Intensity-Modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy

Klem, M. L.; Mechalakos, James; Wolden, Suzanne L.; Zeléfsky, Michael J.; Singh, Bhuvanesh; Kraus, Dennis H.; Shaha, Ashok R.; Shah, Jatin P.; Pfister, David G.; Lee, Nancy Y.

doi:10.1016/j.ijrobp.2007.07.2351

Cited by 72 publications

(50 citation statements)

References 28 publications

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“…Our results are clearly inferior to those reported by several American groups [35][36][37][38][39][40][41][42] but are in line with those reported from institutions in Europe [43][44][45]. The causes of these differences are merely speculative, but most likely they are both patient and tumour related.…”

Section: Discussioncontrasting

confidence: 64%

Intensity-modulated radiotherapy in patients with head and neck cancer: a European single-centre experience

Gestel¹,

Weyngaert²,

Schrijvers³

et al. 2011

BJR

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Methods: Patients with early and locoregionally advanced HNC were treated with inverse-planned step-and-shoot IMRT. The prescribed dose varied from 66 Gy to 70 Gy in those receiving IMRT as definitive treatment and from 60 Gy to 70 Gy in the postoperative setting. IMRT was given alone, after induction chemotherapy (ICT), with concomitant chemotherapy (CRT) or with both. Acute and late toxicities are reported; locoregional control (LRC), locoregional relapse-free survival (LRRFS) and overall survival (OS) were calculated from the start of radiation. Results: IMRT was used in 78 patients (48 as definitive treatment, 30 post-operatively), of whom 20 also received ICT and 35 CRT. Three patients stopped IMRT early, one for toxicity (mucosa). Acute toxicity scoring revealed 5 cases (6%) of severe skin toxicity and 65 cases (83%) of severe mucosal toxicity. After a median follow-up of 18.7 months, late toxicities included xerostomia (44%), loss of taste (14%) and fibrosis of the neck (9%). 16 patients had died, of whom 10 due to tumour recurrence/progression and 2 due to treatment (but not IMRT related). The LRC, LRRFS and OS at 3 years are 66.1%, 48.5% and 60.3% in the definitive IMRT group and 85.4%, 82.5% and 85.9% in the postoperative setting, respectively. Conclusion: We consider IMRT for locoregional HNC feasible not only as a single modality but also after surgery, after induction chemotherapy and concurrently with chemotherapy.

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Section: Discussioncontrasting

confidence: 64%

Intensity-modulated radiotherapy in patients with head and neck cancer: a European single-centre experience

Gestel¹,

Weyngaert²,

Schrijvers³

et al. 2011

BJR

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“…The optimal method of radiotherapy for NUP had been controversial for a long time, as it is difficult to conduct randomized or prospective studies of this rare disease (18). Some case studies have revealed therapeutic outcomes of NUP treated by radiotherapy combined with surgery and/or chemotherapy, which are summarized in Table 5 (3,6,9,11,16,17,(19)(20)(21). Prognostic factors for survival are reported to be nodal stages, number of positive nodes, neck dissection, histopathological grading and ECE (3)(4)(5)7,9,19,20,22,23).…”

Section: Discussionmentioning

confidence: 99%

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Yamazaki

Kodaira

Ota

et al. 2017

Japanese Journal of Clinical Oncology

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Objective: To investigate the optimal treatment method and risk factor of neck node metastasis from unknown primary tumors (NUP) treated by radiotherapy. Methods: Retrospective case study based on a multi-institutional survey was conducted by the Japanese Radiation Oncology Study Group. Patients pathologically diagnosed as having NUP from 1998 to 2007 were identified. Univariate and multivariate analyses of overall survival (OS), progression free survival (PFS), neck progression free survival (NPFS) and mucosal progression free survival (MPFS) were evaluated. Results: In total, 130 patients with median age of 65 years were included. Nodal stages N1, N2a, N2b and N2c were observed for 10, 26, 43, 12 and 39 patients, respectively. All the patients received radiotherapy (RT) with neck dissection in 60 and with chemotherapy in 67 cases. The median doses to the metastatic nodes, prophylactic neck and prophylactic mucosal sites were 60.0, 50.4 and 50.4 Gy, respectively. The median follow-up period for surviving patients was 42 months. Among 12 patients, occult primary tumors in the neck region developed after radiotherapy. The 5-year OS, PFS, NPFS and MPFS were 58.1%, 42.4%, 47.3% and 54.9%, respectively. Univariate analysis showed that lower N stage (N1-2b), non-bulky node (<6 cm) and negative extracapsular extension (ECE) status were the factors associated with favorable OS, PFS, NPFS and MPFS. Radical surgery proved to be a favorable factor of OS, NPFS and MPFS. On multivariate analysis, lower N stage and negative ECE status were correlated with improved survival.

