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Journal of Cancer Research and Clinical Oncology

Published in:

01-04-2020 | Lymphoma | Review – Clinical Oncology

Volume de-escalation in radiation therapy: state of the art and new perspectives

Authors: Bruno Meduri, Fabiana Gregucci, Elisa D’Angelo, Anna Rita Alitto, Elisa Ciurlia, Isacco Desideri, Lorenza Marino, Paolo Borghetti, Michele Fiore, Alba Fiorentino, AIRO Giovani -Italian Association of Radiation Oncology-Young Members

Published in: Journal of Cancer Research and Clinical Oncology | Issue 4/2020

Abstract

Purpose

New RT techniques and data emerging from follow-up for several tumor sites suggest that treatment volume de-escalation may permit to minimize therapy-related side effects and/or obtain better clinical outcomes. Here, we summarize the main evidence about volume de-escalation in RT.

Method

The relevant literature from PubMed was reviewed in this article. The ClinicalTrials.gov database was searched for clinical trials related to the specific topic.

Results

In Lymphoma, large-volume techniques (extended- and involved-field RT) are being successfully replaced by involved-site RT and involved-node RT. In head and neck carcinoma, spare a part of elective neck is controversial. In early breast cancer, partial breast irradiation has been established as a treatment option in low-risk patients. In pancreatic cancer stereotactic body radiotherapy may be used to dose escalation. Stereotactic radiosurgery should be the treatment choice for patients with oligometastatic brain disease and a life expectancy of more than 3 months, and it should be considered an alternative to WBRT for patients with multiple brain metastases.

Conclusion

Further clinical trials are necessary to improve the identification of suitable patient cohorts and the extent of possible volume de-escalation that does not compromise tumor control.

Al-Mamgani A, van Rooij P, Fransen D, Levendag P (2013) Unilateral neck irradiation for well-lateralized oropharyngeal cancer. Radiother Oncol 106:69–73. https://doi.org/10.1016/j.radonc.2012.12.006 CrossRefPubMed

Al-Mamgani A et al (2017) Contralateral regional recurrence after elective unilateral neck irradiation in oropharyngeal carcinoma: a literature-based critical review. Cancer Treat Rev 59:102–108. https://doi.org/10.1016/j.ctrv.2017.07.004 CrossRefPubMed

Alongi F et al (2019) First experience and clinical results using a new non-coplanar mono-isocenter technique (HyperArc) for Linac-based VMAT radiosurgery in brain metastases. J Cancer Res Clin Oncol 145:193–200. https://doi.org/10.1007/s00432-018-2781-7 CrossRefPubMed

Andre MPE et al (2017) Early positron emission tomography response-adapted treatment in stage I and Ii Hodgkin lymphoma: final results of the randomized EORTC/LYSA/FIL H10 Trial. J Clin Oncol 35:1786–1794. https://doi.org/10.1200/JCO.2016.68.6394 CrossRefPubMed

Andrews DW et al (2004) Whole brain radiation therapy with or without stereotactic radiosurgery boost for patients with one to three brain metastases: phase III results of the RTOG 9508 randomised trial. Lancet 363:1665–1672. https://doi.org/10.1016/S0140-6736(04)16250-8 CrossRefPubMed

Ang KK et al (2010) Human papillomavirus and survival of patients with oropharyngeal cancer. N Engl J Med 363:24–35. https://doi.org/10.1056/NEJMoa0912217 CrossRefPubMedPubMedCentral

Aoyama H et al (2006) Stereotactic radiosurgery plus whole-brain radiation therapy vs stereotactic radiosurgery alone for treatment of brain metastases: a randomized controlled trial. JAMA J Am Med Assoc 295:2483–2491. https://doi.org/10.1001/jama.295.21.2483 CrossRef

Baker S, Verduijn G, Petit S, Nuyttens JJ, Sewnaik A, van der Lugt A, Heemsbergen WD (2019) Locoregional failures and their relation to radiation fields following stereotactic body radiotherapy boost for oropharyngeal squamous cell carcinoma. Head Neck 41:1622–1631. https://doi.org/10.1002/hed.25587 CrossRefPubMed

Barrington SF et al. (2014) Role of imaging in the staging and response assessment of lymphoma: consensus of the International Conference on Malignant Lymphomas Imaging Working Group. J Clin Oncol 32:3048–3058 doi:10.1200/JCO.2013.53.5229

Bhatnagar AK, Flickinger JC, Kondziolka D, Lunsford LD (2006) Stereotactic radiosurgery for four or more intracranial metastases. Int J Radiat Oncol Biol Phys 64:898–903. https://doi.org/10.1016/j.ijrobp.2005.08.035 CrossRefPubMed

Bittner MI, Grosu AL, Brunner TB (2015) Comparison of toxicity after IMRT and 3D-conformal radiotherapy for patients with pancreatic cancer - a systematic review. Radiother Oncol 114:117–121. https://doi.org/10.1016/j.radonc.2014.11.043 CrossRefPubMed

