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Unilateral and bilateral neck SIB for head and neck cancer patients

Intensity-modulated proton therapy, tomotherapy, and RapidArc

Unilateraler und bilateraler zervikaler SIB für Patienten mit Kopf-Hals-Tumoren

Intensitätsmodulierte Protonentherapie, Tomotherapie und RapidArc

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Abstract

Aim

To compare simultaneous integrated boost plans for intensity-modulated proton therapy (IMPT), helical tomotherapy (HT), and RapidArc therapy (RA) for patients with head and neck cancer.

Patients and methods

A total of 20 patients with squamous cell carcinoma of the head and neck received definitive chemoradiation with bilateral (n = 14) or unilateral (n = 6) neck irradiation and were planned using IMPT, HT, and RA with 54.4, 60.8, and 70.4 GyE/Gy in 32 fractions. Dose distributions, coverage, conformity, homogeneity to planning target volumes (PTV)s and sparing of organs at risk and normal tissue were compared.

Results

All unilateral and bilateral plans showed excellent PTV coverage and acceptable dose conformity. For unilateral treatment, IMPT delivered substantially lower mean doses to contralateral salivary glands (< 0.001–1.1 Gy) than both rotational techniques did (parotid gland: 6–10 Gy; submandibular gland: 15–20 Gy). Regarding the sparing of classical organs at risk for bilateral treatment, IMPT and HT were similarly excellent and RA was satisfactory.

Conclusion

For unilateral neck irradiation, IMPT may minimize the dry mouth risk in this subgroup but showed no advantage over HT for bilateral neck treatment regarding classical organ–at-risk sparing. All methods satisfied modern standards regarding toxicity and excellent target coverage for unilateral and bilateral treatment of head and neck cancer at the planning level.

Zusammenfassung

Hintergrund

Planvergleich von intensitätsmodulierter Protonentherapie (IMPT), Tomotherapie (HT) und RapidArc-Therapie (RA) für Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region unter Anwendung des simultan integrierten Boost-Konzepts (SIB).

Patienten und Methodik

Für 20 Patienten mit Plattenepithelkarzinomen der Kopf-Hals-Region und bilateraler (n = 14) oder unilateraler (n = 6) zervikaler primärer Radiochemotherapie erfolgte eine IMPT-, HT- und RA-Planung mit 54,4, 60,8 und 70,4 GyE/Gy in 32 Fraktionen. Die Dosisverteilung, Abdeckung, Konformität und Homogenität der PTVs sowie die Risikoorgan- und Normalgewebeschonung wurden verglichen.

Ergebnisse

Alle uni- und bilateralen Pläne zeigten eine exzellente PTV-Abdeckung bei akzeptabler Konformität. IMPT erreichte in der unilateralen Bestrahlungssituation eine wesentlich geringere mittlere Dosis an den kontralateralen Speicheldrüsen (< 0,001–1,1 Gy) als beide Photonentechniken (Glandula parotidea: 6–10 Gy; Glandula submandibularis: 15–20 Gy). In der bilateralen Behandlungssituation scheint die IMPT im Vergleich zur HT keine Vorteile für die klassische Risikoorganschonung zu haben. RA erreichte eine zufriedenstellend gute Risikoorganschonung.

Schlussfolgerung

Durch IMPT konnte in der Patientensubgruppe mit unilateraler Bestrahlung das potentielle Risiko für eine permanente Xerostomie wesentlich reduziert werden. Bei bilateraler Bestrahlung erscheint die Schonung von klassischen Risikoorganen durch die HT vergleichbar gut. Alle untersuchten Bestrahlungsmethoden konnten sowohl für die unilaterale als auch die bilaterale Bestrahlung von Patienten mit Kopf-Hals-Tumoren moderne Bestrahlungsplanungsvorgaben im Sinne einer Limitierung von Nebenwirkungen bei gleichzeitig exzellenter Zielvolumenabdeckung erreichen.

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Acknowledgments

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Authors and Affiliations

  1. Department of Radiation Oncology and Radiotherapy, Charité—Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Germany

    Carmen Stromberger M.D., Volker Budach M.D., Ph.D., Pirus Ghadjar M.D., Waldemar Wlodarczyk Ph.D. & Simone Marnitz M.D.

  2. Radiotherapy and Radiosurgery Department, Humanitas Cancer Center Milan, Milan, Italy

    Luca Cozzi Ph.D. & Antonella Fogliata M.D.

  3. Praxis für Strahlentherapie, Klinikum Frankfurt Oder, Frankfurt Oder, Germany

    Basil Jamil M.D.

  4. Clinic for Oral and Maxillofacial Surgery, Berlin, Germany

    Jan D. Raguse M.D., D.M.D.

  5. Department of Otorhinolaryngology, Charité—Universitätsmedizin Berlin, Berlin, Germany

    Arne Böttcher M.D.

Authors
  1. Carmen Stromberger M.D.
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  2. Luca Cozzi Ph.D.
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  3. Volker Budach M.D., Ph.D.
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  4. Antonella Fogliata M.D.
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  5. Pirus Ghadjar M.D.
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  6. Waldemar Wlodarczyk Ph.D.
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  7. Basil Jamil M.D.
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  8. Jan D. Raguse M.D., D.M.D.
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  10. Simone Marnitz M.D.
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Corresponding author

Correspondence to Carmen Stromberger M.D..

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Conflict of interest

L. Cozzi acts as Scientific Advisor to Varian Medical Systems and is Clinical Research Scientist at Humanitas Cancer Center. C. Stromberger, V. Budach, A. Fogliata, P. Ghadjar, W. Wlodarczyk, B. Jamil, J.D. Raguse, A. Böttcher and S. Marnitz state that there are no conflicts of interest.

This study was approved by the Institutional Review Board of the Charité Universitätsmedizin Berlin.

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Stromberger, C., Cozzi, L., Budach, V. et al. Unilateral and bilateral neck SIB for head and neck cancer patients. Strahlenther Onkol 192, 232–239 (2016). https://doi.org/10.1007/s00066-016-0945-4

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  • DOI: https://doi.org/10.1007/s00066-016-0945-4

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