Skip to main content
Top
Published in: Radiation Oncology 1/2010

Open Access 01-12-2010 | Research

Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients

Authors: Marta Scorsetti, Antonella Fogliata, Simona Castiglioni, Caterina Bressi, Mario Bignardi, Piera Navarria, Pietro Mancosu, Luca Cozzi, Sara Pentimalli, Filippo Alongi, Armando Santoro

Published in: Radiation Oncology | Issue 1/2010

Login to get access

Abstract

Background

To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology.

Methods

During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45Gy and 69.96Gy in 33 fractions (group A); 54.45Gy and 66Gy in 33 fractions (group B) and 55Gy in 25 fractions (group C).

Results

Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition.

Conclusions

These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.
Appendix
Available only for authorised users
Literature
1.
go back to reference Gregoire V, De Neve W, Eisbruch A, Lee N, Vanden Weyngaert D, Van Gestel D: Intensity modulated radiation therapy for head and neck carcinoma. The Oncologist 2007, 12: 555-564. 10.1634/theoncologist.12-5-555CrossRefPubMed Gregoire V, De Neve W, Eisbruch A, Lee N, Vanden Weyngaert D, Van Gestel D: Intensity modulated radiation therapy for head and neck carcinoma. The Oncologist 2007, 12: 555-564. 10.1634/theoncologist.12-5-555CrossRefPubMed
2.
go back to reference Lee N, Puri D, Blanco AI, Chao KS: Intensity modulated radiathion therapy in head and neck cancers: an update. Head and Neck 2007, 29: 387-400. 10.1002/hed.20332CrossRefPubMed Lee N, Puri D, Blanco AI, Chao KS: Intensity modulated radiathion therapy in head and neck cancers: an update. Head and Neck 2007, 29: 387-400. 10.1002/hed.20332CrossRefPubMed
3.
go back to reference Popovtzer A, Eisbruch A: Advances in radiation therapy of head and neck cancer. Expert Rev Anticancer Ther 2008, 8: 633-644. 10.1586/14737140.8.4.633CrossRefPubMed Popovtzer A, Eisbruch A: Advances in radiation therapy of head and neck cancer. Expert Rev Anticancer Ther 2008, 8: 633-644. 10.1586/14737140.8.4.633CrossRefPubMed
4.
go back to reference Li Y, Ten Haken R, Eisbruch A: The impact of dose on parotid recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 2007, 67: 660-669.PubMedCentralCrossRefPubMed Li Y, Ten Haken R, Eisbruch A: The impact of dose on parotid recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys 2007, 67: 660-669.PubMedCentralCrossRefPubMed
5.
go back to reference Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A: Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010,76(l):S58-63.PubMedCentralCrossRefPubMed Deasy JO, Moiseenko V, Marks L, Chao KS, Nam J, Eisbruch A: Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 2010,76(l):S58-63.PubMedCentralCrossRefPubMed
6.
go back to reference Murdoch-Kinch C, Kim H, Vineberg K, Ship J, Eisbruch A: Dose effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72: 373-382.PubMedCentralCrossRefPubMed Murdoch-Kinch C, Kim H, Vineberg K, Ship J, Eisbruch A: Dose effect relationships for the submandibular salivary glands and implications for their sparing by intensity modulated radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72: 373-382.PubMedCentralCrossRefPubMed
7.
go back to reference Narayan S, Lehmann J, Coleman MA, Vaughan A, Yang CC, Enepekides D, Farwell G, Purdy JA, Laredo G, Nolan K, Pearson FS, Vijayakumar S: Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head-and-neck conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72: 756-762.CrossRefPubMed Narayan S, Lehmann J, Coleman MA, Vaughan A, Yang CC, Enepekides D, Farwell G, Purdy JA, Laredo G, Nolan K, Pearson FS, Vijayakumar S: Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head-and-neck conformal radiotherapy. Int J Radiat Oncol Biol Phys 2008, 72: 756-762.CrossRefPubMed
