scholarly journals Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer

2021 ◽  
Vol 11 ◽  
Author(s):  
Heleen Bollen ◽  
Julie van der Veen ◽  
Annouschka Laenen ◽  
Sandra Nuyts
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Survival Rates ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
High Dose ◽  
Treatment Delivery ◽  
Target Volume Definition ◽  
Dose Volume

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 five segmentation methods for [18F]-FDG-PET-CT-based target volume definition in head and neck cancer

2011 ◽  
Vol 27 ◽  
pp. S6-S7
Author(s):  
X. Bontemps ◽  
R. Abgral ◽  
C. Leleu ◽  
A. Turzo ◽  
G. Valette ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Fdg Pet ◽  
Target Volume ◽  
Target Volume Definition ◽  
Pet Ct ◽  
Segmentation Methods ◽  
18F Fdg ◽  
Fdg Pet Ct

Impact of interobserver variability in delineating clinical target volumes (CTV) for head and neck intensity modulated radiation therapy (IMRT): Potential for a geographical miss

2009 ◽  
Vol 27 (15_suppl) ◽  
pp. e17013-e17013
Author(s):  
S. Chilukuri ◽  
S. Surana ◽  
P. P. Mohanty ◽  
R. Kuppuswamy
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Neck Cancer ◽  
Imaging Techniques ◽  
Target Volume ◽  
High Dose ◽  
Observer Variability ◽  
Median Dose ◽  
Median Percentage ◽  
Inter Observer Variability

e17013 Background: Despite modern day imaging techniques and guidelines for delineation of the clinical target volume, there remains significant inter-observer variability in delineating the CTV. With the use of IMRT, the target volume receives a significant tumoricidal dose while the regions just outside the target receive unpredictable doses. In this report, the dose to the region just outside the planning target volume (PTV) (defined as volume of uncertainty [VOU]), presumed to represent the regions subject to maximum inter-observer variability, was studied. Methods: The IMRT plans of 12 patients with head and neck cancer were used to determine the dose just outside the high-risk CTV by growing volumes around CTV with 3 mm, 5 mm, and 7 mm margins. These volumes were edited at regions close to skin/air and bone. PTVs were subsequently grown using the same margins as used in the original plans. With the Boolean operations, each of these volumes was subtracted from the existing PTV to generate the volumes of uncertainty (VOU) in 3 dimensions. The dose to these VOUs was analyzed. D95, D90 and median dose which are the doses received by 95%, 90%, and 50% of the target volume respectively were studied. Results: The median prescribed dose was 68 Gy (60 Gy-72 Gy). The median percentage D95 for 3mm, 5mm and 7mm VOU was 82.5% ± 4.95, 77.25% ± 5.53, and 69% ± 6.93, respectively. The median percentage D90 for these VOU's was 87.7% ± 3.53, 83.2% ± 4.61, and 79% ± 4.5, respectively. The median dose to each of these VOU”s was 96% ± 1.6, 94.5% ± 1.95, and 92.5% ± 1.85 respectively. Conclusions: This study documents that the volumes of uncertainty surrounding the PTV, which could contain subclinical disease, in fact receive a significant amount of RT dose. Hence, despite a large amount of evidence for inter-observer variability in target delineation for head and neck cancer,the majority of locoregional recurrences are within the high dose region and not marginal failures. No significant financial relationships to disclose.

scholarly journals Dosimetric comparison of radiotherapy treatment plans done by IMRT and VMAT technique in head and neck cancer patients

2021 ◽  
Vol 9 (3) ◽  
pp. 167-171
Author(s):  
Dr. Aparajeeta Aparajeeta ◽  
◽  
Dr. Ankita Mehta ◽  
Mr. N.S. Silambarasan ◽  
Dr. Piyush Kumar ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Patients ◽  
Neck Cancer ◽  
Treatment Time ◽  
Statistical Significance ◽  
Target Volume ◽  
Treatment Delivery ◽  
Patient Load ◽  
Treatment Plans

