IMRT in Hypopharyngeal Tumors

Studer, Gabriela; Lütolf, Urs M.; Davis, J.B.; Glanzmann, Christoph

doi:10.1007/s00066-006-1556-2

Cited by 40 publications

(34 citation statements)

References 24 publications

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“…They describe low rates of grade 2 or higher xerostomia (1/26 evaluable patients at 1 year), 6 patients with grade 3 dysphagia at 1 year, and 6 patients with long-term gastrostomy tube dependence. Studer et al 13 described a series of 29 patients with SCC of the hypopharynx treated with IMRT, with 3 grade 3/4 late toxicities, including 2 patients with severe posttreatment dysphagia and 1 patient with posttreatment laryngeal fibrosis.…”

Section: Discussionmentioning

confidence: 98%

“…[4][5][6][7][8][9][10] Scant clinical data exist, however, that evaluate the efficacy of IMRT for tumors located in the hypopharyngeal and laryngeal regions. Several small single-institution series with relatively short follow-up suggest good disease outcomes compared with historical published series, [11][12][13] with less toxicity than that observed with conventional techniques. The purpose of the current study was to build on the existing data for hypopharyngeal and laryngeal SCC treated with IMRT, with a focus on acute toxicity and disease outcomes.…”

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confidence: 90%

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Intensity‐modulated radiotherapy for locally advanced cancers of the larynx and hypopharynx

Daly

Jain

et al. 2011

Head & Neck

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Section: Discussionmentioning

confidence: 98%

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confidence: 90%

Intensity‐modulated radiotherapy for locally advanced cancers of the larynx and hypopharynx

Daly

Jain

et al. 2011

Head & Neck

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“…The site of the primary may influence the rate of DM, with reported ~ 75-80% 2-3y DM-free survival rates in localregionally advanced nasopharyngeal [16,18,21,29], sinonasal [9,13,22], hypopharyngeal [27] and laryngeal tumors [5], ~ 85-95% in oropharyngeal tumors [4,7,15], and ~ 90-95% in oral cavity cancer (OCC) [3][4][5][6]10], respectively. For local-regionally advanced hypopharyngeal tumors, 3y-DM free survival rates of as low as 30% are reported [8,17].…”

Section: Discussionmentioning

confidence: 99%

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

2008

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Background and Purpose: Intensity modulated radiation therapy (IMRT) combined treatment approaches, surgical and radiodiagnostic advances, respectively, lead to improved local-regional control in head neck cancer (HNC). With increasing local-regional control, distant metastases (DM) become more meaningful. In some trials without concomitant chemotherapy, induction chemotherapy (IC) resulted in an absolute reduction of DM by ~10-15%. In order to define a more efficient selection of patients at risk for DM with respect to IC and M-staging, we analysed our patients treated by contemporary standards. Patients and Methods: Between 1/2002 to 12/2007, 409 HNC patients were treated with IMRT; 303/409 (74%) underwent definitive, 106 (26%) postoperative IMRT. The mean/median follow-up was 23/20 months (3-72). 70% tolerated 4-7, 9% 1-3 cycles of simultaneous cisplatin. Treatment followed a prospectively designed protocol. In a previous study with 172 HNC IMRT patients, gross tumor volume (GTV) was found the strongest predictor for local-regional control. In the current study, this criterion has been prospectively tested for DM. Numbers needed to treat were calculated for IC. Results: DM developed in 28/399 (7%) patients; 10 presented initially with DM (total 38/409). In 13/28 (46%), DM remained the only manifestation of disease. GTV was the strongest predictor for DM (p < 0.0001) of all tested. Only 4% of patients with GTV < 70 cc developed DM, vs. 25% (18/73) with > 70 cc; only 6 of them (6/73, 8%) developed isolated DM. Conclusion: GTV was the most significant predictor for DM, that could guide selective pre-treatment M-staging. The subgroup with isolated DM in the high risk group, that could benefit from IC, is small. (Table 1). Die Therapie folgte einem prospektiv festgelegten Protokoll. In einer früheren Studie mit 172 KHTPatienten mit definitiver IMRT wurde das "gross tumor volume" (GTV) als signifikantester Prädiktor für die Lokoregionalkontrolle nachgewiesen. In der hier präsentierten Studie wurde dasselbe volumetrische Staging-System getestet hinsichtlich dessen prä-diktiven Wert für DM, um eine allfällige IC wie auch die initiale Metastasensuche selektiver auf ein Hochrisikopatientensegment beschränken zu können. Ergebnisse: DM fanden sich bei 38/409 Patienten bzw. bei 28/399 mit initialem M0-Status (7%) (Abbildung 1, Tabelle 2); 10 Patienten hatten initial bereits DM. Bei nur 13/28 (46%) blieben DM die einzige Krankheitsmanifestation. Das GTV erwies sich als signifikantester aller getesteter Metastasenprädiktoren (p < 0,0001, Abbildung 2, Tabelle 3); nur 4% der Patienten mit einem GTV < 70 cc entwickelten DM, vs. 25% (18/73) mit GTV > 70 cc, von diesen nur 6 mit isolierter DM (6/73, 8%). IntroductionClinical implementation of intensity modulated radiation therapy (IMRT), together with combined treatment approaches in definitive and postoperative treatment settings, surgical and radio-diagnostic advances, respectively, lead to an encouraging improvement of the loco-regional control in head and neck cancer (HNC)...

