Title: Defining the dose‐volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split‐field IMRT, whole‐field IMRT and VMAT
AbstractPurpose
To determine the optimal dose‐volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck.
Materials and methods
Thirty patients with stage II‐IVA oropharynx cancers received definitive radiotherapy with split‐field IMRT (SF‐IMRT) to the bilateral neck between 2008 and 2013. Each case was re‐planned using whole‐field IMRT (WF‐IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage.
Results
Target coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF‐IMRT than SF‐IMRT (22.1 vs 25.8 Gy;P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF‐IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy;P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy;P < 0.01).
Conclusions
Modern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers.
Summary
We evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split‐field IMRT (SF‐IMRT), whole‐field IMRT (WF‐IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non‐laryngeal organs at risk among techniques.
Diao, Kevin; Nguyen, Theresa P.; Moreno, Amy C.; Reddy, Jay P.; Garden, Adam S.; Wang, Catherine H.; Tung, Samuel; Wang, Congjun; Wang, Xin A.; Rosenthal, David I.; et al(
, Head & Neck)
AbstractBackground
Recurrent head and neck cancer has poor prognosis. Stereotactic body radiotherapy (SBRT) may improve outcomes by delivering ablative radiation doses.
Methods
We reviewed patients who received definitive‐intent SBRT reirradiation at our institution from 2013 to 2020. Patterns of failure, overall survival (OS), and toxicities were analyzed.
Results
One hundred and thirty‐seven patients were evaluated. The median OS was 44.3 months. The median SBRT dose was 45 Gy and median target volume 16.9 cc. The 1‐year local, regional, and distant control was 78%, 66%, and 83%, respectively. Systemic therapy improved regional (p = 0.004) and distant control (p = 0.04) in nonmetastatic patients. Grade 3+ toxicities were more common at mucosal sites (p = 0.001) and with concurrent systemic therapy (p = 0.02).
Conclusions
In a large cohort of SBRT reirradiation for recurrent, small volume head and neck cancers, a median OS of 44.3 months was observed. Systemic therapy improved regional and distant control. Toxicities were modulated by anatomic site and systemic therapy.
MD Anderson Head and Neck Cancer Symptom Working Group; Grant, Stephen; Kamal, Mona; Mohamed, Abdallah S. R.; Zaveri, Jhankruti; Barrow, Martha P.; Gunn, G. Brandon; Lai, Stephen Y.; Lewin, Jan S.; Rosenthal, David I.; et al(
, Cancer)
Background
Two patient‐reported outcomes (PROs) of swallowing and their correlation to quality of life (QOL) were compared in long‐term survivors of oropharyngeal cancer (OPC).
Methods
Scores on the single dysphagia item from the 28‐item, multisymptom MD Anderson Symptom Inventory‐Head and Neck (MDASI‐HN‐S) were compared with scores on the dysphagia‐specific composite MD Anderson Dysphagia Inventory (MDADI) and the EuroQol visual analog scale (EQ‐VAS) in 714 patients who had received definitive radiotherapy ≥12 months before the survey. An MDASI‐HN‐S score ≥6 and an MDADI composite score <60 were considered representative of moderate/severe swallowing dysfunction.
Results
Moderate/severe dysphagia was reported by 17% and 16% of respondents on the MDASI‐HN‐S and the composite MDADI, respectively. Both swallow PROs were predictive of QOL, and the MDASI‐HN‐S model was slightly more parsimonious for the discrimination of EQ‐VAS scores compared with MDADI scores (Bayesian information criteria, 6062 vs 6076, respectively). An MDASI‐HN‐S cutoff score of ≥6 correlated best with a declining EQ‐VAS score (P < .0001) and was associated with increased radiotherapy dose to several normal swallowing structures.
Conclusions
In this cohort, the single‐item MDASI‐HN‐S performed favorably for the discrimination of QOL compared with the multi‐item MDADI. A time‐efficient model for PRO measurement of swallowing is proposed in which the MDADI may be reserved for patients who score ≥6 on the MDASI‐HN‐S.
As a challenging but important optimization problem, the inverse planning for volumetric modulated arc therapy (VMAT) has attracted much research attention. The column generation (CG) type method is so far one of the most effective solution schemes. However, it often relies on simplifications leading to significant gaps between the output and the actual feasible plan. This paper presents a novel column generation (NCG) approach to push the planning results substantially closer to practice.
Methods
The proposed NCG algorithm is equipped with multiple new quality‐enhancing and computation‐facilitating modules as below: (1) Flexible constraints are enabled on both dose rates and treatment time to adapt to machine capabilities as well as planner's preferences, respectively; (2) a cross‐control‐point intermediate aperture simulation is incorporated to better conform to the underlying physics; (3) new pricing and pruning subroutines are adopted to achieve better optimization outputs. To evaluate the effectiveness of this NCG, five VMAT plans, that is, three prostate cases and two head‐and‐neck cases, were computed using proposed NCG. The planning results were compared with those yielded by a historical benchmark planning scheme.
