Initial Data Pooling for Radiation Dose-Volume Tolerance for Carotid Artery Blowout and Other Bleeding Events in Hypofractionated Head and Neck Retreatments

Grimm, Jimm; Vargo, John A.; Mavroidis, Panayiotis; Moiseenko, Vitali; Emami, Bahman; Jain, Siddhant; Caudell, Jimmy J.; Clump, D.A.; Ling, Diane C.; Das, Shiva K.; Moros, Eduardo G.; Vinogradskiy, Yevgeniy; Xue, Jiangyu; Heron, Dwight E.

doi:10.1016/j.ijrobp.2020.12.037

Cited by 19 publications

(17 citation statements)

References 66 publications

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“…Currently, there exists some normal tissue complication probability (NTCP) data to guide radiation dose constraints for SBRT reirradiation for CBOS and laryngeal toxicity, but more organ-specific data is needed. [44][45][46][47] As additional NTCP studies are published and radiation planning techniques advance, these rates may improve. All patients, and in particular those with a mucosal recurrence and/or receiving concurrent systemic therapy, should be counseled on the side effects that can occur with SBRT reirradiation, including feeding tube requirement, lingual artery bleed, CBOS, mucosal ulceration, and osteoradionecrosis.…”

Section: Discussionmentioning

confidence: 99%

“…The use of concurrent systemic therapy was a significant modifier of toxicity, with a rate of grade 3+ toxicity of 20% among those receiving concurrent systemic therapy and only 5% among those who did not. Currently, there exists some normal tissue complication probability (NTCP) data to guide radiation dose constraints for SBRT reirradiation for CBOS and laryngeal toxicity, but more organ‐specific data is needed 44–47 . As additional NTCP studies are published and radiation planning techniques advance, these rates may improve.…”

Section: Discussionmentioning

confidence: 99%

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Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single‐institution, modern cohort study

et al. 2021

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Background Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses. Methods We reviewed patients who received definitive‐intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed. Results One hundred and thirty‐seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1‐year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02). Conclusions In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single‐institution, modern cohort study

et al. 2021

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“…Second, variables other than the prescribed dose, meticulous dosimetric factors for tumor control and organs at risk (V46 Gy, etc.) [ 32 , 33 ], and non-dosimetric factors (performance status, underlying comorbidity, large vessel invasion, preexisting symptoms, surgery (transurethral resection of the prostate), and fractionation, including daily versus every other day irradiation) were not considered [ 23 , 33 ]. Third, retrospective databases may not record toxicity and tumor control outcomes and may thus have ambiguous data owing to the heterogeneous follow-up periods.…”

Section: Discussionmentioning

confidence: 99%

Reirradiation for Nasal Cavity or Paranasal Sinus Tumor—A Multi-Institutional Study

Yamazaki

Suzuki

Aibe

et al. 2021

Cancers

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We evaluated the efficacy and toxicity of reirradiation of nasal cavity or paranasal sinus tumors. We collected and analyzed multi-institutional data of reirradiation cases. Seventy-eight patients with nasal or paranasal sinus tumors underwent reirradiation. The median survival time was 20 months with a medial follow-up of 10.7 months. The 2-year local control and overall survival rates were 43% and 44%, respectively. Tumor volume (≤25 cm3), duration between previous radiotherapy and reirradiation (≤12 months), histology (squamous cell carcinoma), male sex, and lymph node involvement were predisposing factors for poor survival. Distant metastasis was observed in 20 patients (25.6%). Grade ≥ 3 adverse events were observed in 22% of the patients, including five grade 4 (8.6%) cases and one grade 5 (1.2%) case. Tumor location adjacent to the optic pathway was a significant predisposing factor for grade ≥3 visual toxicity. Reirradiation of nasal and paranasal sinus tumors is feasible and effective. However, adverse events, including disease-related toxicities, were significant. Prognostic factors emerge from this study to guide multidisciplinary approaches and clinical trial designs.

