Comprehensive Treatment for Major Salivary Gland Carcinoma Based on Intensity-Modulated Radiotherapy with or without Radical Surgery

Abstract Background The present study aimed to determine a treatment strategy and Intensity-Modulated Radiotherapy (IMRT) target volume for major salivary gland carcinoma (SGC). Methods Patients with SGC treated at our cancer center between August 2009 and August 2020 were retrospectively reviewed. Results The following primary tumor sites were identified: parotid gland in 61 (69.3%) patients, submandibular gland in 21 (23.9%) patients, and sublingual gland in six (6.8%) patients. Lymphoepithelial carcinoma (LEC) was the most common tumor subtype that accounted for 23.9% of cases. A total of 80 (90.9%) patients received radical surgery combined with postoperative radiotherapy. Eight patients (9.1%) received definitive radiotherapy: six patients with advanced-stage disease received induction chemotherapy (IC) combined with concurrent chemoradiotherapy (CCRT), and two patients with early-stage disease received CCRT. Complete response was observed in these eight patients after treatment completion. The median follow-up time of all patients was 42 months (range: 4–129 months). No patient developed local recurrence. The 5-year overall survival, regional failure-free survival, distant metastasis-free survival, and progression-free survival probabilities were 84.1%, 95.6%, 75.3%, and 75.7%, respectively. Distant metastasis was observed in 18 (20.5%) patients, followed by regional 2 (2.3%) recurrence. Permanent facial nerve injury was confirmed in 31 patients by follow-up. None of the patients experienced facial nerve paralysis in the definitive radiotherapy group. Conclusions LECs may be sensitive to chemoradiotherapy, which may achieve a radical effect and avoid unnecessary surgical injury. IC combined with CCRT is expected to become a new treatment strategy for advanced LECs. The IMRT target volume delineation according to the surgical principles may be a more promising method with good clinical efficacy that is worthy of further study.

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Individualized Clinical Target Volume Delineation and Efficacy Analysis in Unilateral Nasopharyngeal Carcinoma Treated with Intensity-Modulated Radiotherapy (IMRT): 10-Year Summary and Results

10.21203/rs.3.rs-938329/v1 ◽

2021 ◽

Author(s):

De-Huan Xie ◽

Zheng Wu ◽

Wang-Zhong Li ◽

Wan-Qin Cheng ◽

Ya-Lan Tao ◽

...

Keyword(s):

Nasopharyngeal Carcinoma ◽

Clinical Target Volume ◽

Parapharyngeal Space ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Recurrence Free Survival ◽

Free Survival ◽

Intensity Modulated

Abstract Purpose: To evaluate the long-term local control, failure patterns, and toxicities after individualized clinical target volume (CTV) delineation in unilateral nasopharyngeal carcinoma (NPC) treated with intensity-modulated radiotherapy (IMRT).Methods: Unilateral NPC was defined as nasopharyngeal mass confined to one side of nasopharynx and did not significantly exceed the midline of nasopharyngeal apex/posterior wall. From November 2003 to December 2017, 95 patients with long-term follow-up were retrospectively included. All patients received IMRT. The CTVs were determined based on the distance from the gross tumor, the contralateral parapharyngeal space and skull base orifices were spared from irradiation.Results: There were 3 local recurrence and 8 regional recurrences in 10 patients during 84- month follow-up. All local recurrences were PGTVnx-in-field, and no recurrences in traditional high-risk area including contralateral parapharyngeal space and skull base orifices. The 10-year local-recurrence free survival, regional-recurrence free survival and overall survival were 96.2%, 90.5% and 84.7%, respectively. The dosimetry parameters of the tumor-contralateral organs were all lower than the values of the tumor-ipsilateral side (P < 0.05). The late toxicities occurred mainly in the tumor-ipsilateral organs, including radiation-induced temporal lobe injury, impaired visuality, hearing loss and subcutaneous fibrosis.Conclusion: Individualized CTV delineation in unilateral NPC could yield excellent long-term local control with limited out-of-field recurrences, reduced dose to tumor- contralateral organs and mild late toxicities, which is worthy of further exploration.

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Clinical target volume design of postoperative intensity-modulated radiotherapy for major salivary gland tumours according to surgical principles: an innovative method

Journal of Cancer Research and Clinical Oncology ◽

10.1007/s00432-021-03646-y ◽

2021 ◽

Author(s):

Shaowen Lyu ◽

Zheng Wu ◽

Dehuan Xie ◽

Zhiqing Long ◽

Rui Zhong ◽

...

