4π noncoplanar stereotactic body radiation therapy for head-and-neck cancer: Potential to improve tumor control and late toxicity

Jean Claude M. Rwigema, Dan Nguyen, Dwight E. Heron, Allen M. Chen, Percy Lee, Pin Chieh Wang, John A. Vargo, Daniel A. Low, M. Saiful Huq, Stephen Tenn, Michael L. Steinberg, Patrick Kupelian, Ke Sheng

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38 Scopus citations

Abstract

Purpose: To evaluate the potential benefit of 4π radiation therapy in recurrent, locally advanced, or metastatic head-and-neck cancer treated with stereotactic body radiation therapy (SBRT). Methods and Materials: Twenty-seven patients with 29 tumors who were treated using SBRT were included. In recurrent disease (n=26), SBRT was delivered with a median 44 Gy (range, 35-44 Gy) in 5 fractions. Three patients with sinonasal mucosal melanoma, metastatic breast cancer, and primary undifferentiated carcinoma received 35 Gy, 22.5 Gy, and 40 Gy in 5 fractions, respectively. Novel 4π treatment plans were created for each patient to meet the objective that 95% of the planning target volume was covered by 100% of the prescription dose. Doses to organs at risk (OARs) and 50% dose spillage volumes were compared against the delivered clinical SBRT plans. Local control (LC), late toxicity, tumor control probability (TCP), and normal tissue complication probability were determined. Results: Using 4π plans, mean/maximum doses to all OARs were reduced by 22% to 89%/10% to 86%. With 4π plans, the 50% dose spillage volume was decreased by 33%. Planning target volume prescription dose escalation by 10 Gy and 20 Gy were achieved while keeping doses to OARs significantly improved or unchanged from clinical plans, except for the carotid artery maximum dose at 20-Gy escalation. At a median follow-up of 10 months (range, 1-41 months), crude LC was 52%. The 2-year LC of 39.2% approximated the predicted mean TCP of 42.2%, which increased to 45.9% with 4p plans. For 10-Gy and 20-Gy dose escalation, 4p plans increased TCP from 80.1% and 88.1% to 85.5% and 91.4%, respectively. The 7.4% rate of grade >3 late toxicity was comparable to the predicted 5.6% mean normal tissue complication probability for OARs, which was significantly reduced by 4p planning at the prescribed and escalated doses. Conclusions: 4p plans may allow dose escalation with significant and consistent improvements in critical organ sparing, tumor control, and coverage.

Original languageEnglish (US)
Pages (from-to)401-409
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume91
Issue number2
DOIs
StatePublished - Jan 1 2015

ASJC Scopus subject areas

  • Radiation
  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Cancer Research

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    Rwigema, J. C. M., Nguyen, D., Heron, D. E., Chen, A. M., Lee, P., Wang, P. C., Vargo, J. A., Low, D. A., Huq, M. S., Tenn, S., Steinberg, M. L., Kupelian, P., & Sheng, K. (2015). 4π noncoplanar stereotactic body radiation therapy for head-and-neck cancer: Potential to improve tumor control and late toxicity. International Journal of Radiation Oncology Biology Physics, 91(2), 401-409. https://doi.org/10.1016/j.ijrobp.2014.09.043