Bottcher A et al (2017) A novel classification scheme for advanced laryngeal cancer midline involvement: implications for the contralateral neck. J Cancer Res Clin Oncol 143:1605–1612. https://doi.org/10.1007/s00432-017-2419-1 CrossRefPubMed

Brown PD et al (2016) Effect of radiosurgery alone vs radiosurgery with whole brain radiation therapy on cognitive function in patients with 1 to 3 brain metastases: a randomized clinical trial. JAMA J Am Med Assoc 316:401–409. https://doi.org/10.1001/jama.2016.9839 CrossRef

Brown PD, Ahluwalia MS, Khan OH, Asher AL, Wefel JS, Gondi V (2018) Whole-brain radiotherapy for brain metastases: evolution or revolution? J Clin Oncol 36:483–491. https://doi.org/10.1200/JCO.2017.75.9589 CrossRefPubMed

Buckley JG, MacLennan K (2000) Cervical node metastases in laryngeal and hypopharyngeal cancer: a prospective analysis of prevalence and distribution. Head Neck 22:380–385. https://doi.org/10.1002/1097-0347(200007)22:4%3c380:aid-hed11%3e3.0.co;2-e CrossRefPubMed

Burr AR, Harari PM, Ko HC, Bruce JY, Kimple RJ, Witek ME (2019) Reducing radiotherapy target volume expansion for patients with HPV-associated oropharyngeal cancer. Oral Oncol 92:52–56. https://doi.org/10.1016/j.oraloncology.2019.03.013 CrossRefPubMedPubMedCentral

Campbell BA, Voss N, Pickles T, Morris J, Gascoyne RD, Savage KJ, Connors JM (2008) Involved-nodal radiation therapy as a component of combination therapy for limited-stage Hodgkin's lymphoma: a question of field size. J Clin Oncol 26:5170–5174. https://doi.org/10.1200/JCO.2007.15.1001 CrossRefPubMed

Chang DT et al (2009) Stereotactic radiotherapy for unresectable adenocarcinoma of the pancreas. Cancer 115:665–672. https://doi.org/10.1002/cncr.24059 CrossRefPubMed

Chang EL et al (2009) Neurocognition in patients with brain metastases treated with radiosurgery or radiosurgery plus whole-brain irradiation: a randomised controlled trial. Lancet Oncol 10:1037–1044. https://doi.org/10.1016/S1470-2045(09)70263-3 CrossRefPubMed

Chang WS, Kim HY, Chang JW, Park YG, Chang JH (2010) Analysis of radiosurgical results in patients with brain metastases according to the number of brain lesions: is stereotactic radiosurgery effective for multiple brain metastases? J Neurosurg 113(Suppl):73–78. https://doi.org/10.3171/2010.8.GKS10994 CrossRefPubMed

Chin RI et al (2017) Comparison of unilateral versus bilateral intensity-modulated radiotherapy for surgically treated squamous cell carcinoma of the palatine tonsil. Cancer 123:4594–4607. https://doi.org/10.1002/cncr.30931 CrossRefPubMed

Chow JM, Levin BC, Krivit JS, Applebaum EL (1989) Radiotherapy or surgery for subclinical cervical node metastases. Archives of Otolaryngol Head Neck Surg 115:981–984. https://doi.org/10.1001/archotol.1989.01860320091025 CrossRef

Chronowski GM et al (2012) Unilateral radiotherapy for the treatment of tonsil cancer. Int J Radiat Oncol Biol Phys 83:204–209. https://doi.org/10.1016/j.ijrobp.2011.06.1975 CrossRefPubMed

Chuong MD et al (2013) Stereotactic body radiation therapy for locally advanced and borderline resectable pancreatic cancer is effective and well tolerated. Int J Radiat Oncol Biol Phys 86:516–522. https://doi.org/10.1016/j.ijrobp.2013.02.022 CrossRefPubMed

Coles CE et al (2017) Partial-breast radiotherapy after breast conservation surgery for patients with early breast cancer (UK IMPORT LOW trial): 5-year results from a multicentre, randomised, controlled, phase 3, non-inferiority trial. The Lancet 390:1048–1060. https://doi.org/10.1016/s0140-6736(17)31145-5 CrossRef

Comito T et al (2017) Can stereotactic body radiation therapy be a viable and efficient therapeutic option for unresectable locally advanced pancreatic adenocarcinoma? Results of a Phase 2 Study. Technol Cancer Rese Treat 16:295–301. https://doi.org/10.1177/1533034616650778 CrossRef

Conway JL et al (2017) Secondary Breast Cancer Risk by Radiation Volume in Women With Hodgkin Lymphoma. Int J Radiat Oncol Biol Phys 97:35–41. https://doi.org/10.1016/j.ijrobp.2016.10.004 CrossRefPubMed

