Prospective trial of high-dose reirradiation using daily image guidance with intensity-modulated radiotherapy for recurrent and second primary head-and-neck cancer

Allen M. Chen, D Gregory Farwell, Quang Luu, Suzan Cheng, Paul J. Donald, James A. Purdy

Research output: Contribution to journalArticle

42 Citations (Scopus)

Abstract

Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72% and 65%, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19% of setups in the medial-lateral, 27% in the superior-inferior, and 33% in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.

Original languageEnglish (US)
Pages (from-to)669-676
Number of pages8
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number3
DOIs
StatePublished - Jul 1 2011

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Intensity-Modulated Radiotherapy
Head and Neck Neoplasms
radiation therapy
cancer
Image-Guided Radiotherapy
dosage
Second Primary Neoplasms
Brachial Plexus Neuropathies
keratitis
Otitis Externa
Lacrimal Apparatus
Keratitis
Spiral Computed Tomography
shift
chemotherapy
Pathologic Constriction
Hospitalization
ducts
pretreatment
Morbidity

Keywords

  • Head and neck
  • Image guidance
  • Recurrent
  • Reirradiation
  • Tomotherapy

ASJC Scopus subject areas

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

Cite this

Prospective trial of high-dose reirradiation using daily image guidance with intensity-modulated radiotherapy for recurrent and second primary head-and-neck cancer. / Chen, Allen M.; Farwell, D Gregory; Luu, Quang; Cheng, Suzan; Donald, Paul J.; Purdy, James A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 80, No. 3, 01.07.2011, p. 669-676.

Research output: Contribution to journalArticle

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abstract = "Purpose: To report a single-institutional experience using intensity-modulated radiotherapy with daily image-guided radiotherapy for the reirradiation of recurrent and second cancers of the head and neck. Methods and Materials: Twenty-one consecutive patients were prospectively treated with intensity-modulated radiotherapy from February 2006 to March 2009 to a median dose of 66 Gy (range, 60-70 Gy). None of these patients received concurrent chemotherapy. Daily helical megavoltage CT scans were obtained before each fraction as part of an image-guided radiotherapy registration protocol for patient alignment. Results: The 1- and 2-year estimates of in-field control were 72{\%} and 65{\%}, respectively. A total of 651 daily megavoltage CT scans were obtained. The mean systematic shift to account for interfraction motion was 1.38 ± 1.25 mm, 1.79 ± 1.45 mm, and 1.98 ± 1.75 mm for the medial-lateral, superior-inferior, and anterior-posterior directions, respectively. Pretreatment shifts of >3 mm occurred in 19{\%} of setups in the medial-lateral, 27{\%} in the superior-inferior, and 33{\%} in the anterior-posterior directions, respectively. There were no treatment-related fatalities or hospitalizations. Complications included skin desquamation, odynophagia, otitis externa, keratitis, naso-lacrimal duct stenosis, and brachial plexopathy. Conclusions: Intensity-modulated radiotherapy with daily image guidance results in effective disease control with relatively low morbidity and should be considered for selected patients with recurrent and second primary cancers of the head and neck.",
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