Inadequate target volume delineation and local–regional recurrence after intensity-modulated radiotherapy for human papillomavirus-positive oropharynx cancer

Chen, Allen M.; Chin, Robert; Beron, P.J.; Yoshizaki, Taeko; Mikaeilian, Argin G.; Cao, Minsong

doi:10.1016/j.radonc.2017.04.015

Cited by 43 publications

(51 citation statements)

References 32 publications

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“…However, marginal misses are a potential risk of IMRT since the high-dose conformity has limited tolerance for unaccounted uncertainties. Some studies analyzing outcomes after curative treatment of HNSCC state that locoregional recurrences tend to appear in high-dose treatment volumes; however, examples of marginal failures or failures outside high-dose areas has also been observed [2][3][4][5].…”

Section: Introductionmentioning

confidence: 99%

Analysis of CT-verified loco-regional recurrences after definitive IMRT for HNSCC using site of origin estimation methods

et al. 2017

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Section: Introductionmentioning

confidence: 99%

Analysis of CT-verified loco-regional recurrences after definitive IMRT for HNSCC using site of origin estimation methods

et al. 2017

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“…24 Multidisciplinary expertise in high-volume centers can affect outcome, given that TL, PL, and CRT can be operator-dependent and influenced by surgeon and radiation oncologist experience. 27,28 It is important to note that, although concurrent CRT is the dominant form of larynx-preserving nonsurgical approach in the United States, there is controversy regarding the timing of chemotherapy with RT. Surgical expertise and high-quality RT design and delivery (including target-volume delineation and the use of an intensity-modulated RT technique) affect outcomes, and we attempted to mitigate their confounding effects in this analysis by adjusting for treatment facility type in our multivariate analyses.…”

Section: Discussionmentioning

confidence: 99%

“…Surgical expertise and high-quality RT design and delivery (including target-volume delineation and the use of an intensity-modulated RT technique) affect outcomes, and we attempted to mitigate their confounding effects in this analysis by adjusting for treatment facility type in our multivariate analyses. 27,28 It is important to note that, although concurrent CRT is the dominant form of larynx-preserving nonsurgical approach in the United States, there is controversy regarding the timing of chemotherapy with RT. On the basis of RTOG 91-11, 4 local control and larynx-preservation rates were significantly higher with concomitant cisplatin and RT; however, the OS curves do separate after 4 years, favoring induction chemotherapy followed by RT alone.…”

Section: Discussionmentioning

confidence: 99%

Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer

Patel

Qureshi

Dyer

et al. 2019

Cancer

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BACKGROUND:The declining 5-year overall survival (OS) of patients with laryngeal cancer has been associated with increased nonsurgical management of stage III/IV disease. To further assess this hypothesis, the authors evaluated recent OS trends and patterns of use between larynx-preserving approaches with chemoradiation (CRT) or partial laryngectomy (PL) and total laryngectomy (TL) stratified by tumor and nodal burden. METHODS: The National Cancer Data Base was used to identify 8703 patients with stage III/IV (excluding T1 tumors) laryngeal squamous cell carcinoma treated between 2003 and 2011 with CRT or upfront PL or TL with or without adjuvant therapy. OS was analyzed using the Kaplan-Meier method and a Cox proportional hazards model. RESULTS: Among patients with non-T4, low nodal burden (T2N1 or T3N0-N1) disease, no survival differences were observed between CRT, PL, and TL. Patients who had non-T4, high nodal burden (T2-T3N2-N3) disease who underwent TL with or without adjuvant treatment had a higher risk of death compared with those who received CRT (hazard ratio, 1.25; 95% CI, 1.04-1.51; P = .016). For T4N0-N3 tumors, TL compared with CRT was associated with improved OS (hazard ratio, 0.80; 95% CI, 0.62-0.92; P = .002). No statistically significant difference in outcome was noted between CRT and PL for all stage groups. The use of CRT has declined and receipt of TL has increased since 2006 for T4 disease, whereas PL rates have remained stably low. CONCLUSIONS: No survival differences were noted between surgical and nonsurgical approaches for patients with non-T4, low nodal burden laryngeal cancer. Patients with non-T4, high nodal burden disease may benefit from definitive CRT. Total laryngectomy remains advantageous in patients with T4 disease. Cancer 2019;125:3367-3377.

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“…Given that in-field recurrences are still a common pattern-of-failure in HNSCC [62][63][64], further treatment intensification is still needed in some patient populations, with radiation dose escalation serving as one possible paradigm. Response-adapted ART is an attractive avenue for dose escalation, since persistent or refractory disease during treatment may be directly targeted, effectively reducing the volume of disease being boosted.…”

Section: Response-adapted Adaptive Radiotherapy (R-art)mentioning

confidence: 99%

Adaptive radiotherapy for head and neck cancer

2020

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Background: Although there have been dramatic improvements in radiotherapy for head and neck squamous cell carcinoma (HNSCC), including robust intensity modulation and daily image guidance, these advances are not able to account for inherent structural and spatial changes that may occur during treatment. Many sources have reported volume reductions in the primary target, nodal volumes, and parotid glands over treatment, which may result in unintended dosimetric changes affecting the side effect profile and even efficacy of the treatment. Adaptive radiotherapy (ART) is an exciting treatment paradigm that has been developed to directly adjust for these changes. Main body: Adaptive radiotherapy may be divided into two categories: anatomy-adapted (A-ART) and responseadapted ART (R-ART). Anatomy-adapted ART is the process of re-planning patients based on structural and spatial changes occurring over treatment, with the intent of reducing overdosage of sensitive structures such as the parotids, improving dose homogeneity, and preserving coverage of the target. In contrast, response-adapted ART is the process of re-planning patients based on response to treatment, such that the target and/or dose changes as a function of interim imaging during treatment, with the intent of dose escalating persistent disease and/or deescalating surrounding normal tissue. The impact of R-ART on local control and toxicity outcomes is actively being investigated in several currently accruing trials. Conclusions: Anatomy-adapted ART is a promising modality to improve rates of xerostomia and coverage in individuals who experience significant volumetric changes during radiation, while R-ART is currently being studied to assess its utility in either dose escalation of radioresistant disease, or de-intensification of surrounding normal tissue following treatment response. In this paper, we will review the existing literature and recent advances regarding A-ART and R-ART.

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Inadequate target volume delineation and local–regional recurrence after intensity-modulated radiotherapy for human papillomavirus-positive oropharynx cancer

Cited by 43 publications

References 32 publications

Analysis of CT-verified loco-regional recurrences after definitive IMRT for HNSCC using site of origin estimation methods

Analysis of CT-verified loco-regional recurrences after definitive IMRT for HNSCC using site of origin estimation methods

Comparing surgical and nonsurgical larynx‐preserving treatments with total laryngectomy for locally advanced laryngeal cancer

Adaptive radiotherapy for head and neck cancer

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