Correa C et al (2017) Accelerated Partial Breast Irradiation: executive summary for the update of an ASTRO Evidence-Based Consensus Statement. Pract Radiat Oncol 7:73–79. https://doi.org/10.1016/j.prro.2016.09.007 CrossRefPubMed

Dan TD et al (2015) Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: updated results of an institutional clinical management approach. Oral Oncol 51:616–621. https://doi.org/10.1016/j.oraloncology.2015.03.013 CrossRefPubMed

Dawson LA, Anzai Y, Marsh L, Martel MK, Paulino A, Ship JA, Eisbruch A (2000) Patterns of local-regional recurrence following parotid-sparing conformal and segmental intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 46:1117–1126. https://doi.org/10.1016/s0360-3016(99)00550-7 CrossRefPubMed

Depaus J, Delcourt A, Andre M (2019) Therapeutic recommendations for early stage Hodgkin lymphomas. Br J Haematol 184:9–16. https://doi.org/10.1111/bjh.15623 CrossRefPubMed

Due AK et al (2014) 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 111:360–365. https://doi.org/10.1016/j.radonc.2014.06.001 CrossRefPubMedPubMedCentral

Eggermont AMM, Robert C, Ribas A (2018) The new era of adjuvant therapies for melanoma. Nat Rev Clin Oncol 15:535–536. https://doi.org/10.1038/s41571-018-0048-5 CrossRefPubMed

Eichenauer DA et al (2018) Hodgkin lymphoma: ESMO Clinical Practice Guidelines for diagnosis, treatment and follow-up. Ann Oncol 29:iV19–iv29. https://doi.org/10.1093/annonc/mdy080 CrossRefPubMed

Fokas E, O'Neill E, Gordon-Weeks A, Mukherjee S, McKenna WG, Muschel RJ (2015) Pancreatic ductal adenocarcinoma: From genetics to biology to radiobiology to oncoimmunology and all the way back to the clinic. Biochem Biophys Acta 1855:61–82. https://doi.org/10.1016/j.bbcan.2014.12.001 CrossRefPubMed

Fuchs M et al (2019) Positron emission tomography-guided treatment in early-stage favorable Hodgkin Lymphoma: final results of the international, randomized phase III HD16 trial by the German Hodgkin Study Group. J Clin Oncol 37:2835–2845. https://doi.org/10.1200/JCO.19.00964 CrossRefPubMed

Giri S, Pathak R, Martin MG, Bhatt VR (2015) Incidence of breast cancer among female survivors of Hodgkin lymphoma: a US-population-based trend analysis from 1973 to 2011. Blood 126:1861–1863. https://doi.org/10.1182/blood-2015-05-647412 CrossRefPubMed

Girinsky T et al (2006) Involved-node radiotherapy (INRT) in patients with early Hodgkin lymphoma: concepts and guidelines. Radiother Oncol 79:270–277. https://doi.org/10.1016/j.radonc.2006.05.015 CrossRefPubMed

Girinsky T et al (2008) The conundrum of Hodgkin lymphoma nodes: to be or not to be included in the involved node radiation fields. The EORTC-GELA lymphoma group guidelines. Radiother Oncol 88:202–210. https://doi.org/10.1016/j.radonc.2008.05.012 CrossRefPubMed

Girinsky T et al (2014) Role of FDG-PET in the implementation of involved-node radiation therapy for Hodgkin lymphoma patients. Int J Radiat Oncol Biol Phys 89:1047–1052. https://doi.org/10.1016/j.ijrobp.2014.04.026 CrossRefPubMed

Goyal K et al (2012) Stereotactic body radiation therapy for nonresectable tumors of the pancreas. J Surg Res 174:319–325. https://doi.org/10.1016/j.jss.2011.07.044 CrossRefPubMed

Gurka MK et al (2013) Stereotactic body radiation therapy with concurrent full-dose gemcitabine for locally advanced pancreatic cancer: a pilot trial demonstrating safety. Radiat Oncol 8:44. https://doi.org/10.1186/1748-717X-8-44 CrossRefPubMedPubMedCentral

Gurka MK et al (2017) Stereotactic body radiation therapy (SBRT) combined with chemotherapy for unresected pancreatic adenocarcinoma. Am J Clin Oncol 40:152–157. https://doi.org/10.1097/COC.0000000000000118 CrossRefPubMed

Halasz LM et al (2016) Comparative effectiveness of stereotactic radiosurgery versus whole-brain radiation therapy for patients with brain metastases from breast or non-small cell lung cancer. Cancer 122:2091–2100. https://doi.org/10.1002/cncr.30009 CrossRefPubMed

Hammel P et al (2016) Effect of chemoradiotherapy vs chemotherapy on survival in patients with locally advanced pancreatic cancer controlled after 4 months of gemcitabine with or without erlotinib: the LAP07 randomized clinical trial. JAMA J Am Med Assoc 315:1844–1853. https://doi.org/10.1001/jama.2016.4324 CrossRef

