Consequences of tumor planning target volume reduction in treatment of T2-T4 laryngeal cancer

Radiation Oncology

Cornelis PJ Raaijmakers¹  Nicolien Kasperts¹  Frank A Pameijer¹  Marielle EP Philippens¹  Chris HJ Terhaard¹  Cornelia AJM Vugts² 

[1] Department of Radiotherapy, University Medical Center Utrecht, Utrecht, The Netherlands;Department of Radiotherapy, Academic Medical Center, Meibergdreef 9, 1105 AZ, Amsterdam, The Netherlands

关键词: NTCP;    Margin reduction;    Laryngeal carcinoma;   

Others  :  1151583
DOI  :  10.1186/1748-717X-9-195

 received in 2013-06-11, accepted in 2014-07-11,  发布年份 2014

【 摘 要 】

Background and purpose

Since lymph nodes volumes are generally four times the volume of the primary PTV, the advantage of using tight margins around the primary PTV is not clear. Therefore treatment margins of T2-T4 laryngeal carcinoma for IMRT are generally chosen in such a way that the PTV is comparable to that in conventional radiotherapy. The aim of this study is to quantify the effect of volume reduction of the primary PTV of T2-T4 laryngeal carcinoma with regard to late toxicity despite elective irradiation of lymph node levels II to IV.

Methods

Two treatment plans based on conservative (GTV-PTV = 15 mm and 20 mm cranial), and on evidence-based tight margins (GTV-PTV = 8 mm) were calculated for 16 patients. Toxicity effects were estimated based on the dose distributions.

Results

Compared to conservative margins, using tight margins resulted in: 1) significant reduction of the normal tissue complication probability (NTCP) for swallowing muscles and submandibular glands, 2) significant reduction of the mean dose in all organs at risk (OAR), 3) a mean dose smaller than 60 Gy for all OARs except for the laryngeal cartilages. When the lymph node levels II to IV were prescribed with an elective dose, an NTCP reduction of 53% for the swallowing muscles and of 23% for the submandibular glands was found by using tight instead of conservative margins. When positive nodes were present, NTCP reduction amounted to 29% and 15%, respectively.

Conclusions

There is a potential benefit in realizing evidence-based tight margins for laryngeal cancer patients despite elective irradiation of lymph node levels II to IV.

【 授权许可】

   
2014 Vugts et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

Figure 3.

Figure 4.

Figure 5.