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“…Other factors, such as proximity of normal tissue organs, and the patient's general condition and tolerability/comorbidity were also considered. Since all the patients received prior radiation therapy, special attention was paid to further optimize the dose distributions with higher priority by sparing the dose to adjacent critical organs including the spinal cord as much as possible (assuming that all previously treated patients received maximal dose of 45 Gy to the spinal cord) and following the head and re‐treatment SRT protocols 20,21 . Heterogenous target doses were allowed, and the hotspot in the center of the GTV were encouraged to increase the mean dose to GTV.…”

Section: Methodsmentioning

confidence: 99%

“…14 For HyperArc VMAT SRT planning, the goal was to maintain highly conformal dose distribution to the recurrent target and minimize dose to adjacent critical organs as much as possible, including the spinal cord. 20,21…”

Section: Patient's Hyperarc Vmat Plansmentioning

confidence: 99%

HyperArc VMAT stereotactic radiotherapy for locally recurrent previously‐irradiated head and neck cancers: Plan quality, treatment delivery accuracy, and efficiency

Pokhrel

Bernard

Johnson

et al. 2022

J Applied Clin Med Phys

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This paper demonstrates the clinical feasibility and efficacy of Hyper-Arc VMAT treatments for locally recurrent, locally advanced, or previously irradiated head and neck cancers treated with stereotactic radiotherapy (SRT). Materials/Methods: First, an anthropomorphic SRS head phantom from the MD Anderson's IROC credentialing laboratory containing a 1.9 cm diameter spherical target, including in vivo dosimetry system, was imaged, planned, and irradiated (25 Gy in 1 fraction) using HyperArc VMAT with a 6 MV flattening filter free (FFF) beam. Second, RANDO phantom was imaged, planned, and irradiated (35 Gy in 5 fractions) by generating eight HyperArc VMAT plans (4 right, 4 left neck tumors) at different anatomical locations (C1-C4). Average tumor volume was 21.7 cm 3 up to 32.3 cm 3 . Distance to isocenter from the central marker of the Encompass device down to neck was 25.8 cm up to 28.0 cm and 24.3 cm up to 27.1 cm for left-and right-sided neck tumors, respectively, and 9 cm from both lateral markers defined by the patient protection zone. Third, seven recurrent head and neck cancer patients with 80.3 cm 3 tumors on average, and up to 159 cm 3 , were imaged, planned, and treated with 30-40 Gy in 5 fractions with HyperArc SRT. Plan quality, treatment delivery accuracy, and efficiency are reported herein. Results: Phantom irradiation results met all the compliance requirements set forth by the IROC for HyperArc SRS treatment. For end-to-end RANDO phantom tests, a highly conformal target dose distribution with 50% isodose fall-off within 5 mm from the surface of the target was obtained. Average beam modulation factor, beam-on-time, and overall treatment time were 2.9, 2.56 min, and 13.96 min with 99.1% pre-treatment quality assurance pass rate for the 2%/2 mm gamma criteria, respectively. Immediately adjacent critical structures, such as the spinal cord (maximum, 3.9 Gy and 0.35 cm 3 of cord, 3.7 Gy) and skin (maximum, 10.3 Gy and 10 cm 3 of skin, 5.7 Gy), were spared. Similar results were found on the patient's HyperArc VMAT plans including highly conformal target coverage, sharp dose fall-off, and low doses to the adjacent critical organs such as the spinal cord (< 5 Gy). Average perfect pitch couch correction was <1.5 mm and 2 • in each direction. Average beam-on-time was approximately 3.21 min and treatments were completed within 15 min.

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Initial Data Pooling for Radiation Dose-Volume Tolerance for Carotid Artery Blowout and Other Bleeding Events in Hypofractionated Head and Neck Retreatments

Cited by 19 publications

References 66 publications

Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single‐institution, modern cohort study

Stereotactic body ablative radiotherapy for reirradiation of small volume head and neck cancers is associated with prolonged survival: Large, single‐institution, modern cohort study

Reirradiation for Nasal Cavity or Paranasal Sinus Tumor—A Multi-Institutional Study

HyperArc VMAT stereotactic radiotherapy for locally recurrent previously‐irradiated head and neck cancers: Plan quality, treatment delivery accuracy, and efficiency

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