Hanna TP, Shafiq J, Delaney GP, Vinod SK, Thompson SR, Barton MB (2018) The population benefit of evidence-based radiotherapy: 5-Year local control and overall survival benefits. Radiother Oncol 126:191–197. https://doi.org/10.1016/j.radonc.2017.11.004 CrossRefPubMed

Haviland JS et al (2013) The UK Standardisation of Breast Radiotherapy (START) trials of radiotherapy hypofractionation for treatment of early breast cancer: 10-year follow-up results of two randomised controlled trials. Lancet Oncol 14:1086–1094. https://doi.org/10.1016/S1470-2045(13)70386-3 CrossRefPubMed

Herman JM et al (2015) Phase 2 multi-institutional trial evaluating gemcitabine and stereotactic body radiotherapy for patients with locally advanced unresectable pancreatic adenocarcinoma. Cancer 121:1128–1137. https://doi.org/10.1002/cncr.29161 CrossRefPubMed

Ho KF, Farnell DJ, Routledge JA, Burns MP, Sykes AJ, Slevin NJ, Davidson SE (2010) Comparison of patient-reported late treatment toxicity (LENT-SOMA) with quality of life (EORTC QLQ-C30 and QLQ-H&N35) assessment after head and neck radiotherapy. Radiother Oncol 97:270–275. https://doi.org/10.1016/j.radonc.2010.01.017 CrossRefPubMed

Hoyer M et al (2005) Phase-II study on stereotactic radiotherapy of locally advanced pancreatic carcinoma. Radiother Oncol 76:48–53. https://doi.org/10.1016/j.radonc.2004.12.022 CrossRefPubMed

Jackson SM, Hay JH, Flores AD, Weir L, Wong FL, Schwindt C, Baerg B (1999) Cancer of the tonsil: the results of ipsilateral radiation treatment. Radiother Oncol 51:123–128. https://doi.org/10.1016/s0167-8140(99)00051-1 CrossRefPubMed

Jensen K, Overgaard M, Grau C (2007) Morbidity after ipsilateral radiotherapy for oropharyngeal cancer. Radiother Oncol 85:90–97. https://doi.org/10.1016/j.radonc.2007.06.005 CrossRefPubMed

Kagei K et al (2000) Ipsilateral irradiation for carcinomas of tonsillar region and soft palate based on computed tomographic simulation. Radiother Oncol 54:117–121. https://doi.org/10.1016/s0167-8140(99)00179-6 CrossRefPubMed

Kennedy WR et al (2016) Ipsilateral radiotherapy for squamous cell carcinoma of the tonsil. Eur Arch Otorhinolaryngol 273:2151–2156. https://doi.org/10.1007/s00405-015-3725-3 CrossRefPubMed

Kocher M et al. (2014) Stereotactic radiosurgery for treatment of brain metastases. A report of the DEGRO Working Group on Stereotactic Radiotherapy Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft [et al] 190:521–532 doi:10.1007/s00066–014–0648–7

Kocher M et al (2011) Adjuvant whole-brain radiotherapy versus observation after radiosurgery or surgical resection of one to three cerebral metastases: results of the EORTC 22952–26001 study. J Clin Oncol 29:134–141. https://doi.org/10.1200/JCO.2010.30.1655 CrossRefPubMed

Koo TR, Wu HG (2013) Long-term results of ipsilateral radiotherapy for tonsil cancer. Radiat Oncol J 31:66–71. https://doi.org/10.3857/roj.2013.31.2.66 CrossRefPubMedPubMedCentral

Koong AC et al (2004) Phase I study of stereotactic radiosurgery in patients with locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 58:1017–1021. https://doi.org/10.1016/j.ijrobp.2003.11.004 CrossRefPubMed

Krishnan S et al (2016) Focal radiation therapy dose escalation improves overall survival in locally advanced pancreatic cancer patients receiving induction chemotherapy and consolidative chemoradiation. Int J Radiat Oncol Biol Phys 94:755–765. https://doi.org/10.1016/j.ijrobp.2015.12.003 CrossRefPubMed

Lacas B et al (2017) Role of radiotherapy fractionation in head and neck cancers (MARCH): an updated meta-analysis. Lancet Oncol 18:1221–1237. https://doi.org/10.1016/S1470-2045(17)30458-8 CrossRefPubMedPubMedCentral

Levy A et al (2018) Diversity of brain metastases screening and management in non-small cell lung cancer in Europe: results of the European Organisation for Research and Treatment of Cancer Lung Cancer Group survey. Eur J Cancer 93:37–46. https://doi.org/10.1016/j.ejca.2018.01.067 CrossRefPubMed

Li D, Xie K, Wolff R, Abbruzzese JL (2004) Pancreatic cancer. Lancet 363:1049–1057. https://doi.org/10.1016/S0140-6736(04)15841-8 CrossRefPubMed

Lin X, DeAngelis LM (2015) Treatment of brain metastases. J Clin Oncol 33:3475–3484. https://doi.org/10.1200/JCO.2015.60.9503 CrossRefPubMedPubMedCentral

