Pieter D de Veij Mestdagh1, Tomas Janssen1, Emmy Lamers1, Casper Carbaat1, Olga Hamming-Vrieze1, Wouter V Vogel2, Jan-Jakob Sonke1, Abrahim Al-Mamgani3. 1. Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 2. Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands; Department of Nuclear Medicine, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands. 3. Department of Radiation Oncology, Netherlands Cancer Institute/Antoni van Leeuwenhoek, Amsterdam, The Netherlands. Electronic address: a.almamgani@nki.nl.
Abstract
BACKGROUND AND PURPOSE: The great majority of patients with lateralized head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy routinely undergo bilateral elective nodal irradiation (ENI), even though the incidence of contralateral regional failure after unilateral ENI is low. Excluding the contralateral neck from elective irradiation could reduce radiation-related toxicity and improve quality-of-life. The current study investigated the dosimetric benefits of a novel approach using lymph drainage mapping by SPECT/CT to select patients for unilateral ENI. PATIENTS AND METHODS: Forty patients with lateralized cT1-3N0-2bM0 HNSCC underwent lymph drainage mapping. Two radiation plans were made; the real plan with which patients were actually treated (selective SPECT/CT-guided plan irradiating the ipsilateral neck ± any contralateral draining level); and the virtual plan (standard plan according to institutional guidelines, as if the same patient would have been treated bilaterally). Radiation doses to clinically important organs-at-risk were compared between the two plans. We used five normal tissue complication probability (NTCP) models to predict the clinical benefits of this approach. RESULTS: Median dose reductions to the contralateral parotid gland, contralateral submandibular gland, glottic larynx, supraglottic larynx, constrictor muscle and thyroid gland were 19.2, 27.3, 11.4, 9.7, 12.1 and 18.4 Gy, respectively. Median NTCP reductions for xerostomia, contralateral parotid function, dysphagia, hypothyroidism and laryngeal edema were 20%, 14%, 10%, 20% and 5% respectively. CONCLUSIONS: Selective SPECT/CT-guided ENI results in significant dose reductions to various organs-at-risk and corresponding NTCP values, and will subsequently reduce the incidence and severity of different troublesome radiation-related toxicities and improve quality-of-life.
BACKGROUND AND PURPOSE: The great majority of patients with lateralized head and neck squamous cell carcinoma (HNSCC) treated with radiotherapy routinely undergo bilateral elective nodal irradiation (ENI), even though the incidence of contralateral regional failure after unilateral ENI is low. Excluding the contralateral neck from elective irradiation could reduce radiation-related toxicity and improve quality-of-life. The current study investigated the dosimetric benefits of a novel approach using lymph drainage mapping by SPECT/CT to select patients for unilateral ENI. PATIENTS AND METHODS: Forty patients with lateralized cT1-3N0-2bM0 HNSCC underwent lymph drainage mapping. Two radiation plans were made; the real plan with which patients were actually treated (selective SPECT/CT-guided plan irradiating the ipsilateral neck ± any contralateral draining level); and the virtual plan (standard plan according to institutional guidelines, as if the same patient would have been treated bilaterally). Radiation doses to clinically important organs-at-risk were compared between the two plans. We used five normal tissue complication probability (NTCP) models to predict the clinical benefits of this approach. RESULTS: Median dose reductions to the contralateral parotid gland, contralateral submandibular gland, glottic larynx, supraglottic larynx, constrictor muscle and thyroid gland were 19.2, 27.3, 11.4, 9.7, 12.1 and 18.4 Gy, respectively. Median NTCP reductions for xerostomia, contralateral parotid function, dysphagia, hypothyroidism and laryngeal edema were 20%, 14%, 10%, 20% and 5% respectively. CONCLUSIONS: Selective SPECT/CT-guided ENI results in significant dose reductions to various organs-at-risk and corresponding NTCP values, and will subsequently reduce the incidence and severity of different troublesome radiation-related toxicities and improve quality-of-life.
Authors: Ahmad Mohamed Eltelety; Mohamed Aly Abou-Zeid; Mena Esmat Abdelmalek; Ahmed Amin Nassar Journal: Indian J Otolaryngol Head Neck Surg Date: 2021-08-17
Authors: Pieter D de Veij Mestdagh; Eric van Werkhoven; Arash Navran; Jan Paul de Boer; Willem H Schreuder; Wouter V Vogel; Abrahim Al-Mamgani Journal: Clin Transl Radiat Oncol Date: 2019-04-19
Authors: Pieter D de Veij Mestdagh; Willem H Schreuder; Wouter V Vogel; Maarten L Donswijk; Eric van Werkhoven; Jacqueline E van der Wal; Richard Dirven; Baris Karakullukcu; Jan-Jakob Sonke; Michiel W M van den Brekel; Corrie A M Marijnen; Abrahim Al-Mamgani Journal: BMC Cancer Date: 2019-11-14 Impact factor: 4.430
Authors: Jared H Hara; Stanley I Gutiontov; Sophia Uddin; Ari J Rosenberg; Alexander T Pearson; Zhen Gooi; Elizabeth A Blair; Nishant Agrawal; Everett E Vokes; Daniel T Ginat; Daniel J Haraf; Aditya Juloori Journal: Cureus Date: 2022-07-31