Purpose
Curative treatment of head and neck squamous cell carcinoma often involves surgery and/or radiotherapy. Delivery of curative treatment may not always be possible, either due to patient frailty, tumour extent, and/or presence of distant metastasis. In this patient cohort, palliative radiotherapy for local tumour control is usually considered for the purposes of improving or delaying potential symptoms such as pain and dysphagia that could affect patient’s quality of life.
Several effective conventional palliative radiotherapy (CPRT) regimens have been developed with varying outcomes in tumour control...
Methods and materials
Eight patients diagnosed with head and neck cancer who were referred for radiotherapy at the Central Coast Cancer Centre between 2017 and 2020 were randomly selected for inclusion in this study.
Target volumes and organs at risk (OAR) were independently contoured by a head and neck radiation oncologist. Three radiotherapy treatment plans were generated for each patient: SABR, CPRT, and CD-VMAT.
For SABR plans, a dose of 45 Gy in 5 fractions with an overall treatment time of 10 days was prescribed. The gross tumour...
Results
The patient characteristics for the 8 patients are summarized in Figure 2. [Fig 2] The median age of diagnosis was 67 years old (range: 48 – 87 years) and there was an equal distribution of male and female patients. The mean tumour volume was 26.91 cm3 (range: 15.08 – 37.57cm3). Target objectives and OAR constraints as defined in the methods section were met in all treatment plans. Figure 3 shows the colourwash representation of the dose distribution of the different plans for patient 1. [Fig...
Conclusion
To our knowledge, this is the first study to compare SABR and CPRT in the de novo, previously unirradiated head and neck cancer patient cohort. This study at least establishes a theoretical basis for this technique, before we embark on a prospective clinical trial on this topic. While imperfect, the radiobiological modelling provides more clinically relevant endpoints than could be achieved by a planning study that only has dosimetric endpoints. We plan on following up this study with a prospective clinical trial on SABR for...
References
Corry J, Peters LJ, Costa ID, et al. The 'QUAD SHOT'--a phase II study of palliative radiotherapy for incurable head and neck cancer. Radiother Oncol. 2005 Nov;77(2):137-42.
Porceddu SV, Rosser B, Burmeister BH, et al. Hypofractionated radiotherapy for the palliation of advanced head and neck cancer in patients unsuitable for curative treatment--"Hypo Trial". Radiother Oncol. 2007 Dec;85(3):456-62.
Khan L, Tjong M, Raziee H, et al. Role of stereotactic body radiotherapy for symptom control in head and neck cancer patients. Support Care Cancer. 2015 Apr;23(4):1099-103.
Gogineni...