Reduction of elective radiotherapy treatment volume in definitive treatment of locally advanced head and neck cancer—comparison of a prospective trial with a revised simulated contouring approach

Weissmann T, Speer S, Putz F, Lettmaier S, Schubert P, Shariff M, Semrau S, Gostian AO, Traxdorf M, Müller SK, Eckstein M, Hautmann M, von der Grün J, Haderlein M, Frey B, Gaipl U, Bert C, Iro H, Fietkau R, Hecht M (2021)

Publication Type: Journal article

Publication year: 2021

Journal

Journal of Clinical Medicine MDPI

Book Volume: 10

Article Number: 4653

Journal Issue: 20

DOI: 10.3390/jcm10204653

Abstract

Definitive radiochemotherapy of locally advanced head and neck squamous cell cancer (HNSCC) achieves high locoregional tumor control rates; but is frequently associated with long-term toxicity. A future direction could be a de-escalation strategy focusing on treated volume rather than radiotherapy dose. This analysis evaluates radiotherapy dose and volume parameters of patients treated with a standard contouring approach in a clinical trial context compared with a revised volume-reduced contouring approach. In this case, 30 consecutive patients from the CheckRad-CD8 trial treated at a single study center were included in this analysis. Treatment toxicity and quality of life were assessed at the end of radiotherapy. Standard treatment plans (ST) following state of the art contouring guidelines that were used for patient treatment and volume reduced treatment plans (VRT) according to a revised simulated approach were calculated for each patient. Planning target volumes (PTV) and mean doses to 38 organs-at-risk structures were compared. At the end of radiotherapy patients reported high rates of mucositis; dysphagia and xerostomia. In addition; patient reported quality of life as assessed by the EORTC QLQ-HN35 questionnaire deteriorated. Comparing the two contouring approaches; the elective PTV_56 Gy and the high risk PTV_63 Gy (shrinking field) were significantly smaller in the VRT group. Significant reduction of mean dose to structures of the oral cavity; the larynx as well as part of the swallowing muscles and the submandibular glands was achieved in the simulated VRT-plan. Treatment de-intensification by reduction of the irradiated volume could potentially reduce treatment volume and mean doses to organs at risk. The proposed contouring approach should be studied further in the context of a clinical trial.

Authors with CRIS profile

Thomas Weissmann Department of Radiation Oncology Stefan Speer Department of Radiation Oncology Florian Putz Department of Radiation Oncology Philipp Schubert Medizinische Fakultät Maya Shariff Department of Radiation Oncology Sabine Semrau Medizinische Fakultät Antoniu-Oreste Gostian Department of Otorhinolaryngology – Head and Neck Surgery (HNO-Klinik) Maximilian Traxdorf Lehrstuhl für Hals-, Nasen- und Ohrenheilkunde Sarina Müller-Hübner Department of Otorhinolaryngology – Head and Neck Surgery (HNO-Klinik) Markus Eckstein Institute of Pathology Marlen Haderlein Department of Radiation Oncology Benjamin Frey Department of Radiation Oncology Udo Gaipl Department of Radiation Oncology Christoph Bert Professur für Med. Strahlenphysik Heinrich Iro Lehrstuhl für Hals-, Nasen- und Ohrenheilkunde Rainer Fietkau Lehrstuhl für Strahlentherapie Markus Hecht Department of Radiation Oncology

Additional Organisation(s)

Tumorzentrum der Universität Erlangen-Nürnberg

Involved external institutions

Universitätsklinikum Frankfurt am Main (KGU) DE Germany (DE) Universitätsklinikum Regensburg DE Germany (DE)

How to cite

APA:

Weissmann, T., Speer, S., Putz, F., Lettmaier, S., Schubert, P., Shariff, M.,... Hecht, M. (2021). Reduction of elective radiotherapy treatment volume in definitive treatment of locally advanced head and neck cancer—comparison of a prospective trial with a revised simulated contouring approach. Journal of Clinical Medicine, 10(20). https://doi.org/10.3390/jcm10204653

MLA:

Weissmann, Thomas, et al. "Reduction of elective radiotherapy treatment volume in definitive treatment of locally advanced head and neck cancer—comparison of a prospective trial with a revised simulated contouring approach." Journal of Clinical Medicine 10.20 (2021).

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