Improving the accuracy of localisation in the radiotherapy treatment of head and neck, and brain cancer: some initial findings

2000 ◽  
Vol 2 (3) ◽  
pp. 125-132 ◽  
Author(s):  
M. J. McJury ◽  
R. Nakielny ◽  
D. Levy ◽  
J. Lilley ◽  
J. Conway ◽  
...  
Keyword(s):  
Head And Neck ◽  
Planning Process ◽  
Radiotherapy Planning ◽  
Ct Scans ◽  
Additional Patient ◽  
Post Contrast ◽  
Significant Difference ◽  
Mean Differences ◽  
The Impact ◽  
Radiotherapy Treatment

Aims: To investigate the impact on localisation of utilising contrast enhanced computed tomography (CT) scans and the formal input of a radiologist in the radiotherapy planning process.Method: Ten head and neck / brain patients had pre- and post-contrast CT scans in the treatment position. Over several months, their unenhanced and enhanced scans were re-contoured by the original oncologist, and a radiologist. These new contours were compared to the original unenhanced contours and differences in contour volume, geographical position and tolerance doses on the associated PTVs were evaluated.Results: The use of contrast lead to significant differences in the size of GTVs. Mean differences in GTVs of 32.8 % were significant at p=0.01. No significant impact on the position of the contour centre was noted. The impact of the radiologist lead to large differences in GTV (mean 20.5 %), but large SDs meant this result was not statistically significant. The contouring precision of the oncologist showed no significant difference for GTVs and PTVs.Conclusions: The use of contrast when planning the radiotherapy treatment for head and neck / brain patients was found to lead to significant differences in GTV size, a lesser effect on PTV definition and little impact on the position of the contour centre. It may have important implications for multi-phase treatments where the GTV (rather than the PTV) is targeted for boost doses. Differences due to the input of a radiologist appear to be considerable and require further investigation when additional patient numbers have been acquired to improve precision.

scholarly journals The role of PET-CT in radiotherapy planning of solid tumours

2015 ◽  
Vol 49 (1) ◽  
pp. 1-9 ◽  
Author(s):  
Stasa Jelercic ◽  
Mirjana Rajer
Keyword(s):  
Treatment Planning ◽  
Planning Process ◽  
Diagnostic Procedures ◽  
Solid Tumours ◽  
Radiotherapy Planning ◽  
Radiotherapy Treatment Planning ◽  
Pet Ct ◽  
Target Volumes ◽  
Radiotherapy Treatment

AbstractBackground. PET-CT is becoming more and more important in various aspects of oncology. Until recently it was used mainly as part of diagnostic procedures and for evaluation of treatment results. With development of personalized radiotherapy, volumetric and radiobiological characteristics of individual tumour have become integrated in the multistep radiotherapy (RT) planning process. Standard anatomical imaging used to select and delineate RT target volumes can be enriched by the information on tumour biology gained by PET-CT. In this review we explore the current and possible future role of PET-CT in radiotherapy treatment planning. After general explanation, we assess its role in radiotherapy of those solid tumours for which PET-CT is being used most.Conclusions. In the nearby future PET-CT will be an integral part of the most radiotherapy treatment planning procedures in an every-day clinical practice. Apart from a clear role in radiation planning of lung cancer, with forthcoming clinical trials, we will get more evidence of the optimal use of PET-CT in radiotherapy planning of other solid tumours

scholarly journals Impact of economic crisis on indications for general versus local anaesthesia in head and neck surgery: a single centre analysis

2014 ◽  
Vol 3 (6) ◽  
pp. 92
Author(s):  
Tatjana Goranovic ◽  
Boris Simunjak ◽  
Dinko Tonkovic ◽  
Miran Martinac
Keyword(s):  
Cost Saving ◽  
Head And Neck ◽  
General Anaesthesia ◽  
Local Anaesthesia ◽  
Neck Surgery ◽  
Head And Neck Surgery ◽  
Significant Difference ◽  
Before And After ◽  
Saving Measure ◽  
The Impact