8.
go back to reference Feng F, Kim H, Lyden T, Feng M, Chepeha D, Eisbruch A: Intensity modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2007, 68: 1289-1298.CrossRefPubMed Feng F, Kim H, Lyden T, Feng M, Chepeha D, Eisbruch A: Intensity modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys 2007, 68: 1289-1298.CrossRefPubMed
9.
go back to reference 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: 64-73. 10.1016/j.radonc.2007.07.009CrossRefPubMed 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: 64-73. 10.1016/j.radonc.2007.07.009CrossRefPubMed
10.
go back to reference Otto K: Volumetric Modulated Arc Therapy: IMRT in a single arc. Med Phys 2008, 35: 310-317. 10.1118/1.2818738CrossRefPubMed Otto K: Volumetric Modulated Arc Therapy: IMRT in a single arc. Med Phys 2008, 35: 310-317. 10.1118/1.2818738CrossRefPubMed
11.
go back to reference Lagerwaard F, Meijer O, van der Hoorn E, Verbakel W, Slotman B, Senan S: Volumetric modulated arc radiotherapy for vestibular schwannomas. Int J Radiat Oncol Biol Phys 2009, 74: 610-615.CrossRefPubMed Lagerwaard F, Meijer O, van der Hoorn E, Verbakel W, Slotman B, Senan S: Volumetric modulated arc radiotherapy for vestibular schwannomas. Int J Radiat Oncol Biol Phys 2009, 74: 610-615.CrossRefPubMed
12.
go back to reference Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L: Intensity modulation with photons for benign intracranial tumors: a planning comparison of volumetric single arc, helical arc and fixed gantry techniques. Radiother Oncol 2008, 89: 254-262. 10.1016/j.radonc.2008.07.021CrossRefPubMed Fogliata A, Clivio A, Nicolini G, Vanetti E, Cozzi L: Intensity modulation with photons for benign intracranial tumors: a planning comparison of volumetric single arc, helical arc and fixed gantry techniques. Radiother Oncol 2008, 89: 254-262. 10.1016/j.radonc.2008.07.021CrossRefPubMed
13.
go back to reference Kjær-Kristoffersen F, Ohlhues L, Medin J, Korreman S: RapidArc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol 2009, 48: 227-232. 10.1080/02841860802266748CrossRefPubMed Kjær-Kristoffersen F, Ohlhues L, Medin J, Korreman S: RapidArc volumetric modulated therapy planning for prostate cancer patients. Acta Oncol 2009, 48: 227-232. 10.1080/02841860802266748CrossRefPubMed
14.
go back to reference Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 118-124. 10.1016/j.radonc.2008.12.020CrossRefPubMed Clivio A, Fogliata A, Franzetti-Pellanda A, Nicolini G, Vanetti E, Wyttenbach R, Cozzi L: Volumetric-modulated arc radiotherapy for carcinomas of the anal canal: A treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 118-124. 10.1016/j.radonc.2008.12.020CrossRefPubMed
15.
go back to reference Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89: 180-191. 10.1016/j.radonc.2008.06.013CrossRefPubMed Cozzi L, Dinshaw KA, Shrivastava SK, Mahantshetty U, Engineer R, Deshpande DD, Jamema SV, Vanetti E, Clivio A, Nicolini G, Fogliata A: A treatment planning study comparing volumetric arc modulation with RapidArc and fixed field IMRT for cervix uteri radiotherapy. Radiother Oncol 2008, 89: 180-191. 10.1016/j.radonc.2008.06.013CrossRefPubMed
16.