Background: The increasing patient load in radiotherapy centres demands selection of thetechnique that provides plans with optimal dosimetry in terms of target volume coverage, organs atrisk (OAR) sparing and a lesser treatment time. This study was designed to compare the two widelypractised conformal techniques, IMRT and VMAT in head and neck cancer patients in terms ofplanning target volume (PTV) coverage, OAR sparing and treatment delivery parameters. Materialsand methods: For ten postoperative head and neck cancer patients who had been treated by IMRTtechnique virtual VMAT plans were generated for study purposes. The dose prescribed to PTV was 60Gy in 30 fractions. The dose-volume parameters of PTV and OARs and the treatment deliveryparameters were compared amongst both the techniques. Statistical significance was calculatedusing paired ‘t’ test. Results: Both the plans were comparable in terms of dosimetry. The onlysignificant difference being better conformity in the IMRT plans. The dose to OARs was alsocomparable in both the techniques except for a significant reduction in the point dose to brainstemwith the IMRT technique. Given the treatment delivery parameters, there was a significant reductionin the treatment delivery time and monitor units with the VMAT technique compared to the IMRTtechnique. Conclusion: VMAT technique gave comparable plans to that of the IMRT technique interms of dosimetry but reduced the treatment time. It seems feasible in radiotherapy centres withincreased patient load.

scholarly journals Image guided high-dose-rate brachytherapy versus volumetric modulated arc therapy for head and neck cancer: A comparative analysis of dosimetry for target volume and organs at risk

2018 ◽  
Vol 52 (4) ◽  
pp. 461-467
Author(s):  
Hironori Akiyama ◽  
Csilla Pesznyák ◽  
Dalma Béla ◽  
Örs Ferenczi ◽  
Tibor Major ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Dose Rate ◽  
Organs At Risk ◽  
Volumetric Modulated Arc Therapy ◽  
Target Volume ◽  
High Dose Rate ◽  
High Dose ◽  
Image Guided ◽  
Arc Therapy

Abstract Background The aim of the study was to present dosimetric comparison of image guided high-dose-rate brachytherapy (IGBT) with volumetric modulated arc therapy (VMAT) for head and neck cancer regarding conformity of dose distribution to planning target volume (PTV) and doses to organs at risk (OARs). Patients and methods Thirty-eight consecutive patients with T1-4 mobile tongue, floor of mouth and base of tongue cancer treated with IGBT were selected. For these patients additional VMAT treatment plans were also prepared using identical computed tomography data. OARs and PTV related parameters (e.g. V98, D0.1cm3, Dmean, etc.) were compared. Results Mean V98 of the PTV was 90.2% vs. 90.4% (p > 0.05) for IGBT and VMAT, respectively. Mean D0.1cm3 to the mandible was 77.0% vs. 85.4% (p < 0.05). Dmean to ipsilateral and contralateral parotid glands was 4.6% vs. 4.6% and 3.0% vs. 3.9% (p > 0.05). Dmean to ipsilateral and contralateral submandibular glands was 16.4% vs. 21.9% (p > 0.05) and 8.2% vs. 16.9% (p < 0.05), respectively. Conclusions Both techniques showed excellent target coverage. With IGBT dose to normal tissues was lower than with VMAT. The results prove the superiority of IGBT in the protection of OARs and the important role of this invasive method in the era of new external beam techniques.

Can FDG-PET assist in radiotherapy target volume definition of metastatic lymph nodes in head-and-neck cancer?

2009 ◽  
Vol 91 (1) ◽  
pp. 95-100 ◽  
Author(s):  
Dominic A.X. Schinagl ◽  
Aswin L. Hoffmann ◽  
Wouter V. Vogel ◽  
Jorn A. van Dalen ◽  
Suzan M.M. Verstappen ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Lymph Nodes ◽  
Head And Neck ◽  
Neck Cancer ◽  
Fdg Pet ◽  
Target Volume ◽  
Metastatic Lymph Nodes ◽  
Target Volume Definition ◽  
Metastatic Lymph ◽  
Definition Of

Head and Neck Cancer: Impact of Induction Chemotherapy on Target Volume Definition

2009 ◽  
Vol 75 (3) ◽  
pp. S428-S429
Author(s):  
C. Guerder ◽  
L. Padovani ◽  
B. Farnault ◽  
F. Peretti ◽  
C. Mercier ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Induction Chemotherapy ◽  
Neck Cancer ◽  
Target Volume ◽  
Target Volume Definition
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