Clinical Experience of Intra-tumoral Central-Dose Escalated Volumetric Modulated Arc Therapy for Lymph Node Metastases in Patients With Advanced Cancer

Background Lymph node metastases (LN mets) are radioresistant, and high-dose irradiation is preferred for their control. The volumetric-modulated arc therapy technique makes it possible to perform intra-tumoral dose escalation without increasing the total prescribed dose of fractionated irradiation. We report its clinical experiences with intra-tumoral central-dose escalated volumetric-modulated arc therapy (ICE-VMAT) for LN mets. Materials and methods This study retrospectively evaluated 31 patients with 50 LN mets from stage III and IV advanced cancers who received ICE-VMAT. The total described dose was 50 Gy, and the median intra-tumoral central dose was 66 Gy (range, 54-79 Gy). Results The median follow-up period was 21 months. The two-year local control and overall survival (OS) rates were 95% and 56%, whereas univariate analysis revealed that the KPS ≥ 80 group had a significantly better OS compared to the KPS < 80 group. Conclusion ICE-VMAT was effective for LN mets. Patients with good KPS may benefit from therapeutic intervention with ICE-VMAT, even if they have multiple distant LN mets.