Temporal Lobe Necrosis in Head and Neck Cancer Patients after Proton Therapy to the Skull Base

Abstract Purpose To demonstrate temporal lobe necrosis (TLN) rate and clinical/dose-volume factors associated with TLN in radiation-naïve patients with head and neck cancer treated with proton therapy where the field of radiation involved the skull base. Materials and Methods Medical records and dosimetric data for radiation-naïve patients with head and neck cancer receiving proton therapy to the skull base were retrospectively reviewed. Patients with <3 months of follow-up, receiving <45 GyRBE or nonconventional fractionation, and/or no follow-up magnetic resonance imaging (MRI) were excluded. TLN was determined using MRI and graded using Common Terminology Criteria for Adverse Events (CTCAE) v5.0. Clinical (gender, age, comorbidities, concurrent chemotherapy, smoking, radiation techniques) and dose-volume parameters were analyzed for TLN correlation. The receiver operating characteristic curve and area under the curve (AUC) were performed to determine the cutoff points of significant dose-volume parameters. Results Between 2013 and 2019, 234 patients were included. The median follow-up time was 22.5 months (range = 3.2–69.3). Overall TLN rates of any grade, ≥ grade 2, and ≥ grade 3 were 5.6% (N = 13), 2.1%, and 0.9%, respectively. The estimated 2-year TLN rate was 4.6%, and the 2-year rate of any brain necrosis was 6.8%. The median time to TLN was 20.9 months from proton completion. Absolute volume receiving 40, 50, 60, and 70 GyRBE (absolute volume [aV]); mean and maximum dose received by the temporal lobe; and dose to the 0.5, 1, and 2 cm3 volume receiving the maximum dose (D0.5cm3, D1cm3, and D2cm3, respectively) of the temporal lobe were associated with greater TLN risk while clinical parameters showed no correlation. Among volume parameters, aV50 gave maximum AUC (0.921), and D2cm3 gave the highest AUC (0.935) among dose parameters. The 11-cm3 cutoff value for aV50 and 62 GyRBE for D2cm3 showed maximum specificity and sensitivity. Conclusion The estimated 2-year TLN rate was 4.6% with a low rate of toxicities ≥grade 3; aV50 ≤11 cm3, D2cm3 ≤62 GyRBE and other cutoff values are suggested as constraints in proton therapy planning to minimize the risk of any grade TLN. Patients whose temporal lobe(s) unavoidably receive higher doses than these thresholds should be carefully followed with MRI after proton therapy.

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Impact of RBE variations on risk estimates of temporal lobe necrosis in patients treated with intensity-modulated proton therapy for head and neck cancer

Acta Oncologica ◽

10.1080/0284186x.2021.1979248 ◽

2021 ◽

pp. 1-8

Author(s):

Grete May Engeseth ◽

Liv Bolstad Hysing ◽

Pablo Yepes ◽

Helge Egil Seime Pettersen ◽

Radhe Mohan ◽

...

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Temporal Lobe ◽

Neck Cancer ◽

Proton Therapy ◽

Intensity Modulated Proton Therapy ◽

Intensity Modulated ◽

Risk Estimates ◽

Temporal Lobe Necrosis

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Radiation associated brain image changes after proton therapy for skull base head and neck cancers

10.1101/2020.02.06.20020610 ◽

2020 ◽

Author(s):

Grete May Engeseth ◽

Sonja Stieb ◽

Abdallah Sherif Radwan Mohamed ◽

Renjie He ◽

Camilla Hanquist Stokkevåg ◽

...