Objective: To analyze the impact of the hospital board’s cost saving measure on physicians’ decision to indicate head and neck surgery according to the type of anaesthesia (general versus local). Methods: Design: a retrospective analysis of medical charts on head and neck surgery and anaesthesia covering 2011-2012. Setting: department of otorhinolaryngology and head and neck surgery, university hospital, Croatia. Participants: patients undergoing head and neck surgery. Intervention(s): reduction of departmental financial fund for general anaesthesia for 10%. Main Outcome Measure(s): an overall of number of head and neck surgeries performed in general versus local anaesthesia before and after the implementation of the intervention measure. Results: There were a total of 984 head and neck surgeries in general anaesthesia in 2011 and 861 in 2012. There were a total of 460 head and neck surgeries in local anaesthesia in 2011 and 528 in 2012. The performance of head and neck surgeries in general anaesthesia was significantly reduced in a year after the implementation of the intervention (p = .01) There was no statistical significant difference in the performance of head and neck surgeries in local anaesthesia before and after the intervention. Conclusions: The reduction of departmental fund for general anaesthesia as a cost saving method resulted only in reducing the total performance of surgeries in general anaesthesia without any switch to performing surgeries in local anaesthesia. It seems that the hospital board’s cost saving measure did not have any impact on physicians’ decisions to indicate more surgeries in local anaesthesia. 

Impact of 18F-fluorodeoxyglucose position emission tomography/computed tomography on radiotherapy treatment planning and outcomes in esophageal cancer.

2016 ◽  
Vol 34 (4_suppl) ◽  
pp. 67-67
Author(s):  
Sweet Ping Ng ◽  
Jennifer Tan ◽  
Glen Osbourne ◽  
Luke Williams ◽  
Mathias Bressel ◽  
...  
Keyword(s):  
Overall Survival ◽  
Esophageal Cancer ◽  
Survival Rates ◽  
Ct Scanning ◽  
Radiotherapy Planning ◽  
Position Emission Tomography ◽  
Pet Ct ◽  
Ct Data ◽  
The Impact ◽  
Radiotherapy Treatment

67 Background: Currently there is no universally accepted method to accurately delineate the gross tumor volume (GTV) of primary esophageal cancer in patients undergoing radiotherapy. This prospective study aims to determine the impact of PET/CT on radiotherapy planning and outcomes in patients with localized esophageal cancer. Methods: 54 patients were recruited between June 2003 - May 2008. All underwent PET/CT scanning in the radiotherapy treatment position and received treatment planned using the PET/CT dataset. Of these, 13 (24.1%) had metastatic disease detected on PET and 3 patients had no radical radiotherapy, while another 3 patients had missing planning PET/CT data (excluded from planning component analysis). GTV was defined separately on PET/CT (GTV-PET) and CT (GTV-CT) data sets. A corresponding planning target volume (PTV) was generated for each patient. Volumetric and spatial analysis quantified the proportion of FDG-avid disease not included in CT-based volumes. Clinical data was collected for 38 patients treated radically to determine locoregional control and overall survival rates. Results: Mean age was 67 years (range:32 - 88). Median follow up was 4 years (range:2.7 – 6.8). FDG-avid disease would have been excluded from GTV-CT in 29 patients (79%) with a mean volume of 17% (range:1-100%). In 5 patients, FDG-avid disease would have been completely excluded from the PTV-CT (median volume missed = 6%, range:2-92%). For 8 patients, less than 95% of PTV-PET would have received at least 95% of prescription dose based on the CT-based plan. GTV-CT underestimated the cranial and caudal extent of FDG-avid tumor in 14 (36%) and 10 (26%) patients respectively. There were no significant differences in radiation doses to the lungs and liver. 5-year overall survival and locoregional failure free survival were 24%, and 42% respectively. Conclusions: PET/CT prevented futile radiotherapy for 1 in 4 patients and avoided geographic misses without significant impact on normal tissues in apparently localized esophageal cancer. However, survival remains suboptimal and indicates the need for further improvement in planning and therapeutic paradigms.

