Adaptive Radiotherapy for Head-and-Neck Cancer: Initial Clinical Outcomes From a Prospective Trial

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• 作者：David L. Schwartz ; M.D.<sup>&lowast ; sup><sup> ; sup><sup>&dagger ; sup><sup> ; sup><sup>&Dagger ; sup><sup> ; sup><sup>dschwartz3@nshs.edusup> ; Adam S. Garden ; M.D.<sup>&Dagger ; sup> ; Jimmy Thomas ; M.D.<sup>&Dagger ; sup> ; Yipei Chen ; B.S.<sup>§ ; sup> ; Yongbin Zhang ; M.S.<sup>§ ; sup> ; Jan Lewin ; Ph.D.<sup>鈥?/sup> ; Mark S. Chambers ; D.M.D.<sup>鈥?/sup> ; Lei Dong ; Ph.D.<sup>§ ; sup>
• 关键词：Adaptive radiotherapy ; Head and neck cancer ; Image-guided ; IMRT ; Clinical trial
• 刊名：International Journal of Radiation Oncology*Biology*Physics
• 出版年：2012
• 期刊代码：136_03603016
• 类别：med
• 出版时间：1 July, 2012
• 卷：83
• 期：3
• 页码：986-993
• 文件大小：971 K

摘要

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lass="h4">Purpose

To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma.

lass="h4">Methods and Materials

A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy.

lass="h4">Results

With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100%local and 95%regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated.

lass="h4">Conclusion

This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.