Results
The NCG generated plans of significantly better quality than the benchmark planning algorithm. For prostate cases, NCG plans satisfied all planning target volume (PTV) criteria whereas CG plans failed on D10% criteria of PTVs for over 9 Gy or more on all cases. For head‐and‐neck cases, again, NCG plans satisfied all PTVs criteria while CG plans failed on D10% criteria of PTVs for over 3 Gy or more on all cases as well as the max dose criteria of both cord and brain stem for over 13 Gy on one case. Moreover, the pruning scheme was found to be effective in enhancing the optimization quality.
Conclusions
The proposed NCG inherits the computational advantages of the traditional CG, while capturing a more realistic characterization of the machine capability and underlying physics. The output solutions of the NCG are substantially closer to practical implementation.
Shiao, Jay C.; Mohamed, Abdallah S. R.; Messer, Jay A.; Hutcheson, Katherine A.; Johnson, Jason M.; Enderling, Heiko; Kamal, Mona; Warren, Benjamin W.; Pham, Brian; Morrison, William H.; et al(
, Head & Neck)
AbstractBackground
The purpose of this study was to determine the impact of CT‐determined pretreatment primary tumor volume on survival and disease control in T4a laryngeal squamous cell carcinoma (SCC).
Methods
We retrospectively reviewed 124 patients with T4a laryngeal cancer from 2000‐2011. Tumor volume measurements were collected and correlated with outcomes.
Results
Five‐year overall survival (OS) for patients with tumor volume ≥21 cm3treated with larynx preservation (n = 26 of 41) was significantly inferior compared to <21 cm3(42% vs 64%, respectively;P= .003). Five‐year OS for patients with tumor volumes ≥21 cm3in the cohort treated with total laryngectomy followed by radiotherapy (RT; n = 42 of 83) was not statistically significant when compared to <21 cm3(50% vs 63%, respectively;P= .058). On multivariate analysis, tumor volume ≥21 cm3was a significant independent correlate of worse disease‐specific survival (DSS;P= .004), event‐free survival (P= .005), recurrence‐free survival (RFS;P= .04), noncancer cause‐specific survival (P= .02), and OS (P= .0002).
Conclusion
Pretreatment CT‐based tumor volume is an independent prognostic factor of outcomes in T4a laryngeal cancer.
Ji, Hangjie; Lafata, Kyle; Mowery, Yvonne; Brizel, David; Bertozzi, Andrea L.; Yin, Fang-Fang; Wang, Chunhao(
, Frontiers in Oncology)
Purpose To develop a method of biologically guided deep learning for post-radiation 18 FDG-PET image outcome prediction based on pre-radiation images and radiotherapy dose information. Methods Based on the classic reaction–diffusion mechanism, a novel biological model was proposed using a partial differential equation that incorporates spatial radiation dose distribution as a patient-specific treatment information variable. A 7-layer encoder–decoder-based convolutional neural network (CNN) was designed and trained to learn the proposed biological model. As such, the model could generate post-radiation 18 FDG-PET image outcome predictions with breakdown biological components for enhanced explainability. The proposed method was developed using 64 oropharyngeal patients with paired 18 FDG-PET studies before and after 20-Gy delivery (2 Gy/day fraction) by intensity-modulated radiotherapy (IMRT). In a two-branch deep learning execution, the proposed CNN learns specific terms in the biological model from paired 18 FDG-PET images and spatial dose distribution in one branch, and the biological model generates post-20-Gy 18 FDG-PET image prediction in the other branch. As in 2D execution, 718/233/230 axial slices from 38/13/13 patients were used for training/validation/independent test. The prediction image results in test cases were compared with the ground-truth results quantitatively. Results The proposed method successfully generated post-20-Gy 18 FDG-PET image outcome prediction with breakdown illustrations of biological model components. Standardized uptake value (SUV) mean values in 18 FDG high-uptake regions of predicted images (2.45 ± 0.25) were similar to ground-truth results (2.51 ± 0.33). In 2D-based Gamma analysis, the median/mean Gamma Index (<1) passing rate of test images was 96.5%/92.8% using the 5%/5 mm criterion; such result was improved to 99.9%/99.6% when 10%/10 mm was adopted. Conclusion The developed biologically guided deep learning method achieved post-20-Gy 18 FDG-PET image outcome predictions in good agreement with ground-truth results. With the breakdown biological modeling components, the outcome image predictions could be used in adaptive radiotherapy decision-making to optimize personalized plans for the best outcome in the future.