Keyword(s):

Head And Neck ◽

Skull Base ◽

Frontal Lobe ◽

Temporal Lobe ◽

Proton Therapy ◽

Cox Regression ◽

Maximum Size ◽

Post Contrast ◽

Dose Volume ◽

The Brain

AbstractBackground and purposeTo characterize patterns and outcomes of brain MR image changes after proton therapy (PT) for skull base head and neck cancer (HNC).Material and methods127 patients treated with PT for HNC who had received at least 40 Gy(RBE) to the brain and had ≥ 1 follow-up MRI > 6 months after PT were analyzed. MRIs were reviewed for radiation- associated image changes (RAIC). MRIs were rigidly registered to planning CTs, and RAIC were contoured on T1 (post-contrast) and T2 weighted sequences, and dose-volume parameters extracted. Probability of RAIC over time was calculated using multistate analysis. Univariate/multivariate analyses were performed using Cox Regression. Recursive partitioning analysis was used to investigate dose-volume correlates of RAIC development.Results17.3% developed RAIC. All RAIC events were asymptomatic and occurred in the temporal lobe (14), frontal lobe (6) and cerebellum (2). The median volume of the RAIC on post-contrast T1 was 0.5 cc at their maximum size. The RAIC spontaneously resolved in 27.3%, progressed in 27.3% and improved or were stable in 29.6% of patients. The 3-year actuarial rate of developing RAIC was 14.3%. Brain and RAIC lesion doses were generally higher for temporal lobe RAIC compared to frontal lobe RAIC. RAIC was observed in 63% of patients when V67 Gy(RBE) of the brain ≥ 0.17 cc.ConclusionRAIC lesions after PT were asymptomatic and either resolved or regressed in the majority of the patients. The estimated dose–volume correlations confirm the importance of minimizing focal high doses to brain when achievable.

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Brain Injury After Proton Therapy or Carbon Ion Therapy for Head-and-Neck Cancer and Skull Base Tumors

International Journal of Radiation Oncology*Biology*Physics ◽

10.1016/j.ijrobp.2008.12.092 ◽

2009 ◽

Vol 75 (2) ◽

pp. 378-384 ◽

Cited By ~ 25

Author(s):

Daisuke Miyawaki ◽

Masao Murakami ◽

Yusuke Demizu ◽

Ryohei Sasaki ◽

Yasue Niwa ◽

...

Keyword(s):

Head And Neck Cancer ◽

Brain Injury ◽

Head And Neck ◽

Skull Base ◽

Neck Cancer ◽

Proton Therapy ◽

Skull Base Tumors ◽

Carbon Ion Therapy ◽

Carbon Ion ◽

Ion Therapy

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Acute toxicity to the skin and mucosa of radiotherapy alone versus radiotherapy in combination with cetuximab or chemotherapy in patients with head and neck cancer

Journal of Clinical Oncology ◽

10.1200/jco.2009.27.15_suppl.e17007 ◽

2009 ◽

Vol 27 (15_suppl) ◽

pp. e17007-e17007

Author(s):

H. I. Garcia-Huttenlocher ◽

C. Timke ◽

A. D. Jensen ◽

P. E. Huber ◽

J. Debus ◽

...

Keyword(s):

