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Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer

PURPOSE: Intensity-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 targe...

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Autores principales: Bollen, Heleen, van der Veen, Julie, Laenen, Annouschka, Nuyts, Sandra
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483718/
https://www.ncbi.nlm.nih.gov/pubmed/34604056
http://dx.doi.org/10.3389/fonc.2021.720052
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author Bollen, Heleen
van der Veen, Julie
Laenen, Annouschka
Nuyts, Sandra
author_facet Bollen, Heleen
van der Veen, Julie
Laenen, Annouschka
Nuyts, Sandra
author_sort Bollen, Heleen
collection PubMed
description PURPOSE: Intensity-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. METHODS: Between 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). RESULTS: Median 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). CONCLUSION: Target 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.
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spelling pubmed-84837182021-10-01 Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer Bollen, Heleen van der Veen, Julie Laenen, Annouschka Nuyts, Sandra Front Oncol Oncology PURPOSE: Intensity-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. METHODS: Between 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). RESULTS: Median 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). CONCLUSION: Target 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. Frontiers Media S.A. 2021-09-16 /pmc/articles/PMC8483718/ /pubmed/34604056 http://dx.doi.org/10.3389/fonc.2021.720052 Text en Copyright © 2021 Bollen, van der Veen, Laenen and Nuyts https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Oncology
Bollen, Heleen
van der Veen, Julie
Laenen, Annouschka
Nuyts, Sandra
Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title_full Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title_fullStr Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title_full_unstemmed Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title_short Recurrence Patterns After IMRT/VMAT in Head and Neck Cancer
title_sort recurrence patterns after imrt/vmat in head and neck cancer
topic Oncology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8483718/
https://www.ncbi.nlm.nih.gov/pubmed/34604056
http://dx.doi.org/10.3389/fonc.2021.720052
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