Wilke, Christopher, Takiar, Vinita, Wang, He, Moreno, Amy C., Tung, Shih‐Ming Samuel, Quinlan‐Davidson, Sean R., Garden, Adam S., Rosenthal, David I., Fuller, Clifton D., Gunn, Gary B., Reddy, Jay P., Morrison, William H., Wang, Congjun, Zhao, George, Hutcheson, Katherine A., and Phan, Jack. Defining the dose‐volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split‐field IMRT, whole‐field IMRT and VMAT. Journal of Applied Clinical Medical Physics 22.1 Web. doi:10.1002/acm2.13009.
Wilke, Christopher, Takiar, Vinita, Wang, He, Moreno, Amy C., Tung, Shih‐Ming Samuel, Quinlan‐Davidson, Sean R., Garden, Adam S., Rosenthal, David I., Fuller, Clifton D., Gunn, Gary B., Reddy, Jay P., Morrison, William H., Wang, Congjun, Zhao, George, Hutcheson, Katherine A., & Phan, Jack. Defining the dose‐volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split‐field IMRT, whole‐field IMRT and VMAT. Journal of Applied Clinical Medical Physics, 22 (1). https://doi.org/10.1002/acm2.13009
Wilke, Christopher, Takiar, Vinita, Wang, He, Moreno, Amy C., Tung, Shih‐Ming Samuel, Quinlan‐Davidson, Sean R., Garden, Adam S., Rosenthal, David I., Fuller, Clifton D., Gunn, Gary B., Reddy, Jay P., Morrison, William H., Wang, Congjun, Zhao, George, Hutcheson, Katherine A., and Phan, Jack.
"Defining the dose‐volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split‐field IMRT, whole‐field IMRT and VMAT". Journal of Applied Clinical Medical Physics 22 (1). Country unknown/Code not available: Wiley Blackwell (John Wiley & Sons). https://doi.org/10.1002/acm2.13009.https://par.nsf.gov/biblio/10453477.
@article{osti_10453477,
place = {Country unknown/Code not available},
title = {Defining the dose‐volume criteria for laryngeal sparing in locally advanced oropharyngeal cancer utilizing split‐field IMRT, whole‐field IMRT and VMAT},
url = {https://par.nsf.gov/biblio/10453477},
DOI = {10.1002/acm2.13009},
abstractNote = {Abstract PurposeTo determine the optimal dose‐volume constraint for laryngeal sparing using three commonly employed intensity modulated radiation therapy (IMRT) approaches in patients with oropharyngeal cancer treated to the bilateral neck. Materials and methodsThirty patients with stage II‐IVA oropharynx cancers received definitive radiotherapy with split‐field IMRT (SF‐IMRT) to the bilateral neck between 2008 and 2013. Each case was re‐planned using whole‐field IMRT (WF‐IMRT) and volumetric modulated arc therapy (VMAT) and plan quality metrics and dose to laryngeal structures was evaluated. Two larynx volumes were defined and compared on the current study: the Radiation Therapy Oncology Group (RTOG) larynx as defined per the RTOG 1016 protocol and the MDACC larynx defined as the components of the larynx bounded by the superior and inferior extent of the thyroid cartilage. ResultsTarget coverage, conformity, and heterogeneity indices were similar in all techniques. The RTOG larynx mean dose was lower with WF‐IMRT than SF‐IMRT (22.1 vs 25.8 Gy;P < 0.01). The MDACC larynx mean dose was 17.5 Gy ± 5.4 Gy with no differences between the 3 techniques. WF‐IMRT and VMAT plans were associated with lower mean doses to the supraglottic larynx (42.1 vs 41.2 vs 54.8 Gy;P < 0.01) and esophagus (18.1 vs 18.2 vs 36 Gy;P < 0.01). ConclusionsModern whole field techniques can provide effective laryngeal sparing in patients receiving radiotherapy to the bilateral neck for advanced oropharyngeal cancers. SummaryWe evaluated laryngeal dose in patients with locally advanced oropharyngeal cancer treated to the bilateral neck using split‐field IMRT (SF‐IMRT), whole‐field IMRT (WF‐IMRT) and volumetric arc therapy (VMAT). All three techniques provided good sparing of laryngeal structures and were able to achieve a mean larynx dose < 33 Gy. There were no significant differences in dose to target structures or non‐laryngeal organs at risk among techniques.},
journal = {Journal of Applied Clinical Medical Physics},
volume = {22},
number = {1},
publisher = {Wiley Blackwell (John Wiley & Sons)},
author = {Wilke, Christopher and Takiar, Vinita and Wang, He and Moreno, Amy C. and Tung, Shih‐Ming Samuel and Quinlan‐Davidson, Sean R. and Garden, Adam S. and Rosenthal, David I. and Fuller, Clifton D. and Gunn, Gary B. and Reddy, Jay P. and Morrison, William H. and Wang, Congjun and Zhao, George and Hutcheson, Katherine A. and Phan, Jack},
}
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