Treatment of neck nodesRecurrence patterns after a decreased dose of 40 Gy to the elective treated neck in head and neck cancer
Section snippets
Methods and materials
Two hundred thirty-three patients that were included in 3 prospective randomized studies, were analyzed in the current study. All patients were treated with definitive radiotherapy or chemoradiotherapy for head and neck cancer between 2009 and 2015. The dose to the elective nodal volume was 40 Gy (EQD2Gy) in all patients. All patients received a CT study with contrast to assess the nodal status before treatment. If indicated further imaging with PET-CT, ultrasound or MRI of the neck was
Results
The patient characteristics can be found in Table 1. All 233 patients received IMRT, of which 142 received concomitant systemic therapy (61%), of which 134 received Cisplatinum (94%). Eight patients were treated with Cetuximab. Only a small minority of patients underwent induction chemotherapy (2%). Thirty-four patients underwent neck dissection prior to IMRT. Patients with various tumor stages were included (cT1-4 N0-2 M0), of which a majority of 69% had a stage IVA-B tumor. Stage I (2%),
Discussion
RT for HNC has significantly changed over the past decades. We hypothesize that, thanks to more accurate nodal staging, more precise treatment planning and delivery and the improved outcome using both concurrent chemotherapy and altered fractionation schedules, lower doses may be sufficient.
The purpose of this study was therefore to investigate the patterns of regional recurrence, and more specifically recurrences in the elective regions, following dose de-escalation to an EQD2Gy of 40 Gy to the
Conflict of interest
None to declare.
References (29)
- et al.
Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis
Lancet
(2006) - et al.
Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): a comprehensive analysis by tumour site
Radiother Oncol
(2011) - et al.
Impact of adding concomitant chemotherapy to hyperfractionated accelerated radiotherapy for advanced head-and-neck squamous cell carcinoma
Int J Radiat Oncol Biol Phys
(2009) - et al.
A predictive model for swallowing dysfunction after curative radiotherapy in head and neck cancer
Radiother Oncol
(2009) - et al.
Dysphagia after chemoradiotherapy for head-and-neck squamous cell carcinoma: dose–effect relationships for the swallowing structures
Int J Radiat Oncol Biol Phys
(2009) - et al.
Dysphagia disorders in patients with cancer of the oropharynx are significantly affected by the radiation therapy dose to the superior and middle constrictor muscle: a dose–effect relationship
Radiother Oncol
(2007) - et al.
Predictive modelling for swallowing dysfunction after primary (chemo)radiation: results of a prospective observational study
Radiother Oncol
(2012) - et al.
Reduction of the dose to the elective neck in head and neck squamous cell carcinoma, a randomized clinical trial using intensity modulated radiotherapy (IMRT). Dosimetrical analysis and effect on acute toxicity
Radiother Oncol
(2013) Reduction of the dose of radiotherapy to the elective neck in head and neck squamous cell carcinoma; a randomized clinical trial. Effect on late toxicity and tumor control
Radiother Oncol
(2017)- et al.
Proposal for the delineation of the nodal CTV in the node-positive and the post-operative neck
Radiother Oncol
(2006)
Selection and delineation of lymph node target volumes in head and neck conformal radiotherapy. Proposal for standardizing terminology and procedure based on the surgical experience
Radiother Oncol
Three-phase adaptive dose-painting-by-numbers for head-and-neck cancer: initial results of the phase I clinical trial
Radiother Oncol
Patterns of failure in patients receiving definitive and postoperative IMRT for head-and-neck cancer
Int J Radiat Oncol Biol Phys
Recurrences after intensity modulated radiotherapy for head and neck squamous cell carcinoma more likely to originate from regions with high baseline [18F]-FDG uptake
Radiother Oncol
Cited by (24)
High Recurrence for HPV-Positive Oropharyngeal Cancer With Neoadjuvant Radiation Therapy to Gross Disease Plus Immunotherapy: Analysis From a Prospective Phase Ib/II Clinical Trial
2023, International Journal of Radiation Oncology Biology PhysicsDose and volume de-escalation of radiotherapy in head and neck cancer
2023, Critical Reviews in Oncology/HematologyHead and neck cancers volume reduction: should we reduce our prophylactic node radiation to spare the antitumor immune response?
2022, Cancer/RadiotherapieCitation Excerpt :Average doses of 40 Gy appear to be sufficient to sterilize metastatic nodes with a diameter of less than 5 mm. This was evaluated in a trial comparing two different dose levels for prophylactic cervical volume (a standard dose of 50 Gy and a reduced dose of 40 Gy) [20]. Toxicity was decreased in the 40 Gy arm, while achieving identical regional control to the 50 Gy arm.
Individualized Prophylactic Neck Irradiation in Patients with cN0 Head and Neck Cancer Based on Sentinel Lymph Node(s) Identification: Definitive Results of a Prospective Phase 1-2 Study
2020, International Journal of Radiation Oncology Biology PhysicsCitation Excerpt :As a consequence, the required dose may be lower.38 A recent multicenter randomized controlled trial assessed an elective dose of 40 Gy (EQD2Gy) compared with 50 Gy (EQD2Gy) and showed a significant reduction of salivary toxicity and a trend toward less dysphagia at 6 months post-EOT in the 40-Gy arm without statistically significant differences in survival and estimated nodal recurrence rates between the arms.39,40 In a multicenter, phase 2 study about to open, we are going to explore both volume and dose de-escalation strategies to the contralateral ENI volume in HNSCC with ipsilateral positive neck.
Advances in cancer imaging require renewed radiotherapy dose and target volume concepts
2020, Radiotherapy and OncologyBalancing Risks and Benefits of Dose and Volume of Radiation Therapy in a Neck Recurrence From Tongue Cancer
2020, International Journal of Radiation Oncology Biology Physics