Lin JC, Jen YM, Li MH, Chao HL, Tsai JT (2015) Comparing outcomes of stereotactic body radiotherapy with intensity-modulated radiotherapy for patients with locally advanced unresectable pancreatic cancer. Eur J Gastroenterol Hepatol 27:259–264. https://doi.org/10.1097/MEG.0000000000000283 CrossRefPubMed

Liu C, Dutu G, Peters LJ, Rischin D, Corry J (2014) Tonsillar cancer: the Peter MacCallum experience with unilateral and bilateral irradiation. Head Neck 36:317–322. https://doi.org/10.1002/hed.23297 CrossRefPubMed

Livi L et al (2015) Accelerated partial breast irradiation using intensity-modulated radiotherapy versus whole breast irradiation: 5-year survival analysis of a phase 3 randomised controlled trial. Eur J Cancer 51:451–463. https://doi.org/10.1016/j.ejca.2014.12.013 CrossRefPubMed

Lynch J, Lal P, Schick U, Nutting CM, Newbold K, Harrington K, Bhide S (2014) Multiple cervical lymph node involvement and extra-capsular extension predict for contralateral nodal recurrence after ipsilateral radiotherapy for squamous cell carcinoma of the tonsil. Oral Oncol 50:901–906. https://doi.org/10.1016/j.oraloncology.2014.06.019 CrossRefPubMed

Machtay M et al (2008) Factors associated with severe late toxicity after concurrent chemoradiation for locally advanced head and neck cancer: an RTOG analysis. J Clin Oncol 26:3582–3589. https://doi.org/10.1200/JCO.2007.14.8841 CrossRefPubMedPubMedCentral

Mahadevan A et al (2011) Induction gemcitabine and stereotactic body radiotherapy for locally advanced nonmetastatic pancreas cancer. Int J Radiat Oncol Biol Phys 81:e615–622. https://doi.org/10.1016/j.ijrobp.2011.04.045 CrossRefPubMed

Maraldo MV, Aznar MC, Vogelius IR, Petersen PM, Specht L (2013) Involved node radiation therapy: an effective alternative in early-stage hodgkin lymphoma. Int J Radiat Oncol Biol Phys 85:1057–1065. https://doi.org/10.1016/j.ijrobp.2012.08.041 CrossRefPubMed

Mazzola R et al (2018) Linac-based stereotactic body radiation therapy for unresectable locally advanced pancreatic cancer: risk-adapted dose prescription and image-guided delivery. Strahlenther Onkol 194:835–842CrossRefPubMed

Meduri B, Baldissera A, Galeandro M, Donini E (2017) Accelerated PBI vs standard radiotherapy (IRMA-trial): interim cosmetic and toxicity results. Radiother Oncol 123:S303CrossRef

Mehta MP et al (2005) The American Society for Therapeutic Radiology and Oncology (ASTRO) evidence-based review of the role of radiosurgery for brain metastases. Int J Radiat Oncol Biol Phys 63:37–46. https://doi.org/10.1016/j.ijrobp.2005.05.023 CrossRefPubMed

Mellon EA et al (2015) Long-term outcomes of induction chemotherapy and neoadjuvant stereotactic body radiotherapy for borderline resectable and locally advanced pancreatic adenocarcinoma. Acta Oncol 54(7):979–985CrossRefPubMed

Mendenhall WM, Million RR, Cassisi NJ (1980) Elective neck irradiation in squamous-cell carcinoma of the head and neck. Head Neck Surg 3:15–20. https://doi.org/10.1002/hed.2890030105 CrossRefPubMed

Nam TK et al (2005) Gamma knife surgery for brain metastases in patients harboring four or more lesions: survival and prognostic factors. J Neurosurg 102(Suppl):147–150. https://doi.org/10.3171/jns.2005.102.s_supplement.0147 CrossRefPubMed

Olivotto IA et al (2013) Interim cosmetic and toxicity results from RAPID: a randomized trial of accelerated partial breast irradiation using three-dimensional conformal external beam radiation therapy. J Clin Oncol 31:4038–4045. https://doi.org/10.1200/JCO.2013.50.5511 CrossRefPubMed

O'Sullivan B et al (2001) The benefits and pitfalls of ipsilateral radiotherapy in carcinoma of the tonsillar region. Int J Radiat Oncol Biol Phys 51:332–343. https://doi.org/10.1016/s0360-3016(01)01613-3 CrossRefPubMed

Passoni P et al (2013) Hypofractionated image-guided IMRT in advanced pancreatic cancer with simultaneous integrated boost to infiltrated vessels concomitant with capecitabine: a phase I study. Int J Radiat Oncol Biol Phys 87:1000–1006. https://doi.org/10.1016/j.ijrobp.2013.09.012 CrossRefPubMed

Patchell RA (2003) The management of brain metastases. Cancer Treat Rev 29:533–540. https://doi.org/10.1016/s0305-7372(03)00105-1 CrossRefPubMed

