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EP-1116: Assessment and topographic characterization of local-regional recurrences in head and neck tumours
ESTRO 33, 2014
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EP-1116 Assessment and topographic characterization of local-regional recurrences in head and neck tumours B. Costa Ferreira1, T. Santos2, R. Vale Marques3, L. Khouri3, M.C. Lopes4 1 Aveiro University, I3N Physics Department, Aveiro, Portugal 2 Coimbra University, Physics Department, Coimbra, Portugal 3 Portuguese Oncology Institute of Coimbra Francisco Gentil, Radiation Therapy Department, Coimbra, Portugal 4 Portuguese Oncology Institute of Coimbra Francisco Gentil, Medical Physics Department, Coimbra, Portugal
EP-1117 Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma K.H. Seol1, J.E. Lee1, J.C. Kim1, I.K. Park1 1 Kyungpook National University School of Medicine, Radiation Oncology, Daegu, Korea Republic of
Purpose/Objective: Three different methods have been used to characterize the topographic localization of local-regional recurrences of head and neck tumours treated with Radiation Therapy (RT).
Materials and Methods: Fifty-six NPC patients (42 men, 14 women) who underwent a definitive chemoradiotherapy (CRT) with the reduced volume approach for ENI between 2006 and 2013 in Kyungpook National University Hospital were reviewed. The stage distribution was as follows: 7 (12.5%) in stage I; 14 (25%) in stage II; 19 (33.9%) in stage III; 16 (28.6%) in stage IV. The ENI included retropharyngeal and level II lymph nodes in all patients, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients were received either a moderate hypofractionated Intensity-modulated radiotherapy for a total of 72.6Gy using 2.2 Gy fractions (49.5 Gy at 1.5 Gy per fraction to elective nodal areas) or a conventional fractionated 3D-conformal radiotherapy for a total of 68.4-72 Gy in 1.8-2 Gy fractions (39.6-45 Gy at 1.8 Gy per fraction to elective nodal areas). Patterns of failure, loco-regional control, and survival were analyzed.
Materials and Methods: 380 patients with head and neck tumours, treated with conformal RT (16%) and IMRT (84%) from 2007 to 2013, were included in the study. Prescription doses to primary tumour volume (PTV-T, post-operative or definitive) and large adenopathies (PTV-N) ranged from 59.4-70.2 Gy, to high risk lymph nodes (PTV-N1) from 54-59 Gy and to low risk lymph nodes (PTV-N2) was 50 Gy. Tumour recurrences occurred in 20 patients (5.3%). This resulted in 26 volumes that were delineated in the diagnostic CT for recurrence. Deformable registration, using Velocity AI(version 2.7), was used to co-register this CT set with the planning CT. Three methods were used to classify tumour recurrences. Method PTV quantified the intersection volume between the recurrence and the PTVs. Method TV quantified the intersection between the Treated Volume (TV, defined as the 95%isodose) and the recurrence volume. Recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and out-field otherwise. Method COM was based on the position of the Centre Of Mass of the recurrence relatively to the PTV, being classified as marginal if the distance between the centre of mass and the PTV margin was inferior to 3mm. Results: Recurrences occurred in tumours of the oral cavity (5), oropharynx (5), hypopharynx (4), larynx (3) and nasopharynx (2) and pharyngeal-laryngeal (1). Most recurrences occurred in patient with high tumours stage: III-IV (18) and I-II (2). Mean time for local-regional recurrence was 17 months (ranging from 7-35). Seven recurrences were classified as out-field by all methods. Consistency between the three methods in characterizing in-field and marginal recurrences was only found in 6/26 of the cases. Recurrences were classified as infield/marginal to gross disease in 8 cases, to post-operative volumes in 3 cases and to cervical nodes in 8 cases (Table 1).
Purpose/Objective: To evaluate the patterns of nodal failure after radiotherapy with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).
