Reduction of Elective Radiotherapy Treatment Volume in Definitive Treatment of Locally Advanced Head and Neck Cancer—Comparison of a Prospective Trial with a Revised Simulated Contouring Approach

Weissmann, Thomas ; Speer, Stefan ; Putz, Florian ; Lettmaier, Sebastian ; Schubert, Philipp ; Shariff, Maya ; Semrau, Sabine ; Gostian, Antoniu-Oreste ; Traxdorf, Maximilian ; Mueller, Sarina K. ; Eckstein, Markus ; Hautmann, Matthias ; von der Grün, Jens ; Haderlein, Marlen ; Frey, Benjamin ; Gaipl, Udo S. ; Bert, Christoph ; Iro, Heinrich ; Fietkau, Rainer ; Hecht, Markus

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Details

Item type:	Article
Journal or Publication Title:	Journal of Clinical Medicine
Publisher:	MDPI
Place of Publication:	BASEL
Volume:	10
Number of Issue or Book Chapter:	20
Page Range:	p. 4653
Date:	2021
Institutions:	Medicine > Lehrstuhl für Strahlentherapie
Identification Number:	Value Type 10.3390/jcm10204653 DOI
Keywords:	SQUAMOUS-CELL CARCINOMA; MODULATED RADIATION-THERAPY; FALSE DISCOVERY RATE; CAROTID STENOSIS; ORAL TONGUE; NCIC CTG; DELINEATION; CHEMOTHERAPY; RISK; CHEMORADIOTHERAPY; de-intensification; radiotherapy; head neck cancer; definitive treatment; volume reduction; salivary glands; swallowing function
Dewey Decimal Classification:	600 Technology > 610 Medical sciences Medicine
Status:	Published
Refereed:	Yes, this version has been refereed
Created at the University of Regensburg:	Yes
Item ID:	56501

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Abstract

Definitive radiochemotherapy of locally advanced head and neck squamous cell cancer (HNSCC) achieves high locoregional tumor control rates; but is frequently associated with long-term toxicity. A future direction could be a de-escalation strategy focusing on treated volume rather than radiotherapy dose. This analysis evaluates radiotherapy dose and volume parameters of patients treated with a ...

Abstract

Definitive radiochemotherapy of locally advanced head and neck squamous cell cancer (HNSCC) achieves high locoregional tumor control rates; but is frequently associated with long-term toxicity. A future direction could be a de-escalation strategy focusing on treated volume rather than radiotherapy dose. This analysis evaluates radiotherapy dose and volume parameters of patients treated with a standard contouring approach in a clinical trial context compared with a revised volume-reduced contouring approach. In this case, 30 consecutive patients from the CheckRad-CD8 trial treated at a single study center were included in this analysis. Treatment toxicity and quality of life were assessed at the end of radiotherapy. Standard treatment plans (ST) following state of the art contouring guidelines that were used for patient treatment and volume reduced treatment plans (VRT) according to a revised simulated approach were calculated for each patient. Planning target volumes (PTV) and mean doses to 38 organs-at-risk structures were compared. At the end of radiotherapy patients reported high rates of mucositis; dysphagia and xerostomia. In addition; patient reported quality of life as assessed by the EORTC QLQ-HN35 questionnaire deteriorated. Comparing the two contouring approaches; the elective PTV_56 Gy and the high risk PTV_63 Gy (shrinking field) were significantly smaller in the VRT group. Significant reduction of mean dose to structures of the oral cavity; the larynx as well as part of the swallowing muscles and the submandibular glands was achieved in the simulated VRT-plan. Treatment de-intensification by reduction of the irradiated volume could potentially reduce treatment volume and mean doses to organs at risk. The proposed contouring approach should be studied further in the context of a clinical trial.

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Metadata last modified: 29 Feb 2024 12:28

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