Patchell RA et al (1990) A randomized trial of surgery in the treatment of single metastases to the brain. N Engl J Med 322:494–500. https://doi.org/10.1056/NEJM199002223220802 CrossRefPubMed

Paumier A et al (2012) Dosimetric benefits of intensity-modulated radiotherapy combined with the deep-inspiration breath-hold technique in patients with mediastinal Hodgkin's lymphoma. Int J Radiat Oncol Biol Phys 82:1522–1527. https://doi.org/10.1016/j.ijrobp.2011.05.015 CrossRefPubMed

Peterson D et al (2015) Predictors of adverse cosmetic outcome in the RAPID trial: an exploratory analysis. Int J Radiat Oncol Biol Phys 91:968–976. https://doi.org/10.1016/j.ijrobp.2014.12.040 CrossRefPubMed

Pignon JP, le Maitre A, Maillard E, Bourhis J, Group M-NC (2009) Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): an update on 93 randomised trials and 17,346 patients. Radiother Oncol 92:4–14. https://doi.org/10.1016/j.radonc.2009.04.014 CrossRef

Pollom EL et al (2014) Single- versus multifraction stereotactic body radiation therapy for pancreatic adenocarcinoma: outcomes and toxicity. Int J Radiat Oncol Biol Phys 90:918–925. https://doi.org/10.1016/j.ijrobp.2014.06.066 CrossRefPubMed

Polistina F et al (2010) Unresectable locally advanced pancreatic cancer: a multimodal treatment using neoadjuvant chemoradiotherapy (gemcitabine plus stereotactic radiosurgery) and subsequent surgical exploration. Ann Surg Oncol 17(8):2092–2101CrossRefPubMed

Rackley TP, Namelo WC, Palaniappan N, Cole N, Owens DM, Evans M (2017) Unilateral radiotherapy for surgically resected lateralized squamous cell carcinoma of the tonsil. Head Neck 39:17–23. https://doi.org/10.1002/hed.24541 CrossRefPubMed

Raktoe SA, Dehnad H, Raaijmakers CP, Braunius W, Terhaard CH (2013) Origin of tumor recurrence after intensity modulated radiation therapy for oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys 85:136–141. https://doi.org/10.1016/j.ijrobp.2012.02.042 CrossRefPubMed

Robin TP et al (2018) Excellent outcomes with radiosurgery for multiple brain metastases in ALK and EGFR driven non-small cell lung cancer. J Thorac Oncol 13:715–720. https://doi.org/10.1016/j.jtho.2017.12.006 CrossRefPubMed

Roh JL et al (2014) 18F fluorodeoxyglucose PET/CT in head and neck squamous cell carcinoma with negative neck palpation findings: a prospective study. Radiology 271:153–161. https://doi.org/10.1148/radiol.13131470 CrossRefPubMed

Rusthoven KE, Raben D, Schneider C, Witt R, Sammons S, Raben A (2009) Freedom from local and regional failure of contralateral neck with ipsilateral neck radiotherapy for node-positive tonsil cancer: results of a prospective management approach. Int J Radiat Oncol Biol Phys 74:1365–1370. https://doi.org/10.1016/j.ijrobp.2008.10.023 CrossRefPubMed

Rutten H et al (2011) Long-term outcome and morbidity after treatment with accelerated radiotherapy and weekly cisplatin for locally advanced head-and-neck cancer: results of a multidisciplinary late morbidity clinic. Int J Radiat Oncol Biol Phys 81:923–929. https://doi.org/10.1016/j.ijrobp.2010.07.013 CrossRefPubMed

Rwigema JC et al (2011) Stereotactic body radiotherapy in the treatment of advanced adenocarcinoma of the pancreas. Am J Clin Oncol 34:63–69CrossRefPubMed

Sahgal A, Ruschin M, Ma L, Verbakel W, Larson D, Brown PD (2017) Stereotactic radiosurgery alone for multiple brain metastases? A review of clinical and technical issues. Neuro-Oncology 19:2–15. https://doi.org/10.1093/neuonc/nox001 CrossRef

Salvetti DJ, Nagaraja TG, McNeill IT, Xu Z, Sheehan J (2013) Gamma Knife surgery for the treatment of 5 to 15 metastases to the brain: clinical article. J Neurosurg 118:1250–1257. https://doi.org/10.3171/2013.2.JNS121213 CrossRefPubMed

Schaapveld M et al (2015) Second cancer risk up to 40 years after treatment for Hodgkin's Lymphoma. N Engl J Med 373:2499–2511. https://doi.org/10.1056/NEJMoa1505949 CrossRefPubMed

Schellenberg D et al (2008) Gemcitabine chemotherapy and single-fraction stereotactic body radiotherapy for locally advanced pancreatic cancer. Int J Radiat Oncol Biol Phys 72:678–686. https://doi.org/10.1016/j.ijrobp.2008.01.051 CrossRefPubMed