Quality of life in patients with locally advanced head and neck cancer undergoing chemoradiation with once-a-week versus once-every-three-weeks cisplatin.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. 12092-12092
Author(s):  
Nandini Sharrel Menon ◽  
Vanita Noronha ◽  
Amit Joshi ◽  
Vijay Maruti Patil ◽  
Atanu Bhattacharjee ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Head And Neck ◽  
Locally Advanced ◽  
Phase Iii ◽  
Locoregional Control ◽  
Advanced Head ◽  
Significant Difference ◽  
Eortc Qlq ◽  
The Impact

12092 Background: This trial was conducted to compare the efficacy of low dose once-a-week cisplatin with once-every-3-weeks cisplatin with radiation in locally advanced head and neck squamous cell carcinoma (LAHNSCC). The current analysis focuses on the quality of life (QoL) of patients in this trial. Methods: In this phase III randomized trial, patients with stage III or IV non-metastatic LAHNSCC were randomized to receive cisplatin 30 mg/m2 once a week or cisplatin 100 mg/m2 once every 3 weeks concurrently with curative intent radiotherapy. The primary endpoint was locoregional control. QoL was a key secondary endpoint. QoL was assessed using the EORTC QLQ-C30 (v.3) and EORTC QLQ-H&N35 (v.1). QoL data were assessed at baseline and days 22 and 43 during treatment; at the end of chemoradiation and at each follow-up. The linear mixed effects model was used for longitudinal analysis of QoL domains to determine the impact of treatment (arm) and time on QoL scores. Results: Three hundred patients were enrolled, 150 in each arm. QoL data from 283 patients with at least one assessable questionnaire were analyzed. The pretreatment QoL scores were similar in both the arms in all domains. There was no significant difference in the global health status/QoL with respect to the treatment arm ( P =0.608) or time ( P=0.0544 ). There was no significant difference in the longitudinal QoL scores between the two treatment arms in all domains except the physical function ( P= .0074), constipation ( P= .0326), trouble with social contact ( P= .0321) and sexuality ( P= .0004). There was a decline in the QoL scores in all domains in both arms during treatment. After completion of treatment, the QoL scores started improving steadily up to 1 year and plateaued thereafter in both arms. Conclusions: The use of once-every-three weeks cisplatin significantly improved the locoregional control without adversely impacting the quality of life as compared to once-a-week cisplatin in combination with radical radiotherapy in locally advanced HNSCC. Clinical trial information: CTRI/2012/10/ 003062. .

The impact of breast size on mean lung dose for patients receiving tangential radiotherapy to the whole breast

2016 ◽  
Vol 15 (2) ◽  
pp. 181-188
Author(s):  
Ashley Schembri ◽  
Susan Mercieca ◽  
Nick Courtier ◽  
Francis Zarb
Keyword(s):  
Significant Variation ◽  
Target Volume ◽  
Breast Size ◽  
Lung Dose ◽  
Breast Radiotherapy ◽  
Large Breast ◽  
Significant Difference ◽  
Mean Lung Dose ◽  
The Impact ◽  
Radiotherapy Treatment

