- Email: [email protected]
Concurrent Chemoradiation Followed by Interstitial Brachytherapy Boost and Neck Dissection for T4 Base of Tongue Cancer
S358
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
be evaluated, however contrast variations did not consistently allow for precise tumor contouring on the MV CBCT. The imaging did allow for visualization of the tumor during treatment. All patients showed variation in the anatomy of the tumor over the course of imaged treatment. Conclusions: This pilot study demonstrates that MV CBCT can be used to obtain 3 dimensional anatomical data during the course of radiation treatment. MV CBCT images were obtained with little additional radiation and with short acquisition times. A unique benefit of MV CBCT is that images are obtained on the treatment machine and with the patient in the treatment position. In addition, with current techniques, evaluation of tumor anatomical changes over time is possible. The next specific aim of this study is to translate these anatomic changes into dosimetric changes. Contours for all sensitive structures and tumor volumes will be transferred to the MV CBCT after correcting for positioning. Original beam configurations and intensity patterns will then be applied. Dose volume histograms from the MV CBCT will be calculated and compared to the original treatment plan to assess dosimetric consequences to all structures.
2218
Concurrent Chemoradiation Followed by Interstitial Brachytherapy Boost and Neck Dissection for T4 Base of Tongue Cancer
P. Han,1 K. Hu,1 B. Culliney,2 S. Malamud,2 D. Frank,3 M. Persky,3 R. Sessions,3 W.I. Kuhel,4 D. Schreiber,1 L.B. Harrison1 1 Radiation Oncology, Beth Israel Medical Center, New York, NY, 2Medical Oncology, Beth Israel Medical Center, New York, NY, 3Head and Neck Surgery, Beth Israel Medical Center, New York, NY, 4Otolaryngology, New York Presbyterian Hospital, New York, NY Purpose/Objective: Concurrent chemoradiation and brachytherapy implant boosts have both been shown to improve outcomes compared to external beam radiation alone for base of tongue cancers. There is minimal data regarding the efficacy of the addition of brachytherapy boost after definitive chemoradiation (CT/RT) for advanced base of tongue cancers. We report our experience treating T4 base of tongue cancer with concurrent chemoradiation followed by planned neck dissection and brachytherapy. Materials/Methods: From 4/98 - 12/04, 18 patients with T4 (1997 AJCC stage) base of tongue cancer were treated by definitive external beam radiation therapy followed by brachytherapy. 17 of the 18 patients received concomitant platinum-based chemotherapy. The median dose of external beam radiation delivered was 6660 cGy (range: 5040 7440cGy) given with conventional fraction radiation (1 patient received hyperfractionation). Planned neck dissection and interstitial Iridium-192 brachytherapy boost were performed at median time of 5 weeks after CT/RT. The median dose of brachytherapy delivered was 1200 cGy (range: 1000 –3000 cGy). Patient characteristics were as follows: median age: 60yrs (range 40 –78yr), 17 were male. Nodal staging distribution was as follows: N0 (1/18), N1 (2/18), N2 (12/18) and N3 (3/18). Results: At a median follow up was 23 months (range 6 to 75 months), the crude local control rate (LC) was 83% (15/18), regional control (RC): 100%, incidence of distant metastasis (DM): 28% (5/18), disease free survival (DFS): 61% (11/18), and overall survival (OS): 94% (17/18). The two-year Kaplan Meier actuarial estimates of LC, RC, LRC, DM, DFS and OS were 84%, 100%, 84%, 36%, 50% and 100%, respectively. The three-year actuarial LC, RC, LRC, DM, DFS and OS were 73%, 100%, 73%, 49%, 40%, and 88%. The one patient who did not receive chemotherapy failed locally. The incidence of acute RTOG/NCI grade 3 toxicity was 69% (11/16) primarily consisting mucositis (6/15), dysphagia (6/15), and leukopenia (6/16). There were three patients with grade 4 toxicity: 2 hematologic and one aspiration pneumonia prior to his implant. There was no treatment-related mortality. The incidence of late grade 3 or greater toxicity was 24% of 17 patients evaluated. Conclusions: Concomitant chemoradiation therapy followed by an interstitial brachytherapy boost and a planned neck dissection provides excellent local and regional control for T4 base of tongue cancers. In general, the treatment is well tolerated. Despite the addition of concurrent platinum-based chemotherapy, distant metastasis remains significant and is the dominant mode of failure.
