TY - JOUR
T1 - Individualized Prophylactic Neck Irradiation in Patients with cN0 Head and Neck Cancer Based on Sentinel Lymph Node(s) Identification
T2 - Definitive Results of a Prospective Phase 1-2 Study
AU - Longton, Eléonore
AU - Lawson, Georges
AU - Bihin, Benoit
AU - Mathieu, Isabelle
AU - Hanin, Francois Xavier
AU - Deheneffe, Stéphanie
AU - Vander Borght, Thierry
AU - Laloux, Marc
AU - Daisne, Jean François
N1 - Funding Information:
E.L. is funded by the FRIA grant (Fonds National de la Recherche Scientifique, Belgium). The study was made possible by 3 research grants from Oncobeth ASBL, Fonds Anciaux of Solidarité-Espoir ASBL and Fondation Cancérologique Saint-Michel ASBL. Research grants covered insurance and single-photon emission computed tomography and computed tomography costs. Funding sources were not involved in any step of the study or manuscript writing. Vincent Bachy, Gilles Delahaut, Sébastien Van der Vorst, and Olivier Desgain are thanked for recruiting patients and performing Nanocoll injections around the tumor. Bernard Willemart, Michel Destiné, and Jean Georges helped with single-photon emission computed tomography/computed tomography acquisitions and reconstructions. Gebhard Müller and Marie-Cécile Nollevaux performed the p16 assessments. Carine Michiels is thanked for her intellectual input in this study. Disclosures: J.F.D. declares a grant from Belgian Fondation Contre le Cancer.
Funding Information:
E.L. is funded by the FRIA grant (Fonds National de la Recherche Scientifique, Belgium). The study was made possible by 3 research grants from Oncobeth ASBL, Fonds Anciaux of Solidarité-Espoir ASBL and Fondation Cancérologique Saint-Michel ASBL. Research grants covered insurance and single-photon emission computed tomography and computed tomography costs. Funding sources were not involved in any step of the study or manuscript writing. Vincent Bachy, Gilles Delahaut, Sébastien Van der Vorst, and Olivier Desgain are thanked for recruiting patients and performing Nanocoll injections around the tumor. Bernard Willemart, Michel Destiné, and Jean Georges helped with single-photon emission computed tomography/computed tomography acquisitions and reconstructions. Gebhard Müller and Marie-Cécile Nollevaux performed the p16 assessments. Carine Michiels is thanked for her intellectual input in this study.
Publisher Copyright:
© 2020 Elsevier Inc.
PY - 2020/7/15
Y1 - 2020/7/15
N2 - PURPOSE: This prospective, nonrandomized, interventional phase 1-2 study investigated the individualization of elective node irradiation in clinically N0 head and neck squamous cell carcinoma by sentinel lymph node (SLN) mapping with single-photon emission computed tomography/computed tomography (SPECT/CT) and its impact on tumor control and radiation-related toxicity.METHODS AND MATERIALS: Forty-four patients with clinically N0 head and neck squamous cell carcinoma treated with definitive (chemo-)radiation therapy were imaged with SPECT/CT after
99mTc nanocolloid injection around the tumor. The neck levels containing up to the 4 hottest SLNs were selected for prophylactic irradiation. A comparative virtual planning was performed with the selection of neck levels based on the current international guidelines. Regional control was monitored as a function of the selected volume. Dosimetric data for the organs at risk were compared between the plans. Normal tissue complication probability (NTCP) rates were derived for xerostomia, dysphagia, and hypothyroidism to predict the clinical benefit and correlated to quality-of-life (QoL) assessments at 6 months.
RESULTS: Sixteen percent of patients presented unpredicted lymphatic drainage, and 48% drained unilaterally. The nodal clinical target volume based on lymphoscintigraphy was smaller than the nodal clinical target volume based on international guidelines by a factor of 2 (P < .0001). After a median follow-up of 46 months, only 1 patient experienced a regional relapse in a nonirradiated area. Significant median dose reductions to organs at risk were observed, particularly to contralateral salivary glands in patients with unilateral drainage (14.6-28.1 Gy) and to the thyroid gland in all patients (22.4-48.9 Gy). Median NTCP reductions were observed for xerostomia (0.3% to 13.7%), dysphagia (1.7% to 10.8%), and hypothyroidism (14.0% to 36.1%). QoL at 6 months was improved, particularly in patients irradiated unilaterally.CONCLUSIONS: Neck SLN mapping with SPECT/CT individualizes and reduces the elective nodal target volumes without compromising the regional control. The NTCP rates were reduced and favorable QoL were observed in all patients, particularly in the case of unilateral irradiation.
AB - PURPOSE: This prospective, nonrandomized, interventional phase 1-2 study investigated the individualization of elective node irradiation in clinically N0 head and neck squamous cell carcinoma by sentinel lymph node (SLN) mapping with single-photon emission computed tomography/computed tomography (SPECT/CT) and its impact on tumor control and radiation-related toxicity.METHODS AND MATERIALS: Forty-four patients with clinically N0 head and neck squamous cell carcinoma treated with definitive (chemo-)radiation therapy were imaged with SPECT/CT after
99mTc nanocolloid injection around the tumor. The neck levels containing up to the 4 hottest SLNs were selected for prophylactic irradiation. A comparative virtual planning was performed with the selection of neck levels based on the current international guidelines. Regional control was monitored as a function of the selected volume. Dosimetric data for the organs at risk were compared between the plans. Normal tissue complication probability (NTCP) rates were derived for xerostomia, dysphagia, and hypothyroidism to predict the clinical benefit and correlated to quality-of-life (QoL) assessments at 6 months.
RESULTS: Sixteen percent of patients presented unpredicted lymphatic drainage, and 48% drained unilaterally. The nodal clinical target volume based on lymphoscintigraphy was smaller than the nodal clinical target volume based on international guidelines by a factor of 2 (P < .0001). After a median follow-up of 46 months, only 1 patient experienced a regional relapse in a nonirradiated area. Significant median dose reductions to organs at risk were observed, particularly to contralateral salivary glands in patients with unilateral drainage (14.6-28.1 Gy) and to the thyroid gland in all patients (22.4-48.9 Gy). Median NTCP reductions were observed for xerostomia (0.3% to 13.7%), dysphagia (1.7% to 10.8%), and hypothyroidism (14.0% to 36.1%). QoL at 6 months was improved, particularly in patients irradiated unilaterally.CONCLUSIONS: Neck SLN mapping with SPECT/CT individualizes and reduces the elective nodal target volumes without compromising the regional control. The NTCP rates were reduced and favorable QoL were observed in all patients, particularly in the case of unilateral irradiation.
UR - http://www.scopus.com/inward/record.url?scp=85086720509&partnerID=8YFLogxK
U2 - 10.1016/j.ijrobp.2020.03.021
DO - 10.1016/j.ijrobp.2020.03.021
M3 - Article
C2 - 32294522
AN - SCOPUS:85086720509
SN - 0360-3016
VL - 107
SP - 652
EP - 661
JO - International journal of radiation oncology, biology, physics
JF - International journal of radiation oncology, biology, physics
IS - 4
ER -