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Kristensen MH, Holm AIS, Hansen CR, Zukauskaite R, Samsøe E, Maare C, Johansen J, Primdahl H, Bratland Å, Kristensen CA, Andersen M, Overgaard J, Eriksen JG. High-dose loco-regional pattern of failure after primary radiotherapy in p16 positive and negative head and neck squamous cell carcinoma - A DAHANCA 19 study. Clin Transl Radiat Oncol 2024; 46:100772. [PMID: 38596816 PMCID: PMC11002542 DOI: 10.1016/j.ctro.2024.100772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2023] [Revised: 02/28/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024] Open
Abstract
Introduction Patients with failure after primary radiotherapy (RT) for head and neck squamous cell carcinoma (HNSCC) have a poor prognosis. This study investigates pattern of failure after primary curatively intended IMRT in a randomized controlled trial in relation to HPV/p16 status. Material and methods Patients with HNSCC of the oral cavity, oropharynx (OPSCC), hypopharynx or larynx were treated with primary curative IMRT (+/-cisplatin) and concomitant nimorazole between 2007 and 12. Of 608 patients, 151 had loco-regional failure within five years, from whom 130 pairs of scans (planning-CT and diagnostic failure scan) were collected and deformably co-registered. Point of origin-based pattern of failure analysis was conducted, including distance to CTV1 and GTV, and estimated dose coverage of the point of origin. Results Of 130 patients with pairs of scans, 104 (80 %) had at least one local or regional failure site covered by 95 % of prescribed dose and 87 (67 %) of the failures had point of origin within the high-dose CTV (CTV1). Of failures from primary p16 + OPSCC, the majority of both mucosal (84 %) and nodal (61 %) failures were covered by curative doses. For p16- tumors (oral cavity, OPSCC p16neg, hypopharynx and larynx), 75 % of mucosal and 66 % of nodal failures were high-dose failures. Conclusion Radioresistance is the primary cause of failure after RT for HNSCC irrespective of HPV/p16 status. Thus, focus on predictors for the response to RT is warranted to identify patients with higher risk of high-dose failure that might benefit from intensified treatment regimens.
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Affiliation(s)
- Morten Horsholt Kristensen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Anne Ivalu Sander Holm
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Christian Rønn Hansen
- Laboratory of Radiation Physics, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
- Danish Centre for Particle Therapy, Aarhus University Hospital, Palle Juul-Jensens Boulevard 25, 8200 Aarhus N, Denmark
- Department of Clinical Research, University of Southern Denmark, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Ruta Zukauskaite
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Eva Samsøe
- Department of Oncology, Zealand University Hospital, Rådmandsengen 5, 4700 Næstved, Denmark
| | - Christian Maare
- Department of Oncology, Copenhagen University Hospital – Herlev, Borgmester Ib Juuls Vej 1, 2730 Herlev, Denmark
| | - Jørgen Johansen
- Department of Oncology, Odense University Hospital, Sdr. Boulevard 29, 5000 Odense C, Denmark
| | - Hanne Primdahl
- Department of Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Åse Bratland
- Department of Oncology, Oslo University Hospital, Ullernchausseen 70, 0372 Oslo, Norway
| | - Claus Andrup Kristensen
- Department of Oncology, Copenhagen University Hospital – Rigshospitalet, Blegdamsvej 9, 2100 Copenhagen, Denmark
| | - Maria Andersen
- Department of Oncology, Aalborg University Hospital, Hobrovej 18, 9000 Aalborg, Denmark
| | - Jens Overgaard
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
| | - Jesper Grau Eriksen
- Department of Experimental Clinical Oncology, Aarhus University Hospital, Palle Juul-Jensens Boulevard 99, 8200 Aarhus N, Denmark
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Poirier VJ, Koh ESY, Darko J, Fleck A, Pinard C, Vail DM. Patterns of local residual disease and local failure after intensity modulated/image guided radiation therapy for sinonasal tumors in dogs. J Vet Intern Med 2021; 35:1062-1072. [PMID: 33660342 PMCID: PMC7995431 DOI: 10.1111/jvim.16076] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Revised: 02/03/2021] [Accepted: 02/04/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Most dogs with sinonasal tumors (SNT) treated with radiation therapy (RT) died because of local disease progression. HYPOTHESIS/OBJECTIVES Our hypothesis is that the majority of local failure and residual disease would occur within the radiation field. ANIMALS Twenty-two dogs with SNT treated with RT. METHODS Retrospective cohort study. INCLUSION CRITERIA dogs with SNT receiving 10 daily fractions of 4.2 Gy with intensity modulated radiation therapy (IMRT)/image guided radiation therapy (IGRT) and follow-up cone beam computed tomography (CBCT). Each CBCT was registered with the original radiation planning CT and the gross tumor volume (GTV) contoured. The GTV was classified as residual (GTVr) or a failure (GTVf). The dose statistic for each GTV was calculated with the original IMRT plan. For GTVf, failures were classified as "in-field," "marginal," or "out-field" if at least 95, 20-95, or less than 20% of the volume of failure was within 95% (D95) of the total prescription dose, respectively. RESULTS There were 52 follow-up CBCT/CTs. Overall there was a GTVr for 20 dogs and GTVf for 16 dogs. The majority of GTVr volume was within the original GTV. GTVf analysis showed that 75% (12/16) were "in-field," 19% (3/16) were "marginal" and 6% (1/16) were "out-field." CONCLUSION AND CLINICAL IMPORTANCE In-field failures are the main pattern for local recurrence, and there is evidence of radioresistant subvolumes within the GTV.
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Affiliation(s)
- Valerie J Poirier
- School of Veterinary Science, Massey University, Palmerston North, New Zealand.,Department of clinical studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - Ethel S Y Koh
- School of Veterinary Science, Massey University, Palmerston North, New Zealand
| | - Johnson Darko
- Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
| | - Andre Fleck
- Department of Medical Physics, Grand River Regional Cancer Centre, Kitchener, Ontario, Canada
| | - Christopher Pinard
- Department of clinical studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
| | - David M Vail
- School of Veterinary Medicine, University of Wisconsin-Madison, Madison, Wisconsin, USA
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