Locoregional Failure Analysis in Head-and-Neck Cancer Patients Treated with IMRT

Abstract

Purpose: Analysis of locoregional failure in head-and-neck cancer (HNC) following intensity-modulated radiation therapy (IMRT), with focus on the location of locoregional failures in relation to the chosen planning target volumes (PTVs) and dose distributions. Patients and Methods: Between January 2002 and May 2006, 280 HNC patients were subjected to IMRT at the authors' institution. Mean follow-up was 23.2 months (3-59.3 months). Definitive IMRT was performed in 75% of all patients. In 71%, simultaneous cisplatin-based chemotherapy was given. 70% of patients presented with T3/4, T1-2 N2c/3 or recurred disease. Locoregional failure patterns were analyzed. Results: 2-year local, nodal, distant, disease-free, and overall survival rates were 80%, 87%, 87%, 73%, and 82%, respectively. 46 local (16%) and 31 nodal (11%) failures have been observed so far. Local tumor persistence was seen in 23/46 cases (50%), and nodal persistence in 12/31 (39%), respectively. One marginal local failure developed in a patient referred for a recurred oral cavity tumor. Three nodal failures developed outside the PTVs at unexpected locations. All other failures have been confirmed "in field". No failure occurred in level Ib or upper level II. Local failure occurred mainly following definitive IMRT for large tumors, nodal failure only in nodally positive patients with nodal high-risk features. Conclusion:The dose-volume concept as used here has shown to be adequate, with disease failure developing at the site of the initial gross tumor manifestation inside the boost volume.

Surgery with Complete Resection Improves Survival in Radiooncologically Treated Patients with Cervical Lymph Node Metastases from Cancer of Unknown Primary

“…Long-term toxicities found by the same authors and others were xerostomia in 63%, subcutaneous or muscular fibrosis in 39% or trismus in 4% of individuals [15,21,29,30]. Today's treatment might lead to a reduction of radia- [19,20,30]. In our study, these complications were not as common: acute grade 3 or 4 mucous membrane or skin toxicities presented in 11% and 33% (grade 4 mucositis in 7%) of the cases, respectively.…”

“…Grade 3 mucositis in 48% or grade 4 dermatitis in 5% as well as grade 4 mucositis in 7% of all patients were described as acute toxicities by Strojan & Anicin [29]. Long-term toxicities found by the same authors and others were xerostomia in 63%, subcutaneous or muscular fibrosis in 39% or trismus in 4% of individuals [15,21,29,30]. Today's treatment might lead to a reduction of radia- [19,20,30].…”

Prediction of Distant Metastasis in Head Neck Cancer Patients: Implications for Induction Chemotherapy and Pre-treatment Staging?

“…When compared with the combined treatment arm of two prospective randomized trials from the near past with conventional irradiation (non IMRT), our IMRT cohort [26] showed an improvement of 3-year local-regional and overall survival rates of ~ 20% each (~ 70 vs. ~ 50%, and ~ 80 vs. ~ 60% [3, 14] respectively). This tendency results in a long term survivor population, for which distant metastasis (DM) may become more meaningful [30].…”

Methods for estimating the site of origin of locoregional recurrence in head and neck squamous cell carcinoma

“…One approach has been to determine the site of recurrence origin directly on the treatment planning scan [9]. Other studies have transferred the delineated recurrence volume by coregistration or expert opinion to the treatment planning scan and ascribed the recurrence to the highest isodose level encompassing either 50% or 95% of the recurrence volume [6,13,17,18,19]. The volume overlap method has some inherent weaknesses, especially when the purpose is to analyze the relation of the recurrence to small regions, and we recently published a pilot study introducing the concept of a focal method in order to analyze the pattern of failure with a spatial resolution matching the achievable dose modulation in dose-painted radiotherapy [5].…”