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“…The dose to the contralateral parotid gland was less than 26 Gy and the dose to other OARs was within tolerance [63]. Three centres have reported their experience of using IMRT to deliver TMI for SCCUP [64][65][66]. The 2-year locoregional control and overall survival were 85-88% and 74-85%, respectively.…”

Section: Squamous Cell Carcinoma With Unknown Primarymentioning

confidence: 99%

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

Bhide

Newbold²,

Harrington³

et al. 2012

BJR

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ABSTRACT. Radiotherapy and surgery are the principal curative modalities in treatment of head and neck cancer. Conventional two-dimensional and three-dimensional conformal radiotherapy result in significant side effects and altered quality of life. Intensity-modulated radiotherapy (IMRT) can spare the normal tissues, while delivering a curative dose to the tumour-bearing tissues. This article reviews the current role of IMRT in head and neck cancer from the point of view of normal tissue sparing, and also reviews the current published literature by individual head and neck cancer subsites. In addition, we briefly discuss the role of image guidance in head and neck IMRT, and future directions in this area. Intensity-modulated radiotherapy (IMRT) is an advanced approach to three-dimensional (3D) treatment planning and conformal therapy. It optimises the delivery of irradiation to irregularly shaped volumes and has the ability to produce concavities in radiation treatment volumes. For head and neck cancer, the clinical target volume 1 (CTV1), which includes the primary tumour and the involved nodes, typically receives a higher radiation dose than CTV2. The different doses to CTV1 and 2 can be delivered simultaneously, while sparing the parotid salivary glands and the spinal cord. In the head and neck region, IMRT has a number of potential advantages: (i) it allows for greater sparing of normal structures such as salivary glands, oesophagus, optic nerves, brain stem and spinal cord [7,8]; (ii) it allows treatment to be delivered in a single treatment phase without the requirement for matching additional fields to provide tumour boosts, and eliminates the need for electron fields to the posterior (levels II and V) neck nodes; and (iii) it offers the possibility of simultaneously delivering higher radiation doses to regions of gross disease and lower doses to areas of microscopic disease-the so-called simultaneous integrated boost (SIB) IMRT [9].IMRT can be delivered using linear accelerators with static multileaf collimators (MLCs; step and shoot IMRT) or dynamic leaf MLCs, tomotherapy machines or volumetric modulated arc therapy (VMAT). Tomotherapy enables the simultaneous use of image guidance and treatment delivery [10]. However, adaptive RT based on image guidance is yet to be clinically optimised in head and neck cancer. VMAT is a newer technique of delivering IMRT. VMAT delivers IMRT-like distributions in a single rotation of the gantry, varying the gantry speed and dose rate during delivery, in contrast to standard IMRT, which uses fixed gantry beams. Planning studies using RT demonstrate shorter planning and treatment time, fewer monitor units for treatment delivery and better dose homogeneity and normal tissue sparing [11,12]. There is a lack of data as regards clinical implementation of this technique.IMRT was first described in 1999; in the last decade numerous retrospective case series (single and multiinstitution) and a few randomised trials have been published studying the clinical implementation of thi...

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Intensity-Modulated Radiotherapy for Head and Neck Cancer of Unknown Primary: Toxicity and Preliminary Efficacy

Cited by 72 publications

References 28 publications

Intensity-modulated radiotherapy in patients with head and neck cancer: a European single-centre experience

Intensity-modulated radiotherapy in patients with head and neck cancer: a European single-centre experience

Retrospective analysis of definitive radiotherapy for neck node metastasis from unknown primary tumor: Japanese Radiation Oncology Study Group study

Clinical evaluation of intensity-modulated radiotherapy for head and neck cancers

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