I. J. Radiation Oncology
● Biology ● Physics
Volume 63, Number 2, Supplement, 2005
be evaluated, however contrast variations did not consistently allow for precise tumor contouring on the MV CBCT. The imaging did allow for visualization of the tumor during treatment. All patients showed variation in the anatomy of the tumor over the course of imaged treatment. Conclusions: This pilot study demonstrates that MV CBCT can be used to obtain 3 dimensional anatomical data during the course of radiation treatment. MV CBCT images were obtained with little additional radiation and with short acquisition times. A unique benefit of MV CBCT is that images are obtained on the treatment machine and with the patient in the treatment position. In addition, with current techniques, evaluation of tumor anatomical changes over time is possible. The next specific aim of this study is to translate these anatomic changes into dosimetric changes. Contours for all sensitive structures and tumor volumes will be transferred to the MV CBCT after correcting for positioning. Original beam configurations and intensity patterns will then be applied. Dose volume histograms from the MV CBCT will be calculated and compared to the original treatment plan to assess dosimetric consequences to all structures.
2218
Concurrent Chemoradiation Followed by Interstitial Brachytherapy Boost and Neck Dissection for T4 Base of Tongue Cancer
P. Han,1 K. Hu,1 B. Culliney,2 S. Malamud,2 D. Frank,3 M. Persky,3 R. Sessions,3 W.I. Kuhel,4 D. Schreiber,1 L.B. Harrison1 1 Radiation Oncology, Beth Israel Medical Center, New York, NY, 2Medical Oncology, Beth Israel Medical Center, New York, NY, 3Head and Neck Surgery, Beth Israel Medical Center, New York, NY, 4Otolaryngology, New York Presbyterian Hospital, New York, NY Purpose/Objective: Concurrent chemoradiation and brachytherapy implant boosts have both been shown to improve outcomes compared to external beam radiation alone for base of tongue cancers. There is minimal data regarding the efficacy of the addition of brachytherapy boost after definitive chemoradiation (CT/RT) for advanced base of tongue cancers. We report our experience treating T4 base of tongue cancer with concurrent chemoradiation followed by planned neck dissection and brachytherapy. Materials/Methods: From 4/98 - 12/04, 18 patients with T4 (1997 AJCC stage) base of tongue cancer were treated by definitive external beam radiation therapy followed by brachytherapy. 17 of the 18 patients received concomitant platinum-based chemotherapy. The median dose of external beam radiation delivered was 6660 cGy (range: 5040 7440cGy) given with conventional fraction radiation (1 patient received hyperfractionation). Planned neck dissection and interstitial Iridium-192 brachytherapy boost were performed at median time of 5 weeks after CT/RT. The median dose of brachytherapy delivered was 1200 cGy (range: 1000 –3000 cGy). Patient characteristics were as follows: median age: 60yrs (range 40 –78yr), 17 were male. Nodal staging distribution was as follows: N0 (1/18), N1 (2/18), N2 (12/18) and N3 (3/18). Results: At a median follow up was 23 months (range 6 to 75 months), the crude local control rate (LC) was 83% (15/18), regional control (RC): 100%, incidence of distant metastasis (DM): 28% (5/18), disease free survival (DFS): 61% (11/18), and overall survival (OS): 94% (17/18). The two-year Kaplan Meier actuarial estimates of LC, RC, LRC, DM, DFS and OS were 84%, 100%, 84%, 36%, 50% and 100%, respectively. The three-year actuarial LC, RC, LRC, DM, DFS and OS were 73%, 100%, 73%, 49%, 40%, and 88%. The one patient who did not receive chemotherapy failed locally. The incidence of acute RTOG/NCI grade 3 toxicity was 69% (11/16) primarily consisting mucositis (6/15), dysphagia (6/15), and leukopenia (6/16). There were three patients with grade 4 toxicity: 2 hematologic and one aspiration pneumonia prior to his implant. There was no treatment-related mortality. The incidence of late grade 3 or greater toxicity was 24% of 17 patients evaluated. Conclusions: Concomitant chemoradiation therapy followed by an interstitial brachytherapy boost and a planned neck dissection provides excellent local and regional control for T4 base of tongue cancers. In general, the treatment is well tolerated. Despite the addition of concurrent platinum-based chemotherapy, distant metastasis remains significant and is the dominant mode of failure.