Abstract
Simple SummaryThe ability to escalate the radiation dose to head and neck tumors has been shown to offer improved local control, and consequently, survival for recurrent head and neck cancer (rHNC) patients. This study evaluates the HyperArc automated non-coplanar planning technique (originally developed for intracranial treatment) for 20 rHNC patients, and compares this technique to conventional planning methods. HyperArc enables significant tumor dose escalation, with average increases in mean target dose of over 11.5 Gy (26%), while maintaining clinically-equivalent doses to nearby organs. Our results show that the average probability of tumor control is 23% higher for HyperArc than conventional techniques.This study evaluates the potential for tumor dose escalation in recurrent head and neck cancer (rHNC) patients with automated non-coplanar volumetric modulated arc therapy (VMAT) stereotactic body radiation therapy (SBRT) planning (HyperArc). Twenty rHNC patients are planned with conventional VMAT SBRT to 40 Gy while minimizing organ-at-risk (OAR) doses. They are then re-planned with the HyperArc technique to match these minimal OAR doses while escalating the target dose as high as possible. Then, we compare the dosimetry, tumor control probability (TCP), and normal tissue complication probability (NTCP) for the two plan types. Our results show that the HyperArc technique significantly increases the mean planning target volume (PTV) and gross tumor volume (GTV) doses by 10.8 ± 4.4 Gy (25%) and 11.5 ± 5.1 Gy (26%) on average, respectively. There are no clinically significant differences in OAR doses, with maximum dose differences of <2 Gy on average. The average TCP is 23% (± 21%) higher for HyperArc than conventional plans, with no significant differences in NTCP for the brainstem, cord, mandible, or larynx. HyperArc can achieve significant tumor dose escalation while maintaining minimal OAR doses in the head and neck—potentially enabling improved local control for rHNC SBRT patients without increased risk of treatment-related toxicities.
Highlights
Between 15 and 50% of head and neck cancer patients treated with radiation experience locoregional recurrence, which is the most common cause of failure [1,2]
We explored the use of the automated non-coplanar volumetric modulated arc therapy (VMAT) planning technique for a wide range of sites in the head and neck and evaluated its ability to escalate target doses for improved tumor control probabilities in recurrent head and neck cancer (rHNC) patients
The HyperArc treatment planning technique achieved conformal dose distributions with substantial dose escalation compared to the conventional plans and with comparable OAR doses
Summary
Between 15 and 50% of head and neck cancer patients treated with radiation experience locoregional recurrence, which is the most common cause of failure [1,2]. Radiation therapy with or without adjuvant chemotherapy is the best option, but reirradiation poses high risks of severe toxicity, including fistula, ulceration, and carotid blowout syndrome [5,6,7]. Despite these risks, the 2-year overall survival rates following conventionally-fractionated reirradiation are only 15–25%. The delivery of higher fractional doses with stereotactic body radiation therapy (SBRT) has been shown to significantly improve local control, with reported 2-year overall survival rates as high as 50% [7,8]. The ability to escalate target doses while sparing normal tissue could improve local control, and survival for rHNC patients
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