adaptive radiotherapy for virally mediated head and neck...
TRANSCRIPT
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Adaptive radiotherapy for virally mediated head and
neck cancer Elizabeth Brown,
Sandro Porceddu, Rebecca Owen, Fiona Harden
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Background
• Emergence of a subgroup of head and neck cancers that are virally mediated
• Patient presentation: – large nodal size – younger – associated with a lower exposure to tobacco and alcohol – more favourable prognosis
• Radioresponsive disease • Adaptive radiotherapy: treatment response results in
need for re-planning during radiotherapy in a subset of patients
(Lassen P. Radiother Oncol. 2010;95(3):371-380.)
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!
Planning CT
Re-CT at #19 of treatment
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Aims
• Determine predictive factors and thresholds for need of re-planning
• Begin this process using retrospective data
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Methodology
• Inclusion criteria: – Study period 2005-2010 presenting at Princess
Alexandra Hospital – Virally-mediated, node positive head and neck
cancer (EBV positive or HPV positive) – Received curative intent RT
• Patient demographics recorded including size of dominant node at diagnosis
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Methodology
• If a re-CT was performed, the reason for the re-CT was evaluated
• The justification for re-CT was assessed using three categories: – tumour and/or nodal regression – weight loss – combination of these factors
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Results
• Reviewed 121 patients from total of 221 treated during study period
• 16 nasopharyngeal and 105 oropharyngeal tumours reviewed
• 25 (21%) patients underwent a re-planning CT at a median of 22 (range, 0-29) fractions
• 16 (13.2%) had re-plan generated
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Patient characteristics
Majority male
Majority N2
Majority orophanrynx
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Results
• Based on evaluation and clinical experience, patients were placed into 3 groups according to maximum dominant nodal size at diagnosis: – Group 1 - ≤35mm – Group 2 - 36-45mm – Group 3 - ≥46mm
• Took into consideration reasonably large standard deviations obtained
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Specific patient characteristics for those that had re-planning scan
Majority due to both tumour regression and weight loss
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44.5mm
32mm
Box and whisker plot
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Results
• Applying these groups to the retrospective data, re-planning CTs were performed: – Group 1 (≤35mm) - 8/68 patients (11.8%) – Group 2 (36-45mm) - 4/28 patients (14.3%) – Group 3 (≥46mm) - 13/25 patients (52%)
• Sample size did not allow statistical analysis to detect a significant difference or exclusion of a lack of difference between the 3 groups
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Conclusion
• In this series, patients with VMHNC and nodal size > 46mm appear to be a high-risk group for the need of re-planning during a course of definitive radiotherapy
• Findings assist in determining predictive factors and thresholds for need of re-planning
• Findings will now be tested in a prospective adaptive RT study
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Acknowledgements
• Management and staff at Princess Alexandra Hospital Radiation Therapy Department
• Queensland University of Technology • Dr David Pryor • Prof. Kerrie Mengersen • Medical Radiation Technologists Board of
Queensland