The impact of margin reduction on outcome and toxicity in head and neck cancer patients treated with image-guided volumetric modulated arc therapy (VMAT)

Autor: Arash Navran, Wilma D. Heemsbergen, Olga Hamming-Vrieze, Marcel Verheij, Tomas Janssen, Charlotte L. Zuur, Abrahim Al-Mamgani, Marcel C.J. Jonker, Michiel W. M. van den Brekel, Peter Remeijer, Jan-Jakob Sonke
Přispěvatelé: Radiotherapy
Rok vydání: 2019
Předmět:
Male
medicine.medical_specialty
medicine.medical_treatment
Planning target volume
Urology
Disease-Free Survival
030218 nuclear medicine & medical imaging
03 medical and health sciences
0302 clinical medicine
SDG 3 - Good Health and Well-being
medicine
Mucositis
Humans
Radiology
Nuclear Medicine and imaging
Radiation Injuries
business.industry
Incidence (epidemiology)
Incidence
Radiotherapy Planning
Computer-Assisted
Head and neck cancer
Radiotherapy Dosage
Hematology
Chemoradiotherapy
Adjuvant
Cone-Beam Computed Tomography
Middle Aged
medicine.disease
Volumetric modulated arc therapy
Dysphagia
Radiation therapy
Treatment Outcome
Oncology
Head and Neck Neoplasms
030220 oncology & carcinogenesis
Toxicity
Female
Radiotherapy
Intensity-Modulated
medicine.symptom
business
Radiotherapy
Image-Guided
Rare cancers Radboud Institute for Health Sciences [Radboudumc 9]
Zdroj: Radiotherapy and Oncology, 130, 1, pp. 25-31
Radiotherapy and Oncology, 130, 25-31. Elsevier Ireland Ltd
Radiotherapy and Oncology, 130, 25-31
ISSN: 0167-8140
DOI: 10.1016/j.radonc.2018.06.032
Popis: Contains fulltext : 203208.pdf (Publisher’s version ) (Closed access) BACKGROUND AND PURPOSE: In recent decades, outcomes of patients with head and neck cancer (HNC) have improved as a result of implementing several strategies, such as chemoradiation. However, these improvements were achieved at the cost of increased toxicity. One way to reduce radiation-related toxicity is by reducing the margins. MATERIALS AND METHODS: Between 2013 and 2016, 206 consecutive patients were treated with CTV-PTV margin of 5mm and subsequently 208 patients with 3mm margin. This study evaluates the impact of reducing clinical target volume (CTV) to planning target volume (PTV) margin on outcome and toxicity. RESULTS: All patients were treated with volumetric modulated arc therapy (VMAT) with daily-image guidance using cone-beam CT (CBCT). Overall acute grade 3 toxicity was significantly lower in 3mm-group, compared to 5mm-group (53.8% vs. 65%, respectively, p=0.032). The same was true for acute grade 3 mucositis (30.8% vs. 42.2%, p=0.008) and for acute grade 3 dysphagia (feeding tube-dependence) (22.1% vs. 33.5%, p=0.026). The incidence of ongoing feeding tube-dependence after 3months of radiotherapy was 11.1% and 20.4%, respectively (p=0.012). The 2-year incidence of late grade >/=2 xerostomia was 15.8% and 19.4% (p=0.8). The 2-year loco-regional control rates of patients treated in 3mm and 5mm-groups were 79.9% and 79.2% (p=1.0). The figures for disease-free survival were 71.5% and 72.7 (p=0.6) and for overall survival were 75.2% and 75.1% (p=0.9). CONCLUSION: Reducing the CTV-PTV margin from 5 to 3mm combined with daily CBCT-guided VMAT reduced the severity, frequency, and duration of radiation-related toxicity without jeopardizing outcome. 7 p.
Databáze: OpenAIRE
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