Local recurrences after curative IMRT for HNSCC: Effect of different GTV to high-dose CTV margins

Zukauskaite, Ruta; Hansen, Christian Rønn; Grau, Cai; Samsøe, E.; Johansen, Jørgen; Petersen, J.; Andersen, Elo; Brink, Carsten; Overgaard, Jens; Eriksen, Jesper Grau

doi:10.1016/j.radonc.2017.11.024

Cited by 45 publications

(32 citation statements)

References 46 publications

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“…Changing the TCP model to use the recurrence rates found by another study resulted in the same values for TCP reduction as a function of setup and range uncertainty setting (Fig. S3) [27].…”

Section: Resultsmentioning

confidence: 70%

“…Due to the low number of recurrences in the prophylactic CTV, the TCP model is less sensitive to underdosage of the prophylactic CTV. An additional analysis is performed, also using the TCP model by Luhr et al, but using the recurrence rates of 51.3%, 29.4% and 19.3% for the GTV, the primary CTV and the prophylactic CTV respectively based on the proportion of recurrences reported to occur in these structures after IMRT in three centers from a recent study [27].…”

Section: Discussionmentioning

confidence: 99%

“…The TCP model also depends on the proportion of recurrences occurring in the different sub-volumes. Therefore we redid the analysis with the same TCP model but with the proportions of recurrences found in a recent study, but this change did not impact our results [27]. While the found differences in TCP were small, the model was calibrated with the conservative assumption that the TCP is 50% for a homogeneous dose of 70 Gy RBE to the CTV.…”

Section: Discussionmentioning

confidence: 99%

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Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting

Wagenaar

Kierkels

Schaaf

et al. 2021

Radiotherapy and Oncology

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Objective: To establish optimal robust optimization uncertainty settings for clinical head and neck cancer (HNC) patients undergoing 3D image-guided pencil beam scanning (PBS) proton therapy. Methods: We analyzed ten consecutive HNC patients treated with 70 and 54.25 Gy RBE to the primary and prophylactic clinical target volumes (CTV) respectively using intensity-modulated proton therapy (IMPT). Clinical plans were generated using robust optimization with 5 mm/3% setup/range uncertainties (RayStation v6.1). Additional plans were created for 4, 3, 2 and 1 mm setup and 3% range uncertainty and for 3 mm setup and 3%, 2% and 1% range uncertainty. Systematic and random error distributions were determined for setup and range uncertainties based on our quality assurance program. From these, 25 treatment scenarios were sampled for each plan, each consisting of a systematic setup and range error and daily random setup errors. Fraction doses were calculated on the weekly verification CT closest to the date of treatment as this was considered representative of the daily patient anatomy. Results: Plans with a 2 mm/3% setup/range uncertainty setting adequately covered the primary and prophylactic CTV (V 95 ! 99% in 98.8% and 90.8% of the treatment scenarios respectively). The average organat-risk dose decreased with 1.1 Gy RBE /mm setup uncertainty reduction and 0.5 Gy RBE /1% range uncertainty reduction. Normal tissue complication probabilities decreased by 2.0%/mm setup uncertainty reduction and by 0.9%/1% range uncertainty reduction. Conclusion: The results of this study indicate that margin reduction below 3 mm/3% is possible but requires a larger cohort to substantiate clinical introduction.

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Section: Resultsmentioning

confidence: 70%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting

Wagenaar

Kierkels

Schaaf

et al. 2021

Radiotherapy and Oncology

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“…Pelvic RT combined with brachytherapy plays a critical role in the definitive treatment of patients with cervical cancer. With rapid developments in RT, IMRT has become widely used in treatment of cervical cancer, and it exhibits a dosimetric advantage because it can deliver a high dose of radiation to tumour tissue while restricting dose exposure of adjacent noncancerous tissues [ 15 , 16 ]. However, because of the highly specific dose distribution in IMRT, the tumour target may be missed, especially in cases of cervical cancer.…”

Section: Discussionmentioning

confidence: 99%

Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis

Lin

Chen

et al. 2018

Radiat Oncol

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BackgroundTo compare the efficacies and toxicities of intensity-modulated radiotherapy (IMRT) with three-dimensional conformal radiotherapy (3D-CRT) or conventional two-dimensional radiotherapy (2D-RT) for definitive treatment of cervical cancer.MethodsA meta-analysis was performed using search engines, including PubMed, Cochrane Library, Web of Science, and Elsevier. In the meta-analysis, odds ratios (ORs) were compared for overall survival (OS), disease-free survival (DFS), and acute and chronic toxicities.ResultsIncluded data were analysed using RevMan 5.2 software. Six studies encompassing a total of 1008 patients who received definitive treatment (IMRT = 350, 3-DCRT/2D-RT = 658) were included in the analysis. A comparison of 3-year OS and 3-year DFS revealed no significant differences between IMRT and 3D-CRT or 2D-RT (3-year OS: OR = 2.41, 95% confidence interval [CI]: 0.62–9.39, p = 0.21; 3-year DFS: OR = 1.44, 95% CI: 0.69–3.01, p = 0.33). The incidence of acute gastrointestinal (GI) toxicity and genitourinary (GU) toxicity in patients who received IMRT was significantly lower than that in the control group (GI: Grade 2: OR = 0.5, 95% CI: 0.28–0.89, p = 0.02; Grade 3 or higher: OR = 0.55, 95% CI: 0.32–0.95, p = 0.03; GU: Grade 2: OR = 0.41, 95% CI: 0.2–0.84; p = 0.01; Grade 3 or higher: OR = 0.31, 95% CI: 0.14–0.67, p = 0.003). Moreover, the IMRT patients experienced fewer incidences of chronic GU toxicity than did the control group (Grade 3: OR = 0.09, 95% CI: 0.01–0.67, p = 0.02).ConclusionIMRT and conventional radiotherapy demonstrated equivalent efficacy in terms of 3-year OS and DFS. Additionally, IMRT significantly reduced acute GI and GU toxicities as well as chronic GU toxicity in patients with cervical cancer.

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“…CTV margins have been estimated based on either post hoc evaluation of local recurrences or on examination of the microscopic tumor extent in histopathological specimens [6] , [10] , [11] , [12] , [13] , [14] , [15] , [16] . The literature on the microscopic spread of primary head and neck tumors is sparse [17] , but studies by Campbell et al [10] and Fleury et al [11] demonstrated that microscopic disease was mainly limited within 5 mm of the GTV defined macroscopically on whole-mount sections. For laryngeal and hypopharyngeal squamous cell carcinomas (SCCs) we concluded, in a previous study, that concentric geometric expansion of the GTV with these CTV margins should be 4–7 mm, dependent on the imaging modality used for GTV delineation [12] .…”

Section: Introductionmentioning

confidence: 99%

Verification of HE-based CTV in laryngeal and hypopharyngeal cancer using pan-cytokeratin

Ligtenberg

Willems

Ruiter

et al. 2018

Clinical and Translational Radiation Oncology

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Local recurrences after curative IMRT for HNSCC: Effect of different GTV to high-dose CTV margins

Cited by 45 publications

References 46 publications

Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting

Head and neck IMPT probabilistic dose accumulation: Feasibility of a 2 mm setup uncertainty setting

Intensity-modulated radiation therapy for definitive treatment of cervical cancer: a meta-analysis

Verification of HE-based CTV in laryngeal and hypopharyngeal cancer using pan-cytokeratin

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