Dosimetric feasibility of sparing the primary site for oropharyngeal squamous cell carcinoma after transoral laser microsurgery in patients with unilateral positive neck nodes

Fried, David; Lehman-Davis, Misty; Willson, Adam K.; Kostich, M.; Hackman, Trevor; Lian, Jun; Burkhardt, Katharin Deschesne; Chera, Bhishamjit S.

doi:10.1016/j.prro.2012.10.001

Cited by 15 publications

(6 citation statements)

References 8 publications

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“…This confirmed similar data already published by different authors that demonstrated that an unintentional relevant dose at the tumor surgical bed was absorbed also in patients for whom the tumor surgical bed was not considered for irradiation. 39–41 Results of the present study strongly support the recommendation to perform an accurate selection of patients eligible for TORS in order to achieve negative surgical margins and to always contour the tumor surgical bed as a separate volume in order to avoid an unnecessarily high radiation dose in that region.…”

Section: Discussionsupporting

confidence: 70%

Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

Alterio

Tagliabue

Muto

et al. 2020

Tumori

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Objective: Postoperative radiotherapy (PORT) is indicated in almost two-thirds of patients treated with transoral robotic surgery (TORS) for head and neck tumors. The aim of this study was to quantify the toxicity profile of patients treated with PORT after TORS in oropharyngeal and supraglottic laryngeal cancer focusing on soft tissue necrosis (STN). Methods: We retrospectively reviewed 28 patients. Acute and late toxicity were examined. Incidence and severity of STN were recorded. Results: No patient experienced acute grade 3 skin or mucosal toxicity; 1 patient had grade 3 dysphagia. At 12 months, no evaluated patient required enteral nutrition and 2 patients had tracheostomy. STN occurred in 4 (14%) patients: 3 out of 4 (75%) patients with STN had diabetes, whereas 6 out of 13 (25%) patients without STN had diabetes ( p = 0.05). Conclusion: We found an acceptable toxicity profile of PORT performed after a TORS procedure. Diabetes mellitus might be a risk factor for STN.

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Section: Discussionsupporting

confidence: 70%

Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

Alterio

Tagliabue

Muto

et al. 2020

Tumori

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“…Fried et al first presented the concept of sparing the primary sites in their pilot study [ 6 ]. Possible dosimetric benefits were discussed for four patients treated with RT after transoral laser microsurgery for OPSCC.…”

Section: Discussionmentioning

confidence: 99%

“…Inspired by recent studies to quantify the dose reduction to the OARs when excluding the primary tumor bed from the target volume, we adopted a comprehensive (Comp) method using the Auto-Planning (AP) technique to evaluate the potential dosimetric benefits of omitting the primary tumor bed from the target volume of the postoperative RT after TORS [ 6 , 7 ].…”

Section: Introductionmentioning

confidence: 99%

Dosimetric Benefits of Omitting Primary Tumor Beds in Postoperative Radiotherapy After Transoral Robotic Surgery Using the Auto-Planning Technique

Cui

Ward

Kittel

et al. 2021

Cureus

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Introduction: It has been suggested that post-transoral robotic surgery (post-TORS) radiotherapy (RT) might reduce the dose to organs at risk (OARs) adjacent to the primary tumor bed; however, the evidence supporting this has yet to be sufficient. This study examined the radiation dose reduction to OARs by omitting the primary tumor bed through the use of an Auto-Planning (AP)-based workflow. Methods: Twelve patients were identified who underwent post-TORS RT to the primary tumor bed and the unilateral/bilateral neck lymph nodes. In each patient, two treatment plans were designed: a Comprehensive (Comp)-plan treating the original planning target volume (PTV) including both the primary tumor bed and the lymph nodes, and a Neck-plan treating only the lymph nodes and omitting the primary tumor bed. Both plans were optimized using AP to ensure plan quality consistency. We compared the doses received by 95% of the primary tumor beds and lymph nodes (D95%) and our institutional dose constraints for the OARs between the Comp- and Neck-plans. Statistical analysis was performed using R Statistical Software (R Foundation for Statistical Computing, Vienna, Austria) with a two-tailed paired Wilcoxon signed-rank test. Results: All plans met target dose coverage requirements with at least 95% of the PTVs covered with the corresponding prescription doses. The primary tumor bed in the Neck-plans was spared with a significantly lower mean D95% (25.9 Gy vs. 60.0 Gy; p < 0.01; Wilcoxon test). The mean dose to the oral cavity (20.9 Gy vs. 28.1 Gy; p < 0.01) and the supraglottis (36.9 Gy vs. 28.2 Gy; p < 0.01) was significantly lower in the Neck-plans. Conclusion: This study suggests that sparing the primary tumor bed during post-TORS RT offers dosimetric benefits to nearby OARs with significant dose reductions to the oral cavity and supraglottis. Further study of the clinical risks and benefits afforded by this strategy is needed.

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“…Of note, while in theory eliminating the primary tumor bed as a target would theoretically lead to a substantial decrease in radiation to normal tissues, dosimetric studies comparing primary plus neck irradiation with neckonly irradiation suggest only a modest potential benefit with this approach [39,40]. This may be due to the fact that the level II lymph nodes, which represent the first echelon nodal drainage for oropharyngeal cancers, and are thus always in the neck radiation volume, sit adjacent to the tonsil and base of tongue.…”

Section: Omitting Adjuvant Radiation To the Primary Tumor Bedmentioning

confidence: 99%

“…There was however a slight benefit in dose to the oral cavity (34.0 Gy vs. 29.8 Gy p = 0.002) and superior pharyngeal constrictors (46.1 Gy vs. 42.9 Gy p = 0.01). A separate study of base of tongue tumors compared radiation plans of patients receiving adjuvant radiation to the bilateral neck and primary tumor to those same patients replanned to receive only bilateral neck radiation and found a decrease in oral cavity dose (47.4 Gy vs. 22.3 Gy) but no significant benefit for contralateral parotid or pharyngeal constrictor muscles [40]. Of note, the primary tumor bed still received a mean dose of 40.2 Gy, which could complicate consideration of future re-irradiation for any patients who may recur.…”

Section: Omitting Adjuvant Radiation To the Primary Tumor Bedmentioning

confidence: 99%

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

Holsinger

Husain

2016

Cancers Head Neck

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Current adjuvant treatment guidelines for oropharyngeal squamous cell carcinoma treated with primary surgery are based on studies that predate the human papillomavirus (HPV) era. HPV-associated oropharynx carcinoma (HPV-OPC) has a much more favorable prognosis compared to HPV-unassociated cancer and is increasingly considered to be a distinct disease entity due to its unique etiology, presentation, and behavior. Currently, there is significant interest in adjuvant treatment de-intensification of HPV-OPC patients in order to reduce treatment-related toxicity while maintaining excellent clinical outcomes. Here, we review the evidence and rationale underlying the ongoing prospective trials of adjuvant treatment de-intensification for HPV-OPC patients.

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Dosimetric feasibility of sparing the primary site for oropharyngeal squamous cell carcinoma after transoral laser microsurgery in patients with unilateral positive neck nodes

Cited by 15 publications

References 8 publications

Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

Soft tissue necrosis in patients treated with transoral robotic surgery and postoperative radiotherapy: preliminary results

Dosimetric Benefits of Omitting Primary Tumor Beds in Postoperative Radiotherapy After Transoral Robotic Surgery Using the Auto-Planning Technique

De-intensification of adjuvant therapy in human papillomavirus-associated oropharyngeal cancer

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