【 参考文献 】

• [1]Terhaard CH, Kal HB, Hordijk GJ: Why to start the concomitant boost in accelerated radiotherapy for advanced laryngeal cancer in week 3. Int J Radiat Oncol Biol Phys 2005, 62:62-69.
• [2]Overgaard J, Hansen HS, Specht L, Overgaard M, Grau C, Andersen E, Bentzen J, Bastholt L, Hansen O, Johansen J, Andersen L, Evensen JF: Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6&7 randomized controlled trial. Lancet 2003, 20:933-940.
• [3]Rancati T, Schwarz M, Allen AM, Feng F, Popovtzer A, Mittal B, Eisbruch AT: Radiation dose-volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys 2010, 75:64-69.
• [4]Rancati T, Fiorino C, Sanguineti G: NTCP Modeling of subacute/late laryngeal edema scored by fiberoptic examination. Int J Radiat Oncol Biol Phys 2009, 75:915-923.
• [5]Murdoch-Kinch CA, Hyugnjin MK, Vineberg KA, Sip JA, Eisbruch A: Dose-effect relationship for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2007, 72:373-382.
• [6]Osman S, Astreinidou E, Levendag P: IMRT for image-guided single vocal cord irradiation. Int J Radiat Oncol Biol Phys 2009, 93:8-13.
• [7]International Commission on Radiation Units and Measurements: ICRU Report 62. Prescribing, recording and reporting photon beam therapy (supplement to ICRU report 50). Bethesda, M: ICRU; 1999.
• [8]Gomez D, Cahlon O, Mechalakos J, Lee N: An investigation of intensity-modulated radiation therapy versus conventional two-dimensional and 3D-conformal radiation therapy for early stage larynx cancer. Radiat Oncol 2010, 5:74. BioMed Central Full Text
• [9]Jensen K, Lambertsen K, Grau C: Late swallowing dysfunction and dysphagia after radiotherapy for pharynx cancer: frequency, intensity and correlation with dose and volume parameters. Radiother Oncol 2007, 85(suppl.1):74-82.
• [10]Eisbruch A, Gregoire V: Balancing risk and reward in target delineation for highly conformal radiotherapy in head and neck cancer. Semin Radiat Oncol 2009, 19:43-52.
• [11]Studer G, Peponi E, Kloeck S, Dossenbach T, Huber G, Glanzmann C: Surviving hypopharynx-larynx carcinoma in the era of IMRT. Int J Radiat Oncol Biol Phys 2010, 77(suppl. 5):1391-1396.
• [12]Perez and Brandy’s: Principles and practice of Radiation oncology. 5th edition. Lippincott Williams and Wilkins; 2008:228. Chapter 8
• [13]Levendag P, Gregoire V, Hamoir M, Voet P, van der Est H, Heijmen B, Kerrebijn J: Intraoperative validation of CT-based lymph nodal levels, sublevels IIa and IIb: Is it of clinical relevance in selective radiation therapy? Int J Radiat Oncol Biol Phys 2005, 62(suppl. 3):690-699.
• [14]van Asselen B, Raaijmakers CP, Lagendijk JJ, Terhaard CH: Intrafraction motions of the larynx during radiotherapy. Int J Radiat Oncol Biol Phys 2003, 56(suppl. 2):384-390.
• [15]Bradley JA, Paulson ES, Ahunbay E, Schultz C, Li XA, Wang D: Dynamic MRI analysis of tumor and organ motion during rest and deglutition and margin assessment for radiotherapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011, 81(suppl.5):e803-e812.
• [16]Daisne JF, Duprez T, Weynand B, Lonneux M, Hamoir M, Reychler H, Grégoire V: Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR Imaging, and FDG PET and validation with surgical specimen. Radiology 2004, 233:93-100.
• [17]Caldas-Magalhaes J, Kasperts N, Kooij N, van den Berg CA, Terhaard CH, Raaijmakers CP, Philippens ME: Validation of imaging with pathology in laryngeal cancer: accuracy of the registration methodology. Int J Radiat Oncol Biol Phys 2012, 82:e289-e298.
• [18]Caldas-Magalhaes J, Kasperts N, Kooij N, Terhaard CH, Raaijmakers CP, Philippens ME: CTV margin in laryngeal and hypopharyngeal cancer: a histology study [abstract]. Radiother Oncol 2012, 103(suppl. 1):S174-S175.
• [19]Osman SO, de Boer HC, Astreinidou E, Gangsaas A, Heijmen BJ, Levendag PC: On-line cone beam CT image guidance for vocal cord tumor targeting. Radiother Oncol 2009, 93:8-13.
• [20]Houweling A, Meer S, Wal E, Terhaard C, Raaijmakers C: Improved immobilization using an individual head support in head-and-neck cancer patients. Radiother Oncol 2010, 96:100-103.
• [21]Jackson A, Fong B, Setton J, Rao S, Wolden S, Lee N: Dose Response of dysphagia in head and neck cancer patients [abstract]. Int J Radiat Oncol Biol Phys 2011, 81:s27.
• [22]Dijkema T: Salivary gland sparing radiotherapy. PhD thesis. Utrecht University, Utrecht, The Netherlands: Radiotherapy department; 2013:91. Chapter 6
• [23]Eisbruch A, Schwarz M, Rash C: Dysphagia and aspiration after chemoradiotherapy for head-and-neck cancer: which anatomic structures are affected and can they be spared by IMRT. Int J Radiat Oncol Biol Phys 2004, 60(suppl 5):1425-1439.
• [24]Peponi E, Glazmann C, Willi B, Huber G, Studer G: Dysphagia in head-and-neck cancer patients follwoing intensity modulated radiotherapy (IMRT). Radiat Oncol 2011, 6:1. BioMed Central Full Text
• [25]Levendag PC, Teguh DN, Voet P, van der Est H, Noever I, de Kruijf WJ, Kolkman-Deurloo IK, Prevost JB, Poll J, Schmitz PI, Heijmen BJ: 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, 85(suppl 1):64-73.