Schwartz DL et al (2017) SBRT for early-stage glottic larynx cancer-Initial clinical outcomes from a phase I clinical trial. PLoS ONE 12:e0172055. https://doi.org/10.1371/journal.pone.0172055 CrossRefPubMedPubMedCentral

Seiwert TY et al (2019) OPTIMA: a phase II dose and volume de-escalation trial for human papillomavirus-positive oropharyngeal cancer. Ann Oncol 30:297–302. https://doi.org/10.1093/annonc/mdy522 CrossRefPubMed

Shoushtari AN et al (2010) Clinical nodal staging of T1–2 tonsillar squamous cell carcinoma stratified by p16 status and implications for ipsilateral neck irradiation. Cancer J 16:284–287. https://doi.org/10.1097/PPO.0b013e3181ddd088 CrossRefPubMed

Silverstein MJ et al (2018) Intraoperative radiation therapy (IORT): a series of 1000 tumors. Ann Surg Oncol 25:2987–2993. https://doi.org/10.1245/s10434-018-6614-3 CrossRefPubMed

Sinha P, Pipkorn P, Thorstad WL, Gay HA, Haughey BH (2016) Does elimination of planned postoperative radiation to the primary bed in p16-positive, transorally-resected oropharyngeal carcinoma associate with poorer outcomes? Oral Oncol 61:127–134. https://doi.org/10.1016/j.oraloncology.2016.08.013 CrossRefPubMed

Smith BD et al (2018) Radiation therapy for the whole breast: executive summary of an American Society for Radiation Oncology (ASTRO) evidence-based guideline. Pract Radiat Oncol 8:145–152. https://doi.org/10.1016/j.prro.2018.01.012 CrossRefPubMed

Soffietti R et al (2013) A European Organisation for Research and Treatment of Cancer phase III trial of adjuvant whole-brain radiotherapy versus observation in patients with one to three brain metastases from solid tumors after surgical resection or radiosurgery: quality-of-life results. J Clin Oncol 31:65–72. https://doi.org/10.1200/JCO.2011.41.0639 CrossRefPubMed

Soffietti R et al (2017) Diagnosis and treatment of brain metastases from solid tumors: guidelines from the European Association of Neuro-Oncology (EANO). Neuro-oncology 19:162–174. https://doi.org/10.1093/neuonc/now241 CrossRefPubMedPubMedCentral

Specht L et al (2014) Modern radiation therapy for Hodgkin lymphoma: field and dose guidelines from the international lymphoma radiation oncology group (ILROG). Int J Radiat Oncol Biol Phys 89:854–862. https://doi.org/10.1016/j.ijrobp.2013.05.005 CrossRefPubMed

Sperduto PW et al (2014) Secondary analysis of RTOG 9508, a phase 3 randomized trial of whole-brain radiation therapy versus WBRT plus stereotactic radiosurgery in patients with 1–3 brain metastases; poststratified by the graded prognostic assessment (GPA). Int J Radiat Oncol Biol Phys 90:526–531. https://doi.org/10.1016/j.ijrobp.2014.07.002 CrossRefPubMedPubMedCentral

Stauder MC, Miller RC (2010) stereotactic body radiation therapy (SBRT) for unresectable pancreatic carcinoma. Cancers 2:1565–1575. https://doi.org/10.3390/cancers2031565 CrossRefPubMedPubMedCentral

Strnad V et al (2016) 5-year results of accelerated partial breast irradiation using sole interstitial multicatheter brachytherapy versus whole-breast irradiation with boost after breast-conserving surgery for low-risk invasive and in-situ carcinoma of the female breast: a randomised, phase 3, non-inferiority trial. The Lancet 387:229–238. https://doi.org/10.1016/s0140-6736(15)00471-7 CrossRef

Studer G, Luetolf UM, Glanzmann C (2007) Locoregional failure analysis in head-and-neck cancer patients treated with IMRT Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft [et al] 183:417–423. doi:10.1007/s00066–007–1663–8 (discussion 424–415)

Vaidya JS et al (2010) Targeted intraoperative radiotherapy versus whole breast radiotherapy for breast cancer (TARGIT-A trial): an international, prospective, randomised, non-inferiority phase 3 trial. Lancet 376:91–102. https://doi.org/10.1016/S0140-6736(10)60837-9 CrossRefPubMed

Vaidya JS et al (2014) Risk-adapted targeted intraoperative radiotherapy versus whole-breast radiotherapy for breast cancer: 5-year results for local control and overall survival from the TARGIT—a randomised trial. Lancet 383:603–613. https://doi.org/10.1016/S0140-6736(13)61950-9 CrossRefPubMed

van den Bosch S, Vogel WV, Raaijmakers CP, Dijkema T, Terhaard CHJ, Al-Mamgani A, Kaanders J (2018) Implications of improved diagnostic imaging of small nodal metastases in head and neck cancer: Radiotherapy target volume transformation and dose de-escalation. Radiother Oncol 128:472–478. https://doi.org/10.1016/j.radonc.2018.04.020 CrossRefPubMed