Head And Neck Cancer ◽

Early Intervention ◽

Acute Toxicity ◽

Head And Neck ◽

Neck Cancer ◽

Skin Toxicity ◽

Platinum Based Chemotherapy ◽

Radiotherapy Alone ◽

Grade 3

e17007 Background: To evaluate acute toxicity of the skin and mucosa in patients with head and neck cancer who received Radiotherapy alone (RT) or in combination with cetuximab (IRT) or chemotherapy (CRT). Methods: We retrospectively analyzed 204 patients with head and neck cancer, treated between 2006 and 2008. RT was combined with cetuximab (n = 57), or with platinum-based chemotherapy (n = 99), 48 patients received RT alone. We included 149 male and 55 female patients with a median age of 62 years (range 22–92). Median radiation dose was 66 Gy (range 26.4–71.6Gy). 126 patients received intensity modulated radiotherapy (IMRT), 78 patients had conventional RT. Toxicity was assessed according to CTCAE Version 3.0. Results: Median follow-up was 9 months (range 1–34). Acute grade 3 toxicity of the skin was observed in 26% of IRT, 0% of RT, and 7% of CRT patients. Typical appearance of grade 3 skin toxicity in IRT was a massive confluent epitheliolysis of the RT field. Grade 3 mucositis appeared in 21% of IRT-, 12.5% of RT-, and 16% of CRT-patients. Rates of skin toxicity grade 3 were 8% in patients with IMRT and 15% in patients with conventional RT. Grade 3 mucositis was seen in 22% of the IMRT-patients and 8% of the patients with conventional RT. Cetuximab did not lead to a higher rate of RT interruptions as compared to RT and CRT. Early intervention and supportive care in case of high grade toxicity was performed for all patients. 8 weeks after RT all patients showed recovery from toxicity. Conclusions: Higher toxicity to the skin and to the mucosa occurred in the IRT group, and seems to be a specific side effect in the treatment of head and neck cancer patients with concomitant cetuximab and RT. But severity of toxicity may also be influenced by other factors such as RT technique. IRT patients need close observation and early intervention in case of therapy induced toxicity in order to prevent RT interruption, which might limit the advantage of cetuximab. Longer follow-up is needed to evaluate outcome and late toxicity of the different treatment groups. [Table: see text]

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Retrospective Review of 24 Cases of Head and Neck Cancer with Skull Base Invasion

Skull Base ◽

10.1055/s-2007-981750 ◽

2007 ◽

Vol 17 (S 2) ◽

Author(s):

Federico Ampil ◽

Cherie Nathan ◽

Gloria Caldito ◽

Anil Nanda ◽

Timothy Lian

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Skull Base ◽

Neck Cancer ◽

Retrospective Review

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Faculty Opinions recommendation of Efficacy of current regular follow-up policy after treatment for head and neck cancer: Need for individualized and obligatory follow-up strategy.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.718003087.793477802 ◽

2013 ◽

Author(s):

Giulio Cantu ◽

Stefano Riccio ◽

Sarah Colombo

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer

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Neutrophilic Dermatosis of Hands as Oncological Finding: Importance of Follow-Up

ORL ◽

10.1159/000513630 ◽

2021 ◽

pp. 1-3

Author(s):

Jérôme R. Lechien ◽

Daphné Delplace ◽

Mohamad Khalife ◽

Sven Saussez

Keyword(s):

Head And Neck Cancer ◽

Head And Neck ◽

Neck Cancer ◽

Paraneoplastic Syndrome ◽

Tobacco Consumption ◽

Neutrophilic Dermatosis ◽

Pharyngeal Cancer ◽

Head And Neck Malignancy ◽

Neck Malignancy

Neutrophilic febrile dermatosis (NFD) is a rare paraneoplastic syndrome that may be found in patients with head and neck cancer. NFD may appear before the neoplasia and may only concern the dorsal faces of the hands. This article reports the NFD findings of a patient with pharyngeal cancer, which was developed 2 years after the occurrence of NFD. The development of NFD in patient with alcohol and tobacco consumption should lead otolaryngologists and dermatologists to suspect head and neck malignancy. In cases of normal otolaryngological examination, patients have to be followed.

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Laryngeal cancer

InnovAiT Education and inspiration for general practice ◽

10.1177/17557380211010564 ◽

2021 ◽

pp. 175573802110105

Author(s):

Kelvin Miu

Keyword(s):

Head And Neck Cancer ◽

Early Diagnosis ◽

Head And Neck ◽

Patient Outcomes ◽

Laryngeal Cancer ◽

Neck Cancer ◽

Early Recognition ◽

Signs And Symptoms ◽

Diagnosis And Treatment

Laryngeal cancer is a common head and neck cancer and typically presents with voice hoarseness in patients older than 60 years. Early recognition of signs and symptoms of laryngeal cancer can lead to early diagnosis and treatment, therefore improving patient outcomes. This article aims to provide an overview of the anatomy of the larynx, presentation and management of laryngeal cancer, and common follow-up problems.

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