Late term tolerance in head neck cancer patients irradiated in the IMRT era

Abstract

BackgroundThe aim was to quantify severe transient and persisting late term effects in our single institution head neck cancer (HNC) cohort treated with curatively intended intensity modulated radiation therapy (IMRT). Hypothesis was if a 2-year follow up (FU) is sufficient to estimate the long term tolerance in HNC irradiated in the IMRT era.MethodsBetween 01/2002-8/2012, 707/1211 (58%) consecutively treated IMRT patients met the inclusion criteria of a FU time >12 months and loco-regional disease control (LRC). 45% presented with loco-regionally advanced disease; 55% were referred for curative definitive IMRT (66 Gy-72 Gy in 30–35 fractions), 45% underwent postoperative IMRT (60-66 Gy in 30–33 fractions). Systemic concomitant therapy was administered in 85%. Highly consistent treatment procedures were performed with respect to contouring processes, dose constraints, radiation schedules, and the use of systemic therapy. Grade 3/4 late term effects were prospectively assessed and analyzed with respect to subgroups at particular risk for specific late effects.ResultsMean/median FU of the cohort was 41/35 months (15–124). 13% of the patients (92/707) experienced any grade 3/4 late effects (101 events in 92/707 patients), 81% in the first 12 months after radiation. 4% of all developed persisting late grade 3/4 effects (25 events in 25/707 patients).ConclusionsIMRT led to a high late term tolerance in loco-regionally disease free HNC patients. The onset of any G3/4 effects showed a plateau at 2 years. The question of the cervical vessel tolerance in disease free long time survivors is still open and currently under evaluation at our institution.

Prospective longitudinal assessment of parotid gland function using dynamic quantitative pertechnate scintigraphy and estimation of dose–response relationship of parotid-sparing radiotherapy in head-neck cancers

“…This decline in salivary function occurs even after parotid-sparing conformal radiotherapy albeit to a lesser degree (both in terms of incidence and severity) particularly with IMRT [ 19 ] with substantial recovery over time. The use of IMRT in clinical practice has resulted in improved tolerance to treatment [ 24 ] for patients with head-neck cancer and reduced delayed or late effects. Dose–response relationship for major salivary glands has traditionally been based on salivary flow-rate measurements [ 9 - 11 ].…”

Risk profile for osteoradionecrosis of the mandible in the IMRT era

“…Grade 3 ORN was shown to be substantially reduced (to < 1 %) by the use of intensity-modulated radiation therapy (IMRT) techniques [ 3 – 8 ]; grade 1–2 ORN (healing after limited surgery such as debridement, decortication, sequestrectomy, or spontaneously following conservative treatment) was reported to be < 10 % in patients at risk [ 9 ].…”

Less may be more: nodal treatment in neck positive head neck cancer patients

“…Treatment plans were calculated by the Varian Treatment Planning System (Eclipse ® External Beam Planning System, Version 7.3.10 and PRO 8.9, AAA 8.9, Varian Medical Systems). Simultaneously integrated boost (SIB)–IMRT was performed using the following schedules (for more details see former publications [ 9 ])…”