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Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

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Title: Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial
Authors: Schwartz, David L.1,2,3 dschwartz3@nshs.edu, Garden, Adam S.3, Thomas, Jimmy3, Chen, Yipei4, Zhang, Yongbin4, Lewin, Jan5, Chambers, Mark S.5, Dong, Lei4
Source: International Journal of Radiation Oncology, Biology, Physics. Jul2012, Vol. 83 Issue 3, p986-993. 8p.
Subjects: Cancer radiotherapy, Head & neck cancer treatment, Health outcome assessment, Longitudinal method, Pharyngeal cancer, Squamous cell carcinoma
Abstract: Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board–approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13–45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond. [ABSTRACT FROM AUTHOR]
Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)
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  Data: <searchLink fieldCode="AR" term="%22Schwartz%2C+David+L%2E%22">Schwartz, David L.</searchLink><relatesTo>1,2,3</relatesTo><i> dschwartz3@nshs.edu</i><br /><searchLink fieldCode="AR" term="%22Garden%2C+Adam+S%2E%22">Garden, Adam S.</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Thomas%2C+Jimmy%22">Thomas, Jimmy</searchLink><relatesTo>3</relatesTo><br /><searchLink fieldCode="AR" term="%22Chen%2C+Yipei%22">Chen, Yipei</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Zhang%2C+Yongbin%22">Zhang, Yongbin</searchLink><relatesTo>4</relatesTo><br /><searchLink fieldCode="AR" term="%22Lewin%2C+Jan%22">Lewin, Jan</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Chambers%2C+Mark+S%2E%22">Chambers, Mark S.</searchLink><relatesTo>5</relatesTo><br /><searchLink fieldCode="AR" term="%22Dong%2C+Lei%22">Dong, Lei</searchLink><relatesTo>4</relatesTo>
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  Data: <searchLink fieldCode="JN" term="%22International+Journal+of+Radiation+Oncology%2C+Biology%2C+Physics%22">International Journal of Radiation Oncology, Biology, Physics</searchLink>. Jul2012, Vol. 83 Issue 3, p986-993. 8p.
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  Data: <searchLink fieldCode="DE" term="%22Cancer+radiotherapy%22">Cancer radiotherapy</searchLink><br /><searchLink fieldCode="DE" term="%22Head+%26+neck+cancer+treatment%22">Head & neck cancer treatment</searchLink><br /><searchLink fieldCode="DE" term="%22Health+outcome+assessment%22">Health outcome assessment</searchLink><br /><searchLink fieldCode="DE" term="%22Longitudinal+method%22">Longitudinal method</searchLink><br /><searchLink fieldCode="DE" term="%22Pharyngeal+cancer%22">Pharyngeal cancer</searchLink><br /><searchLink fieldCode="DE" term="%22Squamous+cell+carcinoma%22">Squamous cell carcinoma</searchLink>
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  Data: Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma. Methods and Materials: A total of 24 patients were enrolled in an institutional review board–approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy. Results: With a 31-month median follow-up (range, 13–45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated. Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond. [ABSTRACT FROM AUTHOR]
– Name: AbstractSuppliedCopyright
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  Data: <i>Copyright of International Journal of Radiation Oncology, Biology, Physics is the property of Pergamon Press - An Imprint of Elsevier Science and its content may not be copied or emailed to multiple sites without the copyright holder's express written permission. Additionally, content may not be used with any artificial intelligence tools or machine learning technologies. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract.</i> (Copyright applies to all Abstracts.)
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        Type: general
      – SubjectFull: Head & neck cancer treatment
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      – SubjectFull: Health outcome assessment
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      – SubjectFull: Pharyngeal cancer
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              Text: Jul2012
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