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“…To date, there is no generally accepted standard fractionation or technique, and for several HNC subsites like hypopharynx, larynx, or oral cavity, IMRT reports are still scant [25] or missing. Encouraging results have been reached at several IMRT centers, by/despite using different IMRT fractionation schedules and technical solutions like dose painting, serial dose application, pure IMRT, or IMRT combined with conventional three-dimensional conformal radiation therapy (3D-CRT).…”

Section: Introductionmentioning

confidence: 99%

Locoregional Failure Analysis in Head-and-Neck Cancer Patients Treated with IMRT

2007

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Purpose: Analysis of locoregional failure in head-and-neck cancer (HNC) following intensity-modulated radiation therapy (IMRT), with focus on the location of locoregional failures in relation to the chosen planning target volumes (PTVs) and dose distributions. Patients and Methods: Between January 2002 and May 2006, 280 HNC patients were subjected to IMRT at the authors' institution. Mean follow-up was 23.2 months (3-59.3 months). Definitive IMRT was performed in 75% of all patients. In 71%, simultaneous cisplatin-based chemotherapy was given. 70% of patients presented with T3/4, T1-2 N2c/3 or recurred disease. Locoregional failure patterns were analyzed. Results: 2-year local, nodal, distant, disease-free, and overall survival rates were 80%, 87%, 87%, 73%, and 82%, respectively. 46 local (16%) and 31 nodal (11%) failures have been observed so far. Local tumor persistence was seen in 23/46 cases (50%), and nodal persistence in 12/31 (39%), respectively. One marginal local failure developed in a patient referred for a recurred oral cavity tumor. Three nodal failures developed outside the PTVs at unexpected locations. All other failures have been confirmed "in field". No failure occurred in level Ib or upper level II. Local failure occurred mainly following definitive IMRT for large tumors, nodal failure only in nodally positive patients with nodal high-risk features. Conclusion:The dose-volume concept as used here has shown to be adequate, with disease failure developing at the site of the initial gross tumor manifestation inside the boost volume.

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IMRT in Hypopharyngeal Tumors

Cited by 40 publications

References 24 publications

Intensity‐modulated radiotherapy for locally advanced cancers of the larynx and hypopharynx

Intensity‐modulated radiotherapy for locally advanced cancers of the larynx and hypopharynx

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

Locoregional Failure Analysis in Head-and-Neck Cancer Patients Treated with IMRT

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