AbstractPurposeTo explore the impact of breast size on mean lung dose (MLD) for patients receiving breast radiotherapy.MethodologyChest wall separation (CWS), volume of tissue receiving 95% isodose and MLD were measured on 80 radiotherapy treatment plans of patients receiving tangential radiotherapy treatment to the whole breast. Breast size was categorised as small (CWS<25 cm and planned target volume (PTV)<1,500 cm3) and large (CWS>25 cm and PTV>1500 cm3). Pearson’s correlation and independent sample t-test were used to analyse data.ResultsMLD was not affected by CWS (r=−0·13, p=0·24) nor volume of tissue receiving 95% isodose (r=−0·08, p=0·49). Significant variation between small and large breasts was noted for CWS (t=8·24, p=0·00) and volume of tissue receiving 95% isodose (t=5·68, p=0·00). No significant variation was noted between small and large breast for MLD (t=−0·26, p=0·80) and between left and right breasts for CWS (t=1·42, p=0·16) and volume of tissue receiving 95% isodose (t=−1·08, p=0·28). Significant difference between left (18–808 cGy) and right breast (325–365 cGy) was demonstrated for MLD (t=3·03, p=0·00).ConclusionThis study demonstrated lack of correlation between breast size and MLD. Further research is recommended for justification of alternative techniques for this subgroup of patients to provide optimised radiotherapy delivery.

scholarly journals The Association of Cachexia with Head and Neck Cancer Burden and Pathologic Features

2020 ◽  
Vol 3 ◽  
Author(s):  
Marelle Rukes ◽  
Alexander Jones ◽  
Leah Novinger ◽  
Kyle Davis ◽  
Vincent Campiti ◽  
...  
Keyword(s):  
Weight Loss ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Head And Neck Carcinoma ◽  
Depth Of Invasion ◽  
Skeletal Muscle Index ◽  
Pathologic Features ◽  
Significant Difference ◽  
The Impact

Background and Hypothesis: Head and neck cancer (HNC) is frequently associated with cachexia, characterized by involuntary weight loss, sarcopenia, and malnutrition. In HNC patients, dysphagia and anorexia from obstructive aerodigestive tumors propagates cachexia even further. However, the impact of pathologic features and burden of HNC on cachexia has yet to be investigated. We therefore hypothesize that larger, more aggressive tumors impose greater cachexia severity in HNC patients.     Methods: A single-institution, retrospective study of adult patients undergoing surgical resection of head and neck carcinoma from 2014-2017 was performed. Patients without 30-day preoperative abdominal CT imaging for skeletal muscle index (SMI, cm2/m2) measurements were excluded. Patient demographics, comorbidities, nutrition data, and cancer pathology reports were collected. Cachexia was defined as unintentional weight loss >5% over 6 months or >2% with BMI <20 kg/m2. Statistical analyses were performed using 2-sided one-way Welch’s ANOVA or Pearson’s c2 tests. Significance was determined at p <0.05.      Results: The cohort included 125 predominantly white (92.0%), male (75.2%) HNC patients age 59.9 ± 11.5 years. Sixty-seven (53.6%) patients had cachexia, twenty (16.0%) of whom were severe (weight loss ≥15%). Patients with severe cachexia had larger tumors (5.5 ± 2.1 cm, p=0.021) than patients with mild-to-moderate cachexia (weight loss 5-14.9%; 4.9 ± 2.1 cm) or no cachexia (4.1 ± 1.9 cm). Worsening cachexia severity was also associated with lower SMI (p=0.004), BMI (p=0.002), and serum albumin (p=0.011). There was no statistically significant difference between cachexia groups comparing patient age, comorbidities, tumor grade, depth of invasion, nodal metastases, cancer stage, perineural invasion, lymphovascular invasion, or extranodal extension.     Conclusion and Potential Impact: Tumor burden of HNC patients, but not adverse pathologic features, is associated with greater cachexia severity. Identifying pro-cachectic markers produced by larger tumors could provide a molecular target for anti-cachexia therapies and improve cancer patient outcomes. 

Which role plays specialized palliative care in patients with relapsed and/or metastatic head and neck cancer? A retrospective analysis in Southern Switzerland.

