Recent trends in radiotherapy for advanced head and neck carcinoma - - PowerPoint PPT Presentation
Recent trends in radiotherapy for advanced head and neck carcinoma ! Phuc Flix Nguyen-Tn MDCM, FRCP(C) ! Assistant Professor ! Department of Radiation-Oncology ! CHUM Notre-Dame ! Goal of Radiotherapy ! Treat the target volume
Phuc Félix Nguyen-Tân MDCM, FRCP(C) ! Assistant Professor ! Department of Radiation-Oncology ! CHUM Notre-Dame !
E.H.!
30%, 50%, 70%, 85%! 30%, 50%, 75%, 88%!
BEV 240! BEV 80! BEV AP!
(Int J Radiat Oncol Biol Phys. 2012 Feb 1;82(2):582-9)!
Author! Site!
Follow-up (months)! Control! Chao! Oropharynx! 74! 33 ! 87%! Lee! Oropharynx! 41! 31 ! 95%! Eisbruch! Varied! 60! 32 ! 82%! De Arruda! Oropharynx! 50! 18 ! 98%! Mendenhall! Base of tongue! 22! 24 ! 90%! Mendenhall! Tonsil ! 17! 37 ! 100%! Notre-Dame! Oropharynx! 100! 35 ! 92%!
Studies Centers N F/U median( month) Local control (%) Dose to parotids Xero ≥Gr2 Chao et al Washington university 74 33 87 < 26 Gy 30% De Arruda et al. MSKCC 50 18 98 2 Pd <26Gy (26%) 1 Pd <26Gy (72%) 33% à 9 months Setton et al. M.D. Anderson Cancer center 442 37 95 Pd Ipsi : <26 Gy Pd Contro:<22Gy 28% at 3 yr Huang et al. USCF 71 33 94 Pd (lobe sup): mean = 25,5 Gy 33% at 2 yr Clavel et al. CHUM 100 33 95 1 Pd <26 Gy 2 Pd >20cc <20Gy 2 Pd 50% <30Gy 20% at 2 yr
Study Centers N Median F/U (month) LCR (%) Doses to parotids (Gy) Xéro ≥Gr2
Nutting et al., The Lancet
PARSPORT (multi- centrique) 94 44 No diff (1an) Pd Contro: < 24Gy 74% vs 38% 12 months Clavel et al. IJROBP 2011 CHUM 249 42 95 vs 85 (p=0.042) 1 Pd <26 Gy 2 Pd >20cc <20Gy 2 Pd 50% <30Gy 82% vs 31% 1 year
lead to potential improvement in locoregional control!
xerostomia!
¹⁸F-FDG-PET imaging in radiotherapy tumor volume delineation in treatment of head and neck cancer
(Radiother Oncol 2011 Dec;101(3):362-8)
neuroradiologist and nucleist on CT then PET! – GTV primary et GTV nodes!
p=0.001
p=0.08
– CT > TEP in 80% of cases!
– Potential for decrease toxicities! – Potential for better locoregional control and survival! – More studies required!
– sw-IMRT: - Eclipse! ! ! - CORVUS! ! !
!
– TH: - Helical tomotherapy!
! Numerous dosimetric studies shown decreased dose to the parotid when comparing sw-IMRT to TH !
!
! ! ! ! ! ! !
parotids which will translate to similar locoregional control while clinically decrease the incidence of longterm xerostomia!
Compare the dose received to the parotids in patients with
advanced oropharyngeal carinoma treated with sw-IMRT vs TH and concomittant chemotherapy!
Compare longterm xerostomia in each group and correlate this
with the dose received to the parotids and the XRT technique "
– Treatments between January 2007 and September 2010 at Notre-Dame Hospital CHUM! – Locally advanced oropharyngeal ca! – Curative intent! – Concomittant chemotherapy with platinum regimen!
Eligibility criteria "
" "
Tumor + margin + lymphatic drainage ! at high risk! !
– N = 89 (sw-IMRT = 45 vs TH = 44) ! – Median follow-up 26 months! !
Median F/U 26 months!
P<0,0001
P<0,0001
P < 0,001
0% 10% 20% 30% 40% 50% 60% 70% 80% 90% 100%
sw-IMRT 6 mois sw-IMRT 12 mois HT 6 mois HT 12 mois
Grade 3 Grade 2 Grade 1 Grade 0
that the XRT technique and the dose to the parotid were the two most predictive factor for the degree of xerostomia!
potentially to a better therapeutic ratio!
into better clinical outcome including quality of life issues!
justify not only its clinical relevance but also its costs !
entre l’utilisation de la TH et une diminution de la xérostomie clinique!
parotide ipsilatérale et la technique de radiothérapie constituent respectivement les deux facteurs prédictifs les plus importants en corrélation avec le niveau de xérostomie!
pour l’irradiation des parotides permettra de diminuer l’incidence clinique de la xérostomie!
différents volumes cible facilitera la mise en place de contraintes plus sévères!
un plus grand nombre de patients (rapid-ARC, V- MAT, TH) pour diminuer la dose aux parotides permettra l’atteinte d’une meilleure qualité de vie chez une proportion plus grande de ceux-ci.!
l’irradiation des parotides permettra de diminuer l’incidence clinique de la xérostomie!
cible facilitera la mise en place de contraintes plus sévères!
grand nombre de patients (rapid-ARC, V-MAT, TH) pour diminuer la dose aux parotides permettra l’atteinte d’une meilleure qualité de vie chez une proportion plus grande de ceux-ci.!
IMRT !
Conventional
RT ! p ! Dermatitis gr.3-4 ! 39% ! 62% ! p < 0.001 ! Mucitis gr. 3-4 ! 77% ! 73% ! p = 0.022 ! Gavage per tx ! 52% ! 51% ! p = 1.000 ! Weight loss per tx ! 10% ! 10% ! p = 0.277 !
IMRT !
Conventional
RT ! p ! No/Vo gr.3-4 ! 12% ! 13% ! p = 0.295 ! Neutropenia gr.3-4 ! 7% ! 6% ! p = 0.848 ! Febrile neutropenia ! 1% ! 2% ! p = 0.794 !
Hospitalisation !
36% ! 37% ! p = 0.898 !
IMRT !
Conventional XRT !
p ! Overall Complete response ! 72% ! 66% ! p = 0.322 ! Complete response primary ! 100% ! 96% ! p = 0.118 ! Complete response neck ! 74% ! 67% ! p = 0.316 !
(Lee et al IJROBP 2006;66(4):966-974)
_ what to treat and what not to treat!
disease!
_ cooperation and expertise of all people involved!
30%, 50%, 70%, 85%! 30%, 50%, 75%, 88%!