Keyword(s):

Salivary Gland ◽

Clinical Target Volume ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Major Salivary Gland ◽

Salivary Gland Tumours ◽

Intensity Modulated ◽

Innovative Method

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Clinical Outcomes and Prognostic Factors of 695 Nasopharyngeal Carcinoma Patients Treated with Intensity-Modulated Radiotherapy

BioMed Research International ◽

10.1155/2014/814948 ◽

2014 ◽

Vol 2014 ◽

pp. 1-10 ◽

Cited By ~ 8

Author(s):

Weidong Wang ◽

Mei Feng ◽

Zixuan Fan ◽

Jie Li ◽

Jinyi Lang

Keyword(s):

Prognostic Factors ◽

Nasopharyngeal Carcinoma ◽

Clinical Outcomes ◽

Distant Metastasis ◽

Clinical Target Volume ◽

Intensity Modulated Radiotherapy ◽

Disease Free Survival ◽

Target Volume ◽

Free Survival ◽

Intensity Modulated

Objective. The 5-year clinical outcomes and prognostic factors of nasopharyngeal carcinoma (NPC) patients treated with intensity modulated radiotherapy (IMRT) were evaluated.Methods. Six hundred ninety five NPC patients primarily treated with IMRT in Sichuan Cancer Hospital from January, 2003 to December, 2006 were analyzed retrospectively, including 540 males and 155 females. The prescription dose was delivered as follows: gross target volume (GTVnx) 67–76 Gy in 30–33 fractions, positive neck lymph nodes (GTVln-R/L) 60–70 Gy in 30–33 fractions, high-risk clinical target volume (CTV1) 60–66 Gy, low-risk clinical target volume (CTV2) 54–60 Gy, and clinical target volume of cervical lymph node regions (CTVln) 50–55 Gy.Results. The 5-year local control (LC), regional control, distant metastasis-free survival (DMFS), disease free survival, disease specific survival, and overall survival (OS) rates were 89.8%, 95.2%, 74.1%, 69.6%, 83.2%, and 77.1%. The 5-year DMFS of IMRT and IMRT combined with chemotherapy was 62.1% and 70.9%, the OS of them was 72.9% and 79.1%. The incidence of grade 3 acute and late toxicity was 38.3% and 4.2%, respectively.Conclusion. The 5-year LC and OS rate of NPC treated with IMRT was 89.8% and 77.1%. The clinical stage, N stage, volume of GTVnx, and chemotherapy were the main prognostic factor for the OS. Distant metastasis was the main pattern of failure.

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The efficacy and safety of simultaneous integrated dose reduction in clinical target volume with intensity-modulated radiotherapy for patients with locally advanced esophageal squamous cell carcinoma

Annals of Translational Medicine ◽

10.21037/atm-20-4366 ◽

2020 ◽

Vol 8 (18) ◽

pp. 1160-1160

Author(s):

Jingjing Zhao ◽

Tongda Lei ◽

Tian Zhang ◽

Xi Chen ◽

Jie Dong ◽

...

Keyword(s):

Squamous Cell Carcinoma ◽

Esophageal Squamous Cell Carcinoma ◽

Cell Carcinoma ◽

Dose Reduction ◽

Clinical Target Volume ◽

Locally Advanced ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Efficacy And Safety ◽

Intensity Modulated

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Impact of Geometric Uncertainties on Dose Distribution During Intensity Modulated Radiotherapy of Head-and-neck Cancer: The Need for a Planning Target Volume and A Planning Organ-at-Risk Volume

Current Oncology ◽

10.3390/curroncol13030010 ◽

2006 ◽

Vol 13 (3) ◽

pp. 108-115 ◽

Cited By ~ 1

Author(s):

O. Ballivy ◽

W. Parker ◽

T. Vuong ◽

G. Shenouda ◽

H. Patrocinio

Keyword(s):

Spinal Cord ◽

At Risk ◽

Neck Cancer ◽

Intensity Modulated Radiotherapy ◽

Target Volume ◽

Ct Scans ◽

Target Coverage ◽

Geometric Uncertainties ◽

Intensity Modulated ◽

Organ At Risk

We assessed the effect of geometric uncertainties on target coverage and on dose to the organs at risk (OARS) during intensity-modulated radiotherapy (IMRT) for head-and-neck cancer, and we estimated the required margins for the planning target volume (PTV) and the planning organ-at-risk volume (PRV). For eight headand- neck cancer patients, we generated IMRT plans with localization uncertainty margins of 0 mm, 2.5 mm, and 5.0 mm. The beam intensities were then applied on repeat computed tomography (CT) scans obtained weekly during treatment, and dose distributions were recalculated. The dose–volume histogram analysis for the repeat CT scans showed that target coverage was adequate (V100 ≥ 95%) for only 12.5% of the gross tumour volumes, 54.3% of the upper-neck clinical target volumes (CTVS), and 27.4% of the lower-neck CTVS when no margins were added for PTV. The use of 2.5-mm and 5.0-mm margins significantly improved target coverage, but the mean dose to the contralateral parotid increased from 25.9 Gy to 29.2 Gy. Maximum dose to the spinal cord was above limit in 57.7%, 34.6%, and 15.4% of cases when 0-mm, 2.5-mm, and 5.0-mm margins (respectively) were used for PRV. Significant deviations from the prescribed dose can occur during IMRT treatment delivery for headand- neck cancer. The use of 2.5-mm to 5.0-mm margins for PTV and PRV greatly reduces the risk of underdosing targets and of overdosing the spinal cord.

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