Results: The median follow-up was 38 months (range, 3-80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (1 in-field recurrence in the 72.6 Gy irradiated nodal area and 2 in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were 6 local failures (10.7%), 3 regional failures (5.4%), and 5 distant metastases (8.9%). Five patients developed in-field local recurrences, 1 of local failures was marginal. Only 1 patient experienced relapse in nasal cavity that was out of the irradiation fields. The 3-year loco-regional control rate was 87.1%, and distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. Conclusions: No patient developed nodal failures in the omitted ENI site. Our investigation demonstrates the reduced volume approach for ENI seems to be a safe treatment approach in NPC. We expect that minimizing the irradiated neck volume could potentially reduce the risk of toxicity and improve the patients’ quality of life. EP-1118 Helical tomotherapy for the reirradiation of locoregional recurrent nasopharyngeal carcinoma J. Garcia Ramirez1, F. Puebla2, J.L. Lopez Guerra3, R. Matute2, I. Marrone2, C. Miguez4, D. Sevillano4, A. Sanchez-Reyes4, J.M. PraenaFernandez5, I. Azinovic2 1 Máster en Aplicaciones Tecnológicas Avanzadas en Oncología Radioterápica. Univer, Radiation Oncology, Madrid, Spain 2 Instituto Madrileño de Oncología/Grupo IMO, Radiation Oncology, Madrid, Spain 3 University Hospital Virgen del Rocio, Radiation Oncology, Sevilla, Spain 4 Instituto Madrileño de Oncología/Grupo IMO, Radiation Physics, Madrid, Spain 5 University Hospital Virgen del Rocio, Methodology Unit- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, Spain
The classification of recurrences as in-field may indicate the need for a dose escalation in the PTV while marginal recurrences may suggest the need to increase PTV margins. A reliable method to characterize recurrences is thus needed. The ideal method of classification of tumour recurrences would be based on the identification of recurrence origin. However this may be misidentified by the volume of the recurrence upon diagnosis and pathways of growth and expansion of the tumour. Conclusions: For RT of head and neck cancers at our institution a low rate of local-regional recurrences was achieved. The three methods, used to assess the topographic characterization of local regional recurrences, are consistent in classifying out-field recurrences. However, the classification of in-field and marginal recurrences is very dependent on the method used for the analysis.
Purpose/Objective: Locoregional recurrent nasopharyngeal carcinoma (LRNPC) may be salvaged by reirradiation with conventional techniques, but with significant morbidity. The advent of helical tomotherapy (HT) has offered the potential of improved target conformation and sparing of critical structures. HT is particularly suitable for NPC due to the irregular target volume and proximity of critical structures. We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for LRNPC patients. Materials and Methods: Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC (11within the nasopharynx and 6 in cervical lymph nodes adjacent to the nasopharynx) patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients (8 cases received the systemic therapy sequentially). Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60-81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50-70.2Gy), resulting in a median cumulative dose of 134 Gy (122-148.2 Gy). The median time interval between initial
S25
EP-1116 Assessment and topographic characterization of local-regional recurrences in head and neck tumours B. Costa Ferreira1, T. Santos2, R. Vale Marques3, L. Khouri3, M.C. Lopes4 1 Aveiro University, I3N Physics Department, Aveiro, Portugal 2 Coimbra University, Physics Department, Coimbra, Portugal 3 Portuguese Oncology Institute of Coimbra Francisco Gentil, Radiation Therapy Department, Coimbra, Portugal 4 Portuguese Oncology Institute of Coimbra Francisco Gentil, Medical Physics Department, Coimbra, Portugal
EP-1117 Patterns of failure after the reduced volume approach for elective nodal irradiation in nasopharyngeal carcinoma K.H. Seol1, J.E. Lee1, J.C. Kim1, I.K. Park1 1 Kyungpook National University School of Medicine, Radiation Oncology, Daegu, Korea Republic of
Purpose/Objective: Three different methods have been used to characterize the topographic localization of local-regional recurrences of head and neck tumours treated with Radiation Therapy (RT).
Materials and Methods: Fifty-six NPC patients (42 men, 14 women) who underwent a definitive chemoradiotherapy (CRT) with the reduced volume approach for ENI between 2006 and 2013 in Kyungpook National University Hospital were reviewed. The stage distribution was as follows: 7 (12.5%) in stage I; 14 (25%) in stage II; 19 (33.9%) in stage III; 16 (28.6%) in stage IV. The ENI included retropharyngeal and level II lymph nodes in all patients, and only encompassed the echelon inferior to the involved level to eliminate the entire neck irradiation. Patients were received either a moderate hypofractionated Intensity-modulated radiotherapy for a total of 72.6Gy using 2.2 Gy fractions (49.5 Gy at 1.5 Gy per fraction to elective nodal areas) or a conventional fractionated 3D-conformal radiotherapy for a total of 68.4-72 Gy in 1.8-2 Gy fractions (39.6-45 Gy at 1.8 Gy per fraction to elective nodal areas). Patterns of failure, loco-regional control, and survival were analyzed.
