Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer

Abstract

PurposeIntensity-modulated radiotherapy (IMRT) and volumetric modulated arc therapy (VMAT), two advanced modes of high-precision radiotherapy (RT), have become standard of care in the treatment of head and neck cancer. The development in RT techniques has markedly increased the complexity of target volume definition and accurate treatment delivery. The aim of this study was to indirectly investigate the quality of current TV delineation and RT delivery by analyzing the patterns of treatment failure for head and neck cancer patients in our high-volume RT center.MethodsBetween 2004 and 2014, 385 patients with pharyngeal, laryngeal, and oral cavity tumors were curatively treated with primary RT (IMRT/VMAT). We retrospectively investigated locoregional recurrences (LRR), distant metastases (DM), and overall survival (OS).ResultsMedian follow-up was 6.4 years (IQR 4.7–8.3 years) during which time 122 patients (31.7%) developed LRR (22.1%) and DM (17.7%). The estimated 2- and 5-year locoregional control was 78.2% (95% CI 73.3, 82.3) and 74.2% (95% CI 69.0, 78.8). One patient developed a local recurrence outside the high-dose volume and five patients developed a regional recurrence outside the high-dose volume. Four patients (1.0%) suffered a recurrence in the electively irradiated neck and two patients had a recurrence outside the electively irradiated neck. No marginal failures were observed. The estimated 2- and 5-year DM-free survival rates were 83.3% (95% CI 78.9, 86.9) and 80.0% (95% CI 75.2, 84.0). The estimated 2- and 5-year OS rates were 73.6% (95% CI 68.9, 77.8) and 52. 6% (95% CI 47.3, 57.6). Median OS was 5.5 years (95% CI 4.5, 6.7).ConclusionTarget volume definition and treatment delivery were performed accurately, as only few recurrences occurred outside the high-dose regions and no marginal failures were observed. Research on dose intensification and identification of high-risk subvolumes might decrease the risk of locoregional relapses. The results of this study may serve as reference data for comparison with future studies, such as dose escalation or proton therapy trials.

Comparison of Volumetric Modulated Arc Therapy (VMAT) and Conventional Intensity-Modulated Radiotherapy (IMRT) for Locally Advanced Head and Neck Squamous Cell Carcinoma: A Retrospective Cohort Study

“…However, to date, few studies have focused on locally advanced HNSCC, which are associated with poorer outcomes. Nevertheless, in our analysis, the three-year LC and OS were 80% and 70%, and the five-year LC and OS were 79.5% and 56.7%, respectively, which is consistent with the values reported in the literature for IMRT treatment of locally advanced HNSCC [20][21][22][23].…”

Benefits of automated gross tumor volume segmentation in head and neck cancer using multi-modality information

“…Furthermore, provided ground truths were not correlated with tumor recurrences. However, before the start of this study, loco-regional recurrences in our center were retrospectively investigated and no marginal failures were observed suggesting accurate GTV delineation [30]. Since our training set was restricted to OPC, the generalizability of the developed networks is limited.…”

Proton Therapy for Squamous Cell Carcinoma of the Head and Neck: Early Clinical Experience and Current Challenges

“…With a new technology like PT, RCTs are indeed more challenging owing to technological complexity. First of all, multiple series proved that the quality of RT treatment planning and delivery is highly dependent on patient volume and varies widely among institutions, for both IMRT [ 100 ]and PT [ 101 ]. This finding renders the comparison between IMRT and PT difficult, since there is neither a standard PT nor a standard IMRT.…”