go back to reference Scorsetti M, Bignardi M, Clivio A, Cozzi L, Fogliata A, Lattuada P, Mancosu P, Navarria P, Nicolini G, Urso G, Vanetti E, Vogorito S, Santoro A: Volumetric modulation arc radiotherapy compared with static gantry IMRT for malignant pleural mesothelioma tumor: a feasibility study. Int J Radiat Oncol Biol Phys 2010, 77: 942-949.CrossRefPubMed Scorsetti M, Bignardi M, Clivio A, Cozzi L, Fogliata A, Lattuada P, Mancosu P, Navarria P, Nicolini G, Urso G, Vanetti E, Vogorito S, Santoro A: Volumetric modulation arc radiotherapy compared with static gantry IMRT for malignant pleural mesothelioma tumor: a feasibility study. Int J Radiat Oncol Biol Phys 2010, 77: 942-949.CrossRefPubMed
17.
go back to reference Mancosu P, Navarria P, Bignardi M, Cozzi L, Fogliata A, Lattuada P, Santoro A, Urso G, Vigorito S, Scorsetti M: Re-irradiation of metastatic spinal cord compression: A feasibility study by volumetric-modulated arc radiotherapy for in-field recurrence creating a dosimetric hole on the central canal. Radiother Oncol 2009, 94: 67-70. 10.1016/j.radonc.2009.11.010CrossRefPubMed Mancosu P, Navarria P, Bignardi M, Cozzi L, Fogliata A, Lattuada P, Santoro A, Urso G, Vigorito S, Scorsetti M: Re-irradiation of metastatic spinal cord compression: A feasibility study by volumetric-modulated arc radiotherapy for in-field recurrence creating a dosimetric hole on the central canal. Radiother Oncol 2009, 94: 67-70. 10.1016/j.radonc.2009.11.010CrossRefPubMed
18.
go back to reference Bignardi M, Cozzi L, Fogliata A, Lattuada P, Mancosu P, Navarria P, Urso G, Vigorito S, Scorsetti M: Critical appraisal of volumetric modulated arc therapy in stereotactic body radiation therapy for metastases to abdominal lymph nodes. Int J Radiat Oncol Biol Phys 2009, 75: 1570-1577.CrossRefPubMed Bignardi M, Cozzi L, Fogliata A, Lattuada P, Mancosu P, Navarria P, Urso G, Vigorito S, Scorsetti M: Critical appraisal of volumetric modulated arc therapy in stereotactic body radiation therapy for metastases to abdominal lymph nodes. Int J Radiat Oncol Biol Phys 2009, 75: 1570-1577.CrossRefPubMed
19.
go back to reference Verbakel W, Cuijpers J, Hoffmans D, Bieker M, Slotman B: Volumetric intensity modulated arc therapy versus conventional IMRT in head and neck cancer: A comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys 2009, 74: 252-259.CrossRefPubMed Verbakel W, Cuijpers J, Hoffmans D, Bieker M, Slotman B: Volumetric intensity modulated arc therapy versus conventional IMRT in head and neck cancer: A comparative planning and dosimetric study. Int J Radiat Oncol Biol Phys 2009, 74: 252-259.CrossRefPubMed
20.
go back to reference Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 111-117. 10.1016/j.radonc.2008.12.008CrossRefPubMed Vanetti E, Clivio A, Nicolini G, Fogliata A, Ghosh-Laskar S, Agarwal JP, Upreti RR, Budrukkar A, Murthy V, Deshpande DD, Shrivastava SK, Dinshaw KA, Cozzi L: Volumetric modulated arc radiotherapy for carcinomas of the oro-pharynx, hypo-pharynx and larynx: a treatment planning comparison with fixed field IMRT. Radiother Oncol 2009, 92: 111-117. 10.1016/j.radonc.2008.12.008CrossRefPubMed
21.
go back to reference Doornaert P, Verbakel W, Bieker M, Slotman BJ, Senan S: RapidArc planning and delivery in patients with locally advanced head-and-neck cancer undergoing chemoradiotherapy. Int J Radiat Oncol Biol Phys 2010, in press. Doornaert P, Verbakel W, Bieker M, Slotman BJ, Senan S: RapidArc planning and delivery in patients with locally advanced head-and-neck cancer undergoing chemoradiotherapy. Int J Radiat Oncol Biol Phys 2010, in press.
22.
go back to reference Nicolini G, Fogliata A, Vanetti E, Clivio A, Cozzi L: GLAaS: an absolute dose calibration algorithm for an amorphous silicon portal imager. Applications to IMRT verifications. Med Phys 2006, 33: 2839-2851. 10.1118/1.2218314CrossRefPubMed Nicolini G, Fogliata A, Vanetti E, Clivio A, Cozzi L: GLAaS: an absolute dose calibration algorithm for an amorphous silicon portal imager. Applications to IMRT verifications. Med Phys 2006, 33: 2839-2851. 10.1118/1.2218314CrossRefPubMed
