PMID- 10725621
OWN - NLM
STAT- MEDLINE
DCOM- 20000412
LR  - 20220317
IS  - 0360-3016 (Print)
IS  - 0360-3016 (Linking)
VI  - 46
IP  - 5
DP  - 2000 Mar 15
TI  - Patterns of local-regional recurrence following parotid-sparing conformal and 
      segmental intensity-modulated radiotherapy for head and neck cancer.
PG  - 1117-26
AB  - PURPOSE: To analyze the patterns of local-regional recurrence in patients with 
      head and neck cancer treated with parotid-sparing conformal and segmental 
      intensity-modulated radiotherapy (IMRT). METHODS AND MATERIALS: Fifty-eight 
      patients with head and neck cancer were treated with bilateral neck radiation 
      (RT) using conformal or segmental IMRT techniques, while sparing a substantial 
      portion of one parotid gland. The targets for CT-based RT planning included the 
      gross tumor volume (GTV) (primary tumor and lymph node metastases) and the 
      clinical target volume (CTV) (postoperative tumor bed, expansions of the GTVs and 
      lymph node groups at risk of subclinical disease). Lymph node targets at risk of 
      subclinical disease included the bilateral jugulodigastric and lower jugular 
      lymph nodes, bilateral retropharyngeal lymph nodes at risk, and high jugular 
      nodes at the base of skull in the side of the neck at highest risk (containing 
      clinical neck metastases and/or ipsilateral to the primary tumor). The CTVs were 
      expanded by 5 mm to yield planning target volumes (PTVs). Planning goals included 
      coverage of all PTVs (with a minimum of 95% of the prescribed dose) and sparing 
      of a substantial portion of the parotid gland in the side of the neck at less 
      risk. The median RT doses to the gross tumor, the operative bed, and the 
      subclinical disease PTVs were 70.4 Gy, 61.2 Gy, and 50.4 Gy respectively. All 
      recurrences were defined on CT scans obtained at the time of recurrence, 
      transferred to the pretreatment CT dataset used for RT planning, and analyzed 
      using dose-volume histograms. The recurrences were classified as 1) "in-field," 
      in which 95% or more of the recurrence volume (V(recur)) was within the 95% 
      isodose; 2) "marginal," in which 20% to 95% of V(recur) was within the 95% 
      isodose; or 3) "outside," in which less than 20% of V(recur) was within the 95% 
      isodose. RESULTS: With a median follow-up of 27 months (range 6 to 60 months), 10 
      regional recurrences, 5 local recurrences (including one noninvasive recurrence) 
      and 1 stomal recurrence were seen in 12 patients, for a 2-year actuarial 
      local-regional control rate of 79% (95% confidence interval 68-90%). Ten patients 
      (80%) relapsed in-field (in areas of previous gross tumor in nine patients), and 
      two patients developed marginal recurrences in the side of the neck at highest 
      risk (one in the high retropharyngeal nodes/base of skull and one in the 
      submandibular nodes). Four regional recurrences extended superior to the 
      jugulodigastric node, in the high jugular and retropharyngeal nodes near the base 
      of skull of the side of the neck at highest risk. Three of these were in-field, 
      in areas that had received the dose intended for subclinical disease. No 
      recurrences were seen in the nodes superior to the jugulodigastric nodes in the 
      side of the neck at less risk, where RT was partially spared. CONCLUSIONS: The 
      majority of local-regional recurrences after conformal and segmental IMRT were 
      "in-field," in areas judged to be at high risk at the time of RT planning, 
      including the GTV, the operative bed, and the first echelon nodes. These findings 
      motivate studies of dose escalation to the highest risk regions.
FAU - Dawson, L A
AU  - Dawson LA
AD  - Department of Radiation Oncology, University of Michigan, Ann Arbor 48109-0010, 
      USA. dawson@umich.edu
FAU - Anzai, Y
AU  - Anzai Y
FAU - Marsh, L
AU  - Marsh L
FAU - Martel, M K
AU  - Martel MK
FAU - Paulino, A
AU  - Paulino A
FAU - Ship, J A
AU  - Ship JA
FAU - Eisbruch, A
AU  - Eisbruch A
LA  - eng
GR  - R03-CA78165/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, U.S. Gov't, P.H.S.
PL  - United States
TA  - Int J Radiat Oncol Biol Phys
JT  - International journal of radiation oncology, biology, physics
JID - 7603616
SB  - IM
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Confidence Intervals
MH  - Female
MH  - Follow-Up Studies
MH  - Head and Neck Neoplasms/drug therapy/*radiotherapy
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mouth Neoplasms/radiotherapy
MH  - *Neoplasm Recurrence, Local/radiotherapy/surgery
MH  - *Parotid Gland
MH  - Prognosis
MH  - Radiotherapy Dosage
MH  - Radiotherapy Planning, Computer-Assisted/methods
MH  - Radiotherapy, Conformal/*methods
MH  - Salvage Therapy
EDAT- 2000/03/22 09:00
MHDA- 2000/04/15 09:00
CRDT- 2000/03/22 09:00
PHST- 2000/03/22 09:00 [pubmed]
PHST- 2000/04/15 09:00 [medline]
PHST- 2000/03/22 09:00 [entrez]
AID - S0360-3016(99)00550-7 [pii]
AID - 10.1016/s0360-3016(99)00550-7 [doi]
PST - ppublish
SO  - Int J Radiat Oncol Biol Phys. 2000 Mar 15;46(5):1117-26. doi: 
      10.1016/s0360-3016(99)00550-7.