Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology · 2025
Dose-escalated stereotactic body radiotherapy re-irradiation in patients with recurrent head and neck cancer: a prospective phase 2 study using automated non-coplanar volumetric modulated arc therapy.
СтатьяКлиническое исследование II фазыПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод в очереди
Обработка статьи · этапы, ошибки и управление
Загрузка состояния…
Ошибки и ограничения
История · было → стало
Состояние обновляется каждые 5 секунд, пока блок открыт. Процент показывается только там, где известен объём работы. Пауза останавливает продолжение этапа; текущий запрос к источнику может завершиться.
Nikitas John, Ma Ting Martin, Cook Kiri, Woods Kaley, Kishan Amar U, Reddy Vishruth K, Hegde John V, St John Maie, Chai-Ho Wanxing, Wong Deborah, Chu Fang-I, Felix Carol, Tenn Stephen, Sheng Ke, Steinberg Michael L, Kadowaki Jennifer Y, Pham Jonathan, O'Connell Dylan P, Cao Minsong, Chin Robert K
Аннотация
BACKGROUND AND PURPOSE: Re-irradiation for recurrent head and neck cancer is associated with poor local control and significant treatment-related toxicity. We hypothesized that automated non-coplanar volumetric modulated arc therapy (VMAT) can deliver more conformal, dose-escalated stereotactic body radiotherapy (SBRT) plans than conventional VMAT, which may improve local control without increasing toxicity.
MATERIALS AND METHODS: This was a single-arm, phase II trial that enrolled patients with histologically-confirmed, recurrent head and neck cancer (diameter < 5 cm) with prior head and neck radiotherapy. Patients were planned for treatment using both conventional VMAT (≤40 Gy) and automated non-coplanar VMAT (≤55 Gy) in 5 every-other-day fractions. Non-coplanar VMAT plans were selected if they could deliver higher planning target volume doses without higher organ-at-risk doses. The primary endpoints were one-year local control (compared to the historical rate of 60 % with SBRT using conventional VMAT) and one-year grade ≥ 3 treatment-related toxicity (compared to the historical rate of 20 %). Local control was estimated via Kaplan-Meier method. Toxicities were graded using Common Terminology Criteria for Adverse Events, v5.0.
RESULTS: Twenty-nine patients were enrolled between February 2020-November 2023. Median follow-up was 18.1 months (interquartile range, 10.9-36.3). Non-coplanar VMAT plans were selected over conventional VMAT for all patients. One-year local control was 83.8 % (95 % confidence interval [CI], 62.4-93.6 %). One-year grade ≥ 3 toxicity was 17.4 %.
CONCLUSION: Automated non-coplanar VMAT achieved superior one-year local control compared to the historical local control rate without higher grade ≥ 3 toxicity. This represents one of the highest local control rates reported in a prospective trial of head and neck re-irradiation and a new approach to head and neck SBRT.
MATERIALS AND METHODS: This was a single-arm, phase II trial that enrolled patients with histologically-confirmed, recurrent head and neck cancer (diameter < 5 cm) with prior head and neck radiotherapy. Patients were planned for treatment using both conventional VMAT (≤40 Gy) and automated non-coplanar VMAT (≤55 Gy) in 5 every-other-day fractions. Non-coplanar VMAT plans were selected if they could deliver higher planning target volume doses without higher organ-at-risk doses. The primary endpoints were one-year local control (compared to the historical rate of 60 % with SBRT using conventional VMAT) and one-year grade ≥ 3 treatment-related toxicity (compared to the historical rate of 20 %). Local control was estimated via Kaplan-Meier method. Toxicities were graded using Common Terminology Criteria for Adverse Events, v5.0.
RESULTS: Twenty-nine patients were enrolled between February 2020-November 2023. Median follow-up was 18.1 months (interquartile range, 10.9-36.3). Non-coplanar VMAT plans were selected over conventional VMAT for all patients. One-year local control was 83.8 % (95 % confidence interval [CI], 62.4-93.6 %). One-year grade ≥ 3 toxicity was 17.4 %.
CONCLUSION: Automated non-coplanar VMAT achieved superior one-year local control compared to the historical local control rate without higher grade ≥ 3 toxicity. This represents one of the highest local control rates reported in a prospective trial of head and neck re-irradiation and a new approach to head and neck SBRT.