2019 ◽  
Vol 37 (15_suppl) ◽  
pp. e17503-e17503
Author(s):  
Vittoria G. Espeli ◽  
Claudia Gamondi ◽  
Tanja Fusi-Schmidhauser
Keyword(s):  
Palliative Care ◽  
Overall Survival ◽  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Unknown Primary ◽  
Early Palliative Care ◽  
Significant Difference ◽  
Specialized Palliative Care ◽  
The Impact

e17503 Background: early palliative care (PC) for patients with advanced cancer improves quality of life, promotes home deaths and can improve survival. Limited data are available regarding PC in advanced head and neck cancer (HNC) patients. To investigate the effect of introducing specialized PC in patients with relapsed and/or metastatic head and neck cancer. Methods: between October 2010 and December 2018, the medical charts of all patients treated in the Oncology Institute of Southern Switzerland with relapsed and/or metastatic HNC were reviewed. Site, status of disease (metastatic at diagnosis, locally or metastatic relapsed), type and lines of treatment, treatment response and referral to specialist palliative care (yes or no) were documented. Comparisons were made between patients referred and non-referred to PC. Results: sixty-two patients with relapsed/metastatic HNC were identified, 32 (51.6%) of which were referred to specialized PC. Patients were mainly men (47, 75.8%), with a median age of 66 years (range 43 – 86). Forty-two patients (67.7%) had a metastatic disease and the most common site of tumor was the oropharynx (35.5%), followed by oral cavity (32.3%), larynx (16.1%), hypopharynx (12.9%), and unknown primary (3.2%). Forty-eight patients (77.4%) were treated with systemic treatment (75% in the PC group and 80% in the non-PC group, p = 0.638). The median overall survival was 8.1 months for all patients, 8 months for the PC group and 8.7 months for the non-PC group, without significant difference (p = 0.440). Of the deceased patients, 70% of the PC group and 73.3% of the non-PC group received chemotherapy in the last three months of life. A greater percentage of patients in the PC group died at home, but without significant difference (39.2% vs. 19%, p = 0.134). Conclusions: only half of the patient had access to specialized PC. Whereas it did not seem to affect overall survival nor influence chemotherapy prescription, it seemed to favor home deaths. Further studies investigating the impact of early PC in recurrent and/or metastatic HNC are needed to improve access to PC and maximize benefits.

scholarly journals Hypothyroidism and risks of cerebrovascular complications among patients with head and neck cancer after radiotherapy

BMC Neurology ◽  
2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Chi-Hung Liu ◽  
Joseph Tung-Chieh Chang ◽  
Tsong-Hai Lee ◽  
Pi-Yueh Chang ◽  
Chien-Hung Chang ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Cox Models ◽  
Cerebrovascular Complications ◽  
Significant Difference ◽  
The Impact ◽  
Cumulative Time ◽  
The Eu

Abstract Background Hypothyroidism (HT) and carotid artery stenosis (CAS) are complications of radiotherapy (RT) in patients with head and neck cancer (HNC). The impact of post-RT HT on CAS progression remains unclear. Methods Between 2013 and 2014, HNC patients who had ever received RT and were under regular follow-up in our hospital were initially screened. Patients were categorized into euthyroid (EU) and HT groups. Details of RT and HNC were recorded. Total plaque scores and degrees of CAS were measured during annual extracranial duplex follow-up. Patients were monitored for CAS progression to > 50 % stenosis or ischemic stroke (IS). Cumulative time to CAS progression and IS between the 2 groups were compared. Data were further analyzed based on the use or nonuse of thyroxine of the HT group. Results 333 HNC patients with RT history were screened. Finally, 216 patients were recruited (94 and 122 patients in the EU and HT groups). Patients of the HT group received higher mean RT doses (HT vs. EU; 7021.55 ± 401.67 vs. 6869.69 ± 425.32 centi-grays, p = 0.02). Multivariate Cox models showed comparable CAS progression (p = 0.24) and IS occurrence (p = 0.51) between the 2 groups. Moreover, no significant difference was observed in time to CAS progression (p = 0.49) or IS (p = 0.31) among patients with EU and HT using and not using thyroxine supplement. Conclusions Our results did not demonstrate significant effects of HT and thyroxine supplementation on CAS progression and IS incidence in patients with HNC after RT.

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