Varadhachary GR et al (2006) Borderline resectable pancreatic cancer: definitions, management, and role of preoperative therapy. Ann Surg Oncol 13:1035–1046. https://doi.org/10.1245/ASO.2006.08.011 CrossRefPubMed

Vergeer MR et al (2010) Ipsilateral irradiation for oral and oropharyngeal carcinoma treated with primary surgery and postoperative radiotherapy. Int J Radiat Oncol Biol Phys 78:682–688. https://doi.org/10.1016/j.ijrobp.2009.08.042 CrossRefPubMed

Veronesi U et al (2013) Intraoperative radiotherapy versus external radiotherapy for early breast cancer (ELIOT): a randomised controlled equivalence trial. Lancet Oncol 14:1269–1277. https://doi.org/10.1016/S1470-2045(13)70497-2 CrossRefPubMed

Villaflor VM et al (2016) Response-adapted volume de-escalation (RAVD) in locally advanced head and neck cancer. Ann Oncol 27:908–913. https://doi.org/10.1093/annonc/mdw051 CrossRefPubMed

Weber DC, Peguret N, Dipasquale G, Cozzi L (2009) Involved-node and involved-field volumetric modulated arc vs. fixed beam intensity-modulated radiotherapy for female patients with early-stage supra-diaphragmatic Hodgkin lymphoma: a comparative planning study. Int J Radiat Oncol Biol Phys 75:1578–1586. https://doi.org/10.1016/j.ijrobp.2009.05.012 CrossRefPubMed

Weber DC, Johanson S, Peguret N, Cozzi L, Olsen DR (2011) Predicted risk of radiation-induced cancers after involved field and involved node radiotherapy with or without intensity modulation for early-stage hodgkin lymphoma in female patients. Int J Radiat Oncol Biol Phys 81:490–497. https://doi.org/10.1016/j.ijrobp.2010.05.035 CrossRefPubMed

Whelan TJ et al (2010) Long-term results of hypofractionated radiation therapy for breast cancer. N Engl J Med 362:513–520. https://doi.org/10.1056/NEJMoa0906260 CrossRefPubMed

Witkowska M, Majchrzak A, Smolewski P (2015) The role of radiotherapy in Hodgkin's lymphoma: what has been achieved during the last 50 years? Biomed Res Int 2015:485071. https://doi.org/10.1155/2015/485071 CrossRefPubMedPubMedCentral

Worni M et al (2013) Modest improvement in overall survival for patients with metastatic pancreatic cancer: a trend analysis using the surveillance, epidemiology, and end results registry from 1988 to 2008. Pancreas 42:1157–1163. https://doi.org/10.1097/MPA.0b013e318291fbc5 CrossRefPubMed

Yamamoto M, Kawabe T, Sato Y, Higuchi Y, Nariai T, Watanabe S, Kasuya H (2014) Stereotactic radiosurgery for patients with multiple brain metastases: a case-matched study comparing treatment results for patients with 2–9 versus 10 or more tumors. J Neurosurg 121(Suppl):16–25. https://doi.org/10.3171/2014.8.GKS141421 CrossRefPubMed

Yamamoto M et al (2014) Stereotactic radiosurgery for patients with multiple brain metastases (JLGK0901): a multi-institutional prospective observational study. Lancet Oncol 15:387–395. https://doi.org/10.1016/S1470-2045(14)70061-0 CrossRefPubMed

Yamazaki Y et al (2008) Assessment of cervical lymph node metastases using FDG-PET in patients with head and neck cancer. Ann Nucl Med 22:177–184. https://doi.org/10.1007/s12149-007-0097-9 CrossRefPubMed

Zhang W (2015) Radiotherapy in early stage classical Hodgkin lymphoma: past, present and future. Chin Clin Oncol 4:6. https://doi.org/10.3978/j.issn.2304-3865.2015.03.05 CrossRefPubMed

Title: Volume de-escalation in radiation therapy: state of the art and new perspectives
Authors: Bruno Meduri
Fabiana Gregucci
Elisa D’Angelo
Anna Rita Alitto
Elisa Ciurlia
Isacco Desideri
Lorenza Marino
Paolo Borghetti
Michele Fiore
Alba Fiorentino
AIRO Giovani -Italian Association of Radiation Oncology-Young Members
Publication date: 01-04-2020
Publisher: Springer Berlin Heidelberg
Keywords: Lymphoma
Breast Cancer
Breast Cancer
Radiotherapy
Pancreatic Cancer
Pancreatic Cancer
Published in: Journal of Cancer Research and Clinical Oncology / Issue 4/2020
Print ISSN: 0171-5216
Electronic ISSN: 1432-1335
DOI: https://doi.org/10.1007/s00432-020-03152-7

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Volume de-escalation in radiation therapy: state of the art and new perspectives

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