Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Bosch, Sven van den; Dijkema, Tim; Verhoef, Lia C.G.; Zwijnenburg, Ellen M.; Janssens, Geert O.; Kaanders, Johannes H.A.M.

doi:10.1016/j.ijrobp.2015.12.002

Cited by 35 publications

(33 citation statements)

References 23 publications

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“…This is demonstrated in the current analysis by the smaller volume (0.46 cc versus 1.02 cc, p < 0.001) of preexisting lymph nodes on the initial treatment planning CT-scan (at the locations of the CTV elective-nodal recurrences) in patients with FDG-PET/CT-based NTV. In an earlier comprehensive volumetric analysis of 1166 electively irradiated nodes in 264 patients of the current cohort with CT-based NTV, an increased risk of recurrence with increasing nodal volume was demonstrated (compared to nodes < 1.0 cc, HR = 5.4 for nodes 1.0-1.5 cc, and HR = 25.7 for nodes > 1.5 cc) [16]. A summed nodal short-and long-axis diameter was shown to be a good alternative for laborious volume calcu- Fig.…”

Section: Discussionmentioning

confidence: 65%

“…FDG-PET is ideal for guidance of such dose de-escalation since it is a driving force for target volume transformation as FDG-uptake may be considered as a surrogate parameter for tumor cell density [23]. On the basis of nodal size and FDGuptake, a graded dose prescription algorithm could be envisaged [16]. Morphologic pathological nodes and borderline sized nodes (e.g.…”

Section: Discussionmentioning

confidence: 99%

“…Excluded were patients who had had previous oncologic treatment to the head and neck area, or who had no indication for elective neck irradiation. Individual patient data from a previously studied cohort was used and supplemented with patients for whom FDG-PET/CT was available for defining the nodal target volume [16]. A total of 633 patients with a median follow-up of 31 months (Range: 1-119 months) were included.…”

Section: Patient Selectionmentioning

confidence: 99%

See 2 more Smart Citations

18F-FDG-PET/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival

Bosch

Doornaert

Dijkema

et al. 2020

Radiotherapy and Oncology

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Section: Discussionmentioning

confidence: 65%

Section: Discussionmentioning

confidence: 99%

Section: Patient Selectionmentioning

confidence: 99%

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18F-FDG-PET/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival

Bosch

Doornaert

Dijkema

et al. 2020

Radiotherapy and Oncology

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“…The current rate of recurrence in electively irradiated lymph nodes was estimated to be 5% at 2 years after treatment [17]. An equal rate of recurrence is expected in the intervention arm, despite elective dose de-escalation.…”

Section: Methodsmentioning

confidence: 99%

“…These criteria are based on an in-depth risk assessment on recurrence in 1166 electively irradiated nodes in 264 patients. Not overtly pathologic lymph nodes with a summed diameter ≥ 17 mm had an increased risk to recur after elective treatment (Hazard Ratio: 17.8, 95%CI: 5.7–55, p < 0.001) [17]. …”

Section: Methodsmentioning

confidence: 99%

Uniform FDG-PET guided GRAdient Dose prEscription to reduce late Radiation Toxicity (UPGRADE-RT): study protocol for a randomized clinical trial with dose reduction to the elective neck in head and neck squamous cell carcinoma

et al. 2017

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BackgroundIn definitive radiation therapy for head and neck cancer, clinically uninvolved cervical lymph nodes are irradiated with a so-called ‘elective dose’ in order to achieve control of clinically occult metastases. As a consequence of high-resolution diagnostic imaging, occult tumor volume has significantly decreased in the last decades. Since the elective dose is dependent on occult tumor volume, the currently used elective dose may be higher than necessary.Because bilateral irradiation of the neck contributes to dysphagia, xerostomia and hypothyroidism in a dose dependent way, dose de-escalation to these regions can open a window of opportunity to reduce toxicity and improve quality of life after treatment.MethodsUPGRADE-RT is a multicenter, phase III, single-blinded, randomized controlled trial.Patients to be treated with definitive radiation therapy for a newly diagnosed stage T2-4 N0-2 M0 squamous cell carcinoma of the oropharynx, hypopharynx or larynx are eligible. Exclusion criteria are recurrent disease, oncologic surgery to the head and neck area, concomitant chemotherapy or epidermal growth factor receptor inhibitors.In total, 300 patients will be randomized in a 2:1 ratio to a treatment arm with or without de-escalation of the elective radiation dose and introduction of an intermediate dose-level for selected lymph nodes. Radiation therapy planning FDG-PET/CT-scans will be acquired to guide risk assessment of borderline-sized cervical nodes that can be treated with the intermediate dose level.Treatment will be given with intensity-modulated radiation therapy or volumetric arc therapy with simultaneous-integrated boost using an accelerated fractionation schedule, 33 fractions in 5 weeks. The primary endpoint is ‘normalcy of diet’ at 1 year after treatment (toxicity). The secondary endpoint is the actuarial rate of recurrence in electively irradiated lymph nodes at 2 years after treatment (safety).DiscussionThe objective of the UPGRADE-RT trial is to investigate whether de-escalation of elective radiation dose and the introduction of an intermediate dose-level for borderline sized lymph nodes in the treatment of head and neck cancer will result in less radiation sequelae and improved quality of life after treatment without compromising the recurrence rate in the electively treated neck.Trial registrationClinicalTrials.gov Identifier: NCT02442375.

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Contemporary management of the neck in nasopharyngeal carcinoma

Tsang

Beitler

et al. 2021

Head & Neck

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Up to 85% of the patients with nasopharyngeal carcinoma present with regional nodal metastasis. Although excellent nodal control is achieved with radiotherapy, a thorough understanding of the current TNM staging criteria and pattern of nodal spread is essential to optimize target delineation and minimize unnecessary irradiation to adjacent normal tissue. Selective nodal irradiation with sparing of the lower neck and submandibular region according to individual nodal risk is now emerging as the preferred treatment option. There has also been continual refinement in staging classification by incorporating relevant adverse nodal features. As for the uncommon occurrence of recurrent nodal metastasis after radiotherapy, surgery remains the standard of care.

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Patterns of Recurrence in Electively Irradiated Lymph Node Regions After Definitive Accelerated Intensity Modulated Radiation Therapy for Head and Neck Squamous Cell Carcinoma

Cited by 35 publications

References 23 publications

18F-FDG-PET/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival

18F-FDG-PET/CT-based treatment planning for definitive (chemo)radiotherapy in patients with head and neck squamous cell carcinoma improves regional control and survival

Uniform FDG-PET guided GRAdient Dose prEscription to reduce late Radiation Toxicity (UPGRADE-RT): study protocol for a randomized clinical trial with dose reduction to the elective neck in head and neck squamous cell carcinoma

Contemporary management of the neck in nasopharyngeal carcinoma

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