23.
go back to reference Nicolini G, Vanetti E, Clivio A, Fogliata A, Korreman S, Bocanek J, Cozzi L: The GLAaS algoritm for portal dosimetry and quality assurance of RapidArc, an intensity modulated rotational therapy. Radiat Oncol 2008, 3: 24. 10.1186/1748-717X-3-24PubMedCentralCrossRefPubMed Nicolini G, Vanetti E, Clivio A, Fogliata A, Korreman S, Bocanek J, Cozzi L: The GLAaS algoritm for portal dosimetry and quality assurance of RapidArc, an intensity modulated rotational therapy. Radiat Oncol 2008, 3: 24. 10.1186/1748-717X-3-24PubMedCentralCrossRefPubMed
24.
go back to reference Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA: Dose, volume and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999, 45: 577-587.CrossRefPubMed Eisbruch A, Ten Haken RK, Kim HM, Marsh LH, Ship JA: Dose, volume and function relationships in parotid salivary glands following conformal and intensity-modulated irradiation of head and neck cancer. Int J Radiat Oncol Biol Phys 1999, 45: 577-587.CrossRefPubMed
25.
go back to reference de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, Stambuk H, Pfister D, Kraus D, Shaha A, Shah J, Lee NY: Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kattering Cancer Center experience. Int J Radiat Oncol Biol Phys 2006, 64: 363-373.CrossRefPubMed de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, Stambuk H, Pfister D, Kraus D, Shaha A, Shah J, Lee NY: Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kattering Cancer Center experience. Int J Radiat Oncol Biol Phys 2006, 64: 363-373.CrossRefPubMed
26.
go back to reference Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, Low DA: A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 2001, 29: 907-918.CrossRef Chao KS, Deasy JO, Markman J, Haynie J, Perez CA, Purdy JA, Low DA: A prospective study of salivary function sparing in patients with head-and-neck cancers receiving intensity-modulated or three-dimensional radiation therapy: initial results. Int J Radiat Oncol Biol Phys 2001, 29: 907-918.CrossRef
27.
go back to reference Fogliata A, Bolsi A, Cozzi L, Bernier J: Comparative dosimetric evaluation of the simultaneous integrated boost with photon intensity modulation in head and neck cancer patients. Radiother Oncol 2003, 69: 267-275. 10.1016/j.radonc.2003.10.003CrossRefPubMed Fogliata A, Bolsi A, Cozzi L, Bernier J: Comparative dosimetric evaluation of the simultaneous integrated boost with photon intensity modulation in head and neck cancer patients. Radiother Oncol 2003, 69: 267-275. 10.1016/j.radonc.2003.10.003CrossRefPubMed
28.
go back to reference Nicolini G, Clivio A, Fogliata A, Vanetti E, Cozzi L: Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy. Radiat Oncol 2009, 4: 27. 10.1186/1748-717X-4-27PubMedCentralCrossRefPubMed Nicolini G, Clivio A, Fogliata A, Vanetti E, Cozzi L: Simultaneous integrated boost radiotherapy for bilateral breast: a treatment planning and dosimetric comparison for volumetric modulated arc and fixed field intensity modulated therapy. Radiat Oncol 2009, 4: 27. 10.1186/1748-717X-4-27PubMedCentralCrossRefPubMed
Metadata
Title
Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients
Authors
Marta Scorsetti
Antonella Fogliata
Simona Castiglioni
Caterina Bressi
Mario Bignardi
Piera Navarria
Pietro Mancosu
Luca Cozzi
Sara Pentimalli
Filippo Alongi
Armando Santoro
Publication date
01-12-2010
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2010
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/1748-717X-5-93

Other articles of this Issue 1/2010

Radiation Oncology 1/2010 Go to the issue