Materials and Methods: 380 patients with head and neck tumours, treated with conformal RT (16%) and IMRT (84%) from 2007 to 2013, were included in the study. Prescription doses to primary tumour volume (PTV-T, post-operative or definitive) and large adenopathies (PTV-N) ranged from 59.4-70.2 Gy, to high risk lymph nodes (PTV-N1) from 54-59 Gy and to low risk lymph nodes (PTV-N2) was 50 Gy. Tumour recurrences occurred in 20 patients (5.3%). This resulted in 26 volumes that were delineated in the diagnostic CT for recurrence. Deformable registration, using Velocity AI(version 2.7), was used to co-register this CT set with the planning CT. Three methods were used to classify tumour recurrences. Method PTV quantified the intersection volume between the recurrence and the PTVs. Method TV quantified the intersection between the Treated Volume (TV, defined as the 95%isodose) and the recurrence volume. Recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and out-field otherwise. Method COM was based on the position of the Centre Of Mass of the recurrence relatively to the PTV, being classified as marginal if the distance between the centre of mass and the PTV margin was inferior to 3mm. Results: Recurrences occurred in tumours of the oral cavity (5), oropharynx (5), hypopharynx (4), larynx (3) and nasopharynx (2) and pharyngeal-laryngeal (1). Most recurrences occurred in patient with high tumours stage: III-IV (18) and I-II (2). Mean time for local-regional recurrence was 17 months (ranging from 7-35). Seven recurrences were classified as out-field by all methods. Consistency between the three methods in characterizing in-field and marginal recurrences was only found in 6/26 of the cases. Recurrences were classified as infield/marginal to gross disease in 8 cases, to post-operative volumes in 3 cases and to cervical nodes in 8 cases (Table 1).
Purpose/Objective: To evaluate the patterns of nodal failure after radiotherapy with the reduced volume approach for elective neck nodal irradiation (ENI) in nasopharyngeal carcinoma (NPC).
Results: The median follow-up was 38 months (range, 3-80 months). The out-of-field nodal failure when omitting ENI was none. Three patients developed neck recurrences (1 in-field recurrence in the 72.6 Gy irradiated nodal area and 2 in the elective irradiated region of 39.6 Gy). Overall disease failure at any site developed in 11 patients (19.6%). Among these, there were 6 local failures (10.7%), 3 regional failures (5.4%), and 5 distant metastases (8.9%). Five patients developed in-field local recurrences, 1 of local failures was marginal. Only 1 patient experienced relapse in nasal cavity that was out of the irradiation fields. The 3-year loco-regional control rate was 87.1%, and distant failure-free rate was 90.4%; disease-free survival and overall survival at 3 years was 80% and 86.8%, respectively. Conclusions: No patient developed nodal failures in the omitted ENI site. Our investigation demonstrates the reduced volume approach for ENI seems to be a safe treatment approach in NPC. We expect that minimizing the irradiated neck volume could potentially reduce the risk of toxicity and improve the patients’ quality of life. EP-1118 Helical tomotherapy for the reirradiation of locoregional recurrent nasopharyngeal carcinoma J. Garcia Ramirez1, F. Puebla2, J.L. Lopez Guerra3, R. Matute2, I. Marrone2, C. Miguez4, D. Sevillano4, A. Sanchez-Reyes4, J.M. PraenaFernandez5, I. Azinovic2 1 Máster en Aplicaciones Tecnológicas Avanzadas en Oncología Radioterápica. Univer, Radiation Oncology, Madrid, Spain 2 Instituto Madrileño de Oncología/Grupo IMO, Radiation Oncology, Madrid, Spain 3 University Hospital Virgen del Rocio, Radiation Oncology, Sevilla, Spain 4 Instituto Madrileño de Oncología/Grupo IMO, Radiation Physics, Madrid, Spain 5 University Hospital Virgen del Rocio, Methodology Unit- Fundación Pública Andaluza para la Gestión de la Investigación en Salud de Sevilla, Sevilla, Spain
The classification of recurrences as in-field may indicate the need for a dose escalation in the PTV while marginal recurrences may suggest the need to increase PTV margins. A reliable method to characterize recurrences is thus needed. The ideal method of classification of tumour recurrences would be based on the identification of recurrence origin. However this may be misidentified by the volume of the recurrence upon diagnosis and pathways of growth and expansion of the tumour. Conclusions: For RT of head and neck cancers at our institution a low rate of local-regional recurrences was achieved. The three methods, used to assess the topographic characterization of local regional recurrences, are consistent in classifying out-field recurrences. However, the classification of in-field and marginal recurrences is very dependent on the method used for the analysis.
Purpose/Objective: Locoregional recurrent nasopharyngeal carcinoma (LRNPC) may be salvaged by reirradiation with conventional techniques, but with significant morbidity. The advent of helical tomotherapy (HT) has offered the potential of improved target conformation and sparing of critical structures. HT is particularly suitable for NPC due to the irregular target volume and proximity of critical structures. We assessed therapeutic outcomes of reirradiation with helical tomotherapy (HT) for LRNPC patients. Materials and Methods: Treatment outcomes were evaluated retrospectively in 17 consecutive LRNPC (11within the nasopharynx and 6 in cervical lymph nodes adjacent to the nasopharynx) patients receiving HT between 2006 and 2012. Median age was 57 years and most patients (n = 13) were male. Simultaneous systemic therapy was applied in 5 patients (8 cases received the systemic therapy sequentially). Initial treatment covered the gross tumor volume with a median dose of 70 Gy (60-81.6 Gy). Reirradiation was confined to the local relapse region with a median dose of 63 Gy (50-70.2Gy), resulting in a median cumulative dose of 134 Gy (122-148.2 Gy). The median time interval between initial