Patterns-of-failure after helical tomotherapy-based chemoradiotherapy for head and neck cancer: Implications for CTV margin, elective nodal dose and bilateral parotid sparing

Virag Dandekar, Tiffany Morgan, Julius Turian, Mary Jo Fidler, John Showel, Thomas Nielsen, Joy Coleman, Aidnag Diaz, David J. Sher

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Objectives There is debate about the optimal clinical target volume (CTV) expansion and prophylactic nodal dose (PND) in head and neck IMRT. We evaluated our patterns-of-failure (POF) after helical tomotherapy-based concurrent chemoradiotherapy (CCRT) to assess the oncologic safety of reducing the CTV, PND, and bilateral parotid sparing (BPS). Materials and Methods All patients with locally advanced squamous cell carcinoma of the head and neck treated with curative intent CCRT between January 2007 and April 2013 at a single institution were included in this retrospective study. Locoregional recurrences (LRR) were overlaid on the treatment plan, and POF was determined relative to planned dose. Results One hundred and fourteen patients treated with CCRT were evaluated, 74% of whom underwent BPS. The median follow-up for surviving patients was 29.3 months. The 3-year cumulative incidence of locoregional failure, distant metastasis, progression-free and overall survival were 20%, 20%, 56% and 73% respectively. The local failures (n = 12) were either entirely contained within or centered on the original gross tumor volume (GTV), and all but 2 regional recurrences were in GTV. There were no nodal failures in the low-dose or peri-parotid neck (including ipsilateral neck). Discussion Nearly all LRR were located within the GTV suggesting that minimal-to-zero margin is required for CTV 70. The nodal recurrence pattern suggests the safety of routine bilateral parotid sparing and relatively low biologically equivalent dose (54 Gy in 33fx) to the low-risk neck.

Original languageEnglish (US)
Pages (from-to)520-526
Number of pages7
JournalOral Oncology
Volume50
Issue number5
DOIs
StatePublished - Jan 1 2014

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Intensity-Modulated Radiotherapy
Chemoradiotherapy
Head and Neck Neoplasms
Neck
Tumor Burden
Recurrence
Safety
Disease-Free Survival
Retrospective Studies
Head
Neoplasm Metastasis
Incidence
Therapeutics

Keywords

  • Combined modality therapy
  • Head and neck cancer
  • IMRT
  • Parotid sparing
  • Pattern-of-failure

ASJC Scopus subject areas

  • Oral Surgery
  • Oncology
  • Cancer Research

Cite this

Patterns-of-failure after helical tomotherapy-based chemoradiotherapy for head and neck cancer : Implications for CTV margin, elective nodal dose and bilateral parotid sparing. / Dandekar, Virag; Morgan, Tiffany; Turian, Julius; Fidler, Mary Jo; Showel, John; Nielsen, Thomas; Coleman, Joy; Diaz, Aidnag; Sher, David J.

In: Oral Oncology, Vol. 50, No. 5, 01.01.2014, p. 520-526.

Research output: Contribution to journalArticle

Dandekar, Virag ; Morgan, Tiffany ; Turian, Julius ; Fidler, Mary Jo ; Showel, John ; Nielsen, Thomas ; Coleman, Joy ; Diaz, Aidnag ; Sher, David J. / Patterns-of-failure after helical tomotherapy-based chemoradiotherapy for head and neck cancer : Implications for CTV margin, elective nodal dose and bilateral parotid sparing. In: Oral Oncology. 2014 ; Vol. 50, No. 5. pp. 520-526.
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abstract = "Objectives There is debate about the optimal clinical target volume (CTV) expansion and prophylactic nodal dose (PND) in head and neck IMRT. We evaluated our patterns-of-failure (POF) after helical tomotherapy-based concurrent chemoradiotherapy (CCRT) to assess the oncologic safety of reducing the CTV, PND, and bilateral parotid sparing (BPS). Materials and Methods All patients with locally advanced squamous cell carcinoma of the head and neck treated with curative intent CCRT between January 2007 and April 2013 at a single institution were included in this retrospective study. Locoregional recurrences (LRR) were overlaid on the treatment plan, and POF was determined relative to planned dose. Results One hundred and fourteen patients treated with CCRT were evaluated, 74{\%} of whom underwent BPS. The median follow-up for surviving patients was 29.3 months. The 3-year cumulative incidence of locoregional failure, distant metastasis, progression-free and overall survival were 20{\%}, 20{\%}, 56{\%} and 73{\%} respectively. The local failures (n = 12) were either entirely contained within or centered on the original gross tumor volume (GTV), and all but 2 regional recurrences were in GTV. There were no nodal failures in the low-dose or peri-parotid neck (including ipsilateral neck). Discussion Nearly all LRR were located within the GTV suggesting that minimal-to-zero margin is required for CTV 70. The nodal recurrence pattern suggests the safety of routine bilateral parotid sparing and relatively low biologically equivalent dose (54 Gy in 33fx) to the low-risk neck.",
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T1 - Patterns-of-failure after helical tomotherapy-based chemoradiotherapy for head and neck cancer

