The impact of margin reduction on outcome and toxicity in head and neck cancer patients treated with image-guided volumetric modulated arc therapy (VMAT)

Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology
Arash NavranAbrahim Al-Mamgani

Abstract

In recent decades, outcomes of patients with head and neck cancer (HNC) have improved as a result of implementing several strategies, such as chemoradiation. However, these improvements were achieved at the cost of increased toxicity. One way to reduce radiation-related toxicity is by reducing the margins. Between 2013 and 2016, 206 consecutive patients were treated with CTV-PTV margin of 5 mm and subsequently 208 patients with 3 mm margin. This study evaluates the impact of reducing clinical target volume (CTV) to planning target volume (PTV) margin on outcome and toxicity. All patients were treated with volumetric modulated arc therapy (VMAT) with daily-image guidance using cone-beam CT (CBCT). Overall acute grade 3 toxicity was significantly lower in 3 mm-group, compared to 5 mm-group (53.8% vs. 65%, respectively, p = 0.032). The same was true for acute grade 3 mucositis (30.8% vs. 42.2%, p = 0.008) and for acute grade 3 dysphagia (feeding tube-dependence) (22.1% vs. 33.5%, p = 0.026). The incidence of ongoing feeding tube-dependence after 3 months of radiotherapy was 11.1% and 20.4%, respectively (p = 0.012). The 2-year incidence of late grade ≥2 xerostomia was 15.8% and 19.4% (p = 0.8). The 2-year loco-regional control rat...Continue Reading

Citations

Oct 17, 2019·Frontiers in Oncology·Anja Charlotte Lundgren MortensenMarika Nestor
Nov 23, 2019·Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]·Erik Haehl, Nils H Nicolay
Sep 9, 2020·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Dirk WagenaarStefan Both
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Mar 24, 2021·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Alexander RühleNils H Nicolay
Apr 24, 2021·Strahlentherapie und Onkologie : Organ der Deutschen Röntgengesellschaft ... [et al]·Madalyne ChamberlainPanagiotis Balermpas
Jun 11, 2021·Physical and Engineering Sciences in Medicine·Susannah ClelandTanya Kairn
Jul 27, 2021·Radiotherapy and Oncology : Journal of the European Society for Therapeutic Radiology and Oncology·Abrahim Al-MamganiCorrie A M Marijnen
Jan 5, 2022·Technology in Cancer Research & Treatment·Hayate WashioTeruki Teshima

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