Impact of elective nodal irradiation ≥ 60 Gy on severe weight loss during intensity-modulated radiation therapy in patients with head and neck squamous cell carcinoma
Abstract
Background: This study aimed to investigate the association between radiotherapy-related factors and the incidence of severe weight loss (WL) during radiotherapy in patients with head and neck squamous cell carcinoma (HNSCC) in the intensity-modulated radiation therapy (IMRT) era.
Materials and methods: Seventy-nine patients with HNSCC who received IMRT between January 2011 and December 2020 were reviewed. The 10% WL was defined as severe WL. The median prescribed doses of IMRT were 70 Gy for the high-risk planning target volume (HRPTV); 60 Gy for the intermediate-risk PTV (IRPTV); 54 Gy for the low-risk PTV.
Results: Larger volumes of ≥ 60 Gy (PTV60Gy) had a significant impact on WL, whereas volumes of ≥ 70 Gy and ≥ 54 Gy did not. PTV60Gy to the ipsilateral level II or III necks had a significant impact on WL, whereas PTV60Gy to the ipsilateral levels Ⅰ, IV, V, or VII did not. The primary site of the nasopharynx/oropharynx had a significant impact on WL, whereas the hypopharynx/larynx did not. In the stepwise regression and multivariate analyses, primary site and PTV60Gy volume were important factors for severe WL.
Conclusions: Reducing the PTV60Gy volume can be useful in reducing severe WL. Because the clinical significance of IRPTV is unclear, the omission of IRPTV should be considered while balancing risks and benefits.
Keywords: weight lossplanning target volumeintensity-modulated radiation therapyhead and necksquamous cell carcinoma
References
- Ghadjar P, Hayoz S, Zimmermann F, et al. Swiss Group for Clinical Cancer Research (SAKK). Impact of weight loss on survival after chemoradiation for locally advanced head and neck cancer: secondary results of a randomized phase III trial (SAKK 10/94). Radiat Oncol. 2015; 10: 21.
- Langius JAE, Bakker S, Rietveld DHF, et al. Critical weight loss is a major prognostic indicator for disease-specific survival in patients with head and neck cancer receiving radiotherapy. Br J Cancer. 2013; 109(5): 1093–1099.
- Pai PC, Chuang CC, Tseng CK, et al. Impact of pretreatment body mass index on patients with head-and-neck cancer treated with radiation. Int J Radiat Oncol Biol Phys. 2012; 83(1): e93–e9e100.
- Duma MN, Kampfer S, Schuster T, et al. Adaptive radiotherapy for soft tissue changes during helical tomotherapy for head and neck cancer. Strahlenther Onkol. 2012; 188(3): 243–247.
- Stauch Z, Zoller W, Tedrick K, et al. An evaluation of adaptive planning by assessing the dosimetric impact of weight loss throughout the course of radiotherapy in bilateral treatment of head and neck cancer patients. Med Dosim. 2020; 45(1): 52–59.
- Chen AM, Daly ME, Cui J, et al. Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning. Head Neck. 2014; 36(11): 1541–1546.
- Langius JAE, Twisk J, Kampman M, et al. Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo)radiotherapy. Oral Oncol. 2016; 52: 91–96.
- Mallick I, Gupta SK, Ray R, et al. Predictors of weight loss during conformal radiotherapy for head and neck cancers - how important are planning target volumes? Clin Oncol (R Coll Radiol). 2013; 25(9): 557–563.
- Lee NY, Raiz N, Lu JJ. (eds). Target volume delineation for conformal and intensity-modulated radiation therapy. Springer International Publishing, Switzerland 2015.
- Biau J, Lapeyre M, Troussier I, et al. Selection of lymph node target volumes for definitive head and neck radiation therapy: a 2019 Update. Radiother Oncol. 2019; 134: 1–9.
- Hansen CR, Johansen J, Samsøe E, et al. Consequences of introducing geometric GTV to CTV margin expansion in DAHANCA contouring guidelines for head and neck radiotherapy. Radiother Oncol. 2018; 126(1): 43–47.
- Deschuymer S, Nevens D, Duprez F, et al. Randomized clinical trial on reduction of radiotherapy dose to the elective neck in head and neck squamous cell carcinoma; update of the long-term tumor outcome. Radiother Oncol. 2020; 143: 24–29.
- Sher DJ, Pham NL, Shah JL, et al. Prospective Phase 2 Study of Radiation Therapy Dose and Volume De-escalation for Elective Neck Treatment of Oropharyngeal and Laryngeal Cancer. Int J Radiat Oncol Biol Phys. 2021; 109(4): 932–940.
- Tsai CJ, McBride SM, Riaz N, et al. Evaluation of Substantial Reduction in Elective Radiotherapy Dose and Field in Patients With Human Papillomavirus-Associated Oropharyngeal Carcinoma Treated With Definitive Chemoradiotherapy. JAMA Oncol. 2022; 8(3): 364–372.
- Pandit P, Patil R, Palwe V, et al. Predictors of Weight Loss in Patients With Head and Neck Cancer Receiving Radiation or Concurrent Chemoradiation Treated at a Tertiary Cancer Center. Nutr Clin Pract. 2020; 35(6): 1047–1052.
- Nazari V, Pashaki AS, Hasanzadeh E. The reliable predictors of severe weight loss during the radiotherapy of Head and Neck Cancer. Cancer Treat Res Commun. 2021; 26: 100281.
- Zhao JZ, Zheng H, Li LY, et al. Predictors for Weight Loss in Head and Neck Cancer Patients Undergoing Radiotherapy: A Systematic Review. Cancer Nurs. 2015; 38(6): E37–E45.
- Viani GA, Faustino AC, Danelichen AF, et al. Radiotherapy for locally advanced head and neck cancer in elderly patients: results and prognostic factors a single cohort. Rep Pract Oncol Radiother. 2021; 26(1): 12–19.
- Sundaram V, Khanna D, Mohandass P, et al. Comparison of Progressive Resolution Optimizer and Photon Optimizer algorithms in RapidArc delivery for head and neck SIB treatments. Rep Pract Oncol Radiother. 2023; 28(5): 623–635.