T2 - Implications for CTV margin, elective nodal dose and bilateral parotid sparing

AU - Dandekar, Virag

AU - Morgan, Tiffany

AU - Turian, Julius

AU - Fidler, Mary Jo

AU - Showel, John

AU - Nielsen, Thomas

AU - Coleman, Joy

AU - Diaz, Aidnag

AU - Sher, David J.

PY - 2014/1/1

Y1 - 2014/1/1

N2 - Objectives There is debate about the optimal clinical target volume (CTV) expansion and prophylactic nodal dose (PND) in head and neck IMRT. We evaluated our patterns-of-failure (POF) after helical tomotherapy-based concurrent chemoradiotherapy (CCRT) to assess the oncologic safety of reducing the CTV, PND, and bilateral parotid sparing (BPS). Materials and Methods All patients with locally advanced squamous cell carcinoma of the head and neck treated with curative intent CCRT between January 2007 and April 2013 at a single institution were included in this retrospective study. Locoregional recurrences (LRR) were overlaid on the treatment plan, and POF was determined relative to planned dose. Results One hundred and fourteen patients treated with CCRT were evaluated, 74% of whom underwent BPS. The median follow-up for surviving patients was 29.3 months. The 3-year cumulative incidence of locoregional failure, distant metastasis, progression-free and overall survival were 20%, 20%, 56% and 73% respectively. The local failures (n = 12) were either entirely contained within or centered on the original gross tumor volume (GTV), and all but 2 regional recurrences were in GTV. There were no nodal failures in the low-dose or peri-parotid neck (including ipsilateral neck). Discussion Nearly all LRR were located within the GTV suggesting that minimal-to-zero margin is required for CTV 70. The nodal recurrence pattern suggests the safety of routine bilateral parotid sparing and relatively low biologically equivalent dose (54 Gy in 33fx) to the low-risk neck.

AB - Objectives There is debate about the optimal clinical target volume (CTV) expansion and prophylactic nodal dose (PND) in head and neck IMRT. We evaluated our patterns-of-failure (POF) after helical tomotherapy-based concurrent chemoradiotherapy (CCRT) to assess the oncologic safety of reducing the CTV, PND, and bilateral parotid sparing (BPS). Materials and Methods All patients with locally advanced squamous cell carcinoma of the head and neck treated with curative intent CCRT between January 2007 and April 2013 at a single institution were included in this retrospective study. Locoregional recurrences (LRR) were overlaid on the treatment plan, and POF was determined relative to planned dose. Results One hundred and fourteen patients treated with CCRT were evaluated, 74% of whom underwent BPS. The median follow-up for surviving patients was 29.3 months. The 3-year cumulative incidence of locoregional failure, distant metastasis, progression-free and overall survival were 20%, 20%, 56% and 73% respectively. The local failures (n = 12) were either entirely contained within or centered on the original gross tumor volume (GTV), and all but 2 regional recurrences were in GTV. There were no nodal failures in the low-dose or peri-parotid neck (including ipsilateral neck). Discussion Nearly all LRR were located within the GTV suggesting that minimal-to-zero margin is required for CTV 70. The nodal recurrence pattern suggests the safety of routine bilateral parotid sparing and relatively low biologically equivalent dose (54 Gy in 33fx) to the low-risk neck.

KW - Combined modality therapy

KW - Head and neck cancer

KW - IMRT

KW - Parotid sparing

KW - Pattern-of-failure

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