A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes
Abstract
:Simple Summary
Abstract
1. Introduction
2. Methods
2.1. Patient Characteristics
2.2. Simulation and Treatment Planning
2.3. Treatment Delivery
2.4. Clinical Assessment
2.4.1. Toxicity Measurement
2.4.2. Quality of Life Measurement
2.5. Statistical Analysis
3. Results
3.1. Dosimetry
3.2. Treatment Delivery
3.3. Toxicity and Patient-Reported Outcomes
4. Discussion
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
Appendix A
Translations (mm) | Rotations (°) | |||||
---|---|---|---|---|---|---|
Lateral | Vertical | Longitudinal | Pitch | Yaw | Roll | |
Shift measurements | 0.5 ± 0.4 | 0.4 ± 0.4 | 0.5 ± 0.3 | 0.2 ± 0.1 | 0.3 ± 0.1 | 0.2 ± 0.1 |
Systematic error | 0.4 | 0.4 | 0.3 | 0.1 | 0.1 | 0.1 |
Random error | 0.7 | 0.7 | 0.6 | 0.3 | 0.3 | 0.2 |
van Herk PTV margin | 1.4 | 1.5 | 1.2 | 0.5 | 0.6 | 0.4 |
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Pt | Age (years) | Sex | Initial Primary Tumor/RT Site | Prior Dose (Gy) | Interval between RT (months) | Recurrent Site | Histology | PTV Volume (cm3) | Concurrent Systemic Therapy |
---|---|---|---|---|---|---|---|---|---|
1 | 57 | M | Left floor of mouth | 66 1 | 4 | Right neck | SCC | 77.1 | Pembrolizumab |
2 | 59 | M | Right nasopharynx | 70 | 19 | Right neck | Undifferentiated carcinoma | 4.9 * [2.7, 1.2, 1.0] | None |
3 | 66 | F | Left floor of mouth | 66 | 3 | Right neck | SCC | 38.8 * [19.1, 19.6] | Pembrolizumab |
4 | 70 | F | Right oral tongue | 60 | 5 | Right supraclavicular | SCC | 13.8 | Pembrolizumab |
5 | 80 | M | Right base of tongue | 72 | 76 | Right base of tongue | SCC | 9.5 | None |
6 | 60 | M | Left parotid | 66 | 15 | Temporalis | Salivary ductal carcinoma | 44.5 | Trastuzumab emtansine |
7 | 75 | M | Floor of mouth | 70 | 38 | Inferior hypopharynx | SCC | 2.5 | None |
8 | 71 | M | Left oral tongue | 54 | 127 | Tongue | SCC | 9.5 | None |
9 | 51 | M | Right oral tongue | 66 | 40 | Palate, sphenoid | SCC | 30.0 * [11.6, 18.4] | None |
10 | 87 | M | Right floor of mouth | 66 2 | 33 | Left retropharyngeal LN | SCC | 7.2 | Pembrolizumab |
11 | 73 | M | Right base of tongue | 66 | 29 | Right parotid | SCC | 24.6 | None |
12 | 77 | M | Right base of tongue | 70 | 179 | Left soft palate | SCC | 15.2 | None |
13 | 53 | M | Left lateral tongue | Unk | 168 | Right oral cavity | SCC | 13.5 | Pembrolizumab |
14 | 67 | M | Right nasal passage | 60 | 33 | Left ethmoid Sinus | Adenocarcinoma | 43 | None |
15 | 85 | F | Hard palate | 66 | 48 | Right mandible | SCC | 9.9 | None |
Delivery Time, Conformity, and Target Dose | |||||
---|---|---|---|---|---|
cVMAT | HyperArc | Absolute difference | p value | ||
Mean delivery time (min) | 2.5 ± 0.7 | 5.2 ± 2.1 | 2.8 ± 2.2 | <0.001 * | |
R50% | 4.1 ± 3.0 | 2.9 ± 1.3 | −1.2 ± 2.1 | 0.039 * | |
Gradient measure | 0.8 ± 0.2 | 0.7 ± 0.1 | −0.1 ± 0.1 | <0.001 * | |
PTV mean (Gy) | 40.6 ± 5.4 | 56.3 ± 9.1 | 15.7 ± 4.9 | <0.001 * | |
PTV max (Gy) | 48.0 ± 7.2 | 68.4 ± 8.8 | 20.4 ± 7.0 | <0.001 * | |
GTV mean (Gy) | 41.1 ± 6.5 | 58.2 ± 11.0 | 17.1 ± 6.0 | <0.001 * | |
GTV max (Gy) | 47.8 ± 7.4 | 68.4 ± 8.9 | 20.6 ± 7.1 | <0.001 * | |
Maximum OAR Doses † (Gy) | |||||
Planning constraint | cVMAT | HyperArc | Absolute difference | p value | |
Larynx | ≤20 | 3.6 ± 6.6 | 6.0 ± 6.1 | 2.4 ± 1.9 | <0.001 * |
Cord | ≤8 | 3.7 ± 2.3 | 4.1 ± 1.7 | 0.4 ± 2.1 | 0.506 |
Mandible | ≤20 | 11.4 ± 7.9 | 13.0 ± 6.3 | 1.6 ± 2.9 | 0.051 |
Brainstem | ≤8 | 3.4 ± 4.6 | 4.7 ± 4.4 | 1.3 ± 2.4 | 0.047 * |
Skin | ≤39.5 | 23.0 ± 11.8 | 21.3 ± 12.8 | −1.8 ± 2.2 | 0.009 * |
Chiasm | ≤8 | 1.6 ± 3.2 | 2.8 ± 3.3 | 1.2 ± 3.1 | 0.167 |
Right optic nerve | ≤8 | 1.1 ± 2.5 | 3.5 ± 3.0 | 2.4 ± 2.8 | 0.005 * |
Left optic nerve | ≤8 | 2.9 ± 6.7 | 3.4 ± 4.4 | 0.5 ± 3.4 | 0.567 |
Right cochlea | ≤25 | 0.8 ± 1.3 | 3.2 ± 2.5 | 2.3 ± 2.5 | 0.003 * |
Left cochlea | ≤25 | 1.7 ± 3.9 | 3.4 ± 4.5 | 1.7 ± 2.0 | 0.006 * |
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Woods, K.E.; Ma, T.M.; Cook, K.A.; Morris, E.D.; Gao, Y.; Sheng, K.; Kishan, A.U.; Hegde, J.V.; Felix, C.; Basehart, V.; et al. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers 2022, 14, 939. https://doi.org/10.3390/cancers14040939
Woods KE, Ma TM, Cook KA, Morris ED, Gao Y, Sheng K, Kishan AU, Hegde JV, Felix C, Basehart V, et al. A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes. Cancers. 2022; 14(4):939. https://doi.org/10.3390/cancers14040939
Chicago/Turabian StyleWoods, Kaley E., Ting Martin Ma, Kiri A. Cook, Eric D. Morris, Yu Gao, Ke Sheng, Amar U. Kishan, John V. Hegde, Carol Felix, Vincent Basehart, and et al. 2022. "A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes" Cancers 14, no. 4: 939. https://doi.org/10.3390/cancers14040939