms. Comparison of pre- and post-ESS imaging revealed a significant improvement in Lund-Mackay scores after ESS (P < 0.001) from 12.8 (range 5-22) to 7 (range). Despite symptomatic improvement, all patients continued to have nasal crusting. All patients who initially presented with recurrent facial cellulitis had no further episodes after ESS. None of the endoscopically drained mucoceles recurred. CONCLUSION For patients previously treated for sinonasal malignancy with refractory CRS, ESS appears to be a safe and effective treatment option. ESS in these patients results in subjective improvement in sinonasal symptoms as well as objective improvement in radiographic CRS disease burden, although sinonasal crusting will likely not resolve. LEVEL OF EVIDENCE 4.
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Affiliation(s)
- Stacey T Gray
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
| | - Peter M Sadow
- Department of Pathology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Derrick T Lin
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
| | - Ahmad R Sedaghat
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary.,Department of Otology and Laryngology
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Coplanar VMAT vs. noncoplanar VMAT in the treatment of sinonasal cancer. Strahlenther Onkol 2014; 191:34-42. [PMID: 25293728 DOI: 10.1007/s00066-014-0760-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2014] [Accepted: 09/06/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Previous studies showed that noncoplanar intensity-modulated radiotherapy (NC-IMRT) for sinonasal cancer is superior to coplanar intensity-modulated radiotherapy (IMRT). Volumetric-modulated arc therapy (VMAT) is a newly introduced treatment modality, and the performance of noncoplanar VMAT for sinonasal cancer has not been well described to date. PURPOSE To compare the dosimetry difference of noncoplanar VMAT (NC-VMAT), coplanar VMAT (co-VMAT), and NC-IMRT for sinonasal cancer. PATIENTS AND METHODS Ten postoperative patients with sinonasal cancer were randomly selected for planning with NC-VMAT, co-VMAT, and NC-IMRT. Two planning target volumes (PTVs) were contoured representing high-risk and low-risk regions set to receive a median absorbed dose (D50%) of 68 Gy and 59 Gy, respectively. The homogeneity index (HI), conformity index (CI), dose-volume histograms (DVHs), and delivery efficiency were all evaluated. RESULTS Both NC-VMAT and co-VMAT showed superior dose homogeneity and conformity in PTVs compared with NC-IMRT. There was no significant difference between NC-VMAT and co-VMAT in PTV coverage. Both VMAT plans provided a better protection for organs at risk (OARs) than NC-IMRT plans, and NC-VMAT showed a small improvement over co-VMAT in sparing of OARs. For peripheral doses, the doses to breast, thyroid, and larynx in the NC-IMRT plans were significantly higher than those in both VMAT plans. Compared to NC-VMAT, co-VMAT significantly reduced peripheral doses. NC-VMAT and co-VMAT reduced the average delivery time by 63.2 and 64.2%, respectively, in comparison with NC-IMRT. No differences in delivery efficiency were observed between the two VMAT plans. CONCLUSION Compared to NC-VMAT, co-VMAT showed similar PTV coverage and comparable OAR sparing but significantly reduced peripheral doses and positioning uncertainty. We propose to give priority to coplanar VMAT in the treatment of sinonasal cancer.
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A dosimetric comparison of volumetric modulated arc therapy (VMAT) and non-coplanar intensity modulated radiotherapy (IMRT) for nasal cavity and paranasal sinus cancer. Radiat Oncol 2014; 9:193. [PMID: 25175383 PMCID: PMC4261880 DOI: 10.1186/1748-717x-9-193] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Accepted: 08/09/2014] [Indexed: 11/15/2022] Open
Abstract
Background To compare dosimetric parameters of volumetric modulated arc therapy (VMAT) and non-coplanar intensity modulated radiotherapy (IMRT) for nasal cavity and paranasal sinus cancer with regard to the coverage of planning target volume (PTV) and the sparing of organs at risk (OAR). Methods Ten patients with nasal cavity or paranasal sinus cancer were re-planned by VMAT (two-arc) plan and non-coplanar IMRT (7-, 11-, and 15-beam) plans. Planning objectives were to deliver 60 Gy in 30 fractions to 95% of PTV, with maximum doses (Dmax) of <50 Gy to the optic nerves, optic chiasm, and brainstem, <40 Gy to the eyes and <10 Gy to the lenses. The target mean dose (Dmean) to the parotid glands was <25 Gy, and no constraints were applied to the lacrimal glands. Planning was optimized to minimized doses to OAR without compromising coverage of the PTV. VMAT and three non-coplanar IMRT (7-, 11-, and 15-beam) plans were compared using the heterogeneity and conformity indices (HI and CI) of the PTV, Dmax and Dmean of the OAR, treatment delivery time, and monitor units (MUs). Results The HI and CI of VMAT plan were superior to those of the 7-, 11-, and 15-beam non-coplanar IMRT. VMAT and non-coplanar IMRT (7-, 11-, and 15-beam) showed equivalent sparing effects for the optic nerves, optic chiasm, brainstem, and parotid glands. For the eyes and lenses, VMAT achieved equivalent or better sparing effects when compared with the non-coplanar IMRT plans. VMAT showed lower MUs and reduced treatment delivery time when compared with non-coplanar IMRT. Conclusions In 10 patients with nasal cavity or paranasal sinus cancer, a VMAT plan provided better homogeneity and conformity for PTV than non-coplanar IMRT plans, with a shorter treatment delivery time, while achieving equal or better OAR-sparing effects and using fewer MUs.
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Lapierre A, Martin F, Lapeyre M. [Intensity-modulated radiation therapy and stereotactic body radiation therapy for head and neck tumors: evidence-based medicine]. Cancer Radiother 2014; 18:468-72. [PMID: 25155467 DOI: 10.1016/j.canrad.2014.06.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2014] [Revised: 06/21/2014] [Accepted: 06/24/2014] [Indexed: 11/20/2022]
Abstract
Over the last decade, there have been many technical advances in radiation therapy, such as the spread of intensity-modulated conformal radiotherapy, and the rise of stereotactic body radiation therapy. By allowing better dose-to-target conformation and thus better organs at risk-sparing, these techniques seem very promising, particularly in the field of head and neck tumors. The present work aims at analyzing the level of evidence and recommendation supporting the use of high-technology radiotherapy in head and neck neoplasms, by reviewing the available literature.
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Affiliation(s)
- A Lapierre
- Service d'oncologie-radiothérapie, centre hospitalier Lyon Sud, 165, chemin du Grand-Revoyet, 69310 Pierre-Bénite, France.
| | - F Martin
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France
| | - M Lapeyre
- Département de radiothérapie, centre Jean-Perrin, 58, rue Montalembert, BP 392, 63011 Clermont-Ferrand cedex 1, France
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