Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Feb 14;14(4):939.
doi: 10.3390/cancers14040939.

A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes

Kaley E Woods  1   2 , Ting Martin Ma  1 , Kiri A Cook  3 , Eric D Morris  1 , Yu Gao  1 , Ke Sheng  1 , Amar U Kishan  1 , John V Hegde  1 , Carol Felix  1 , Vincent Basehart  1 , Kelsey Narahara  1 , Zhouhuizi Shen  1 , Stephen Tenn  1 , Michael L Steinberg  1 , Robert K Chin  1 , Minsong Cao  1
Affiliations

A Prospective Phase II Study of Automated Non-Coplanar VMAT for Recurrent Head and Neck Cancer: Initial Report of Feasibility, Safety, and Patient-Reported Outcomes

Kaley E Woods et al. Cancers (Basel). .

Abstract

This study reports the initial results for the first 15 patients on a prospective phase II clinical trial exploring the safety, feasibility, and efficacy of the HyperArc technique for recurrent head and neck cancer treatment. Eligible patients were simulated and planned with both conventional VMAT and HyperArc techniques and the plan with superior dosimetry was selected for treatment. Dosimetry, delivery feasibility and safety, treatment-related toxicity, and patient-reported quality of life (QOL) were all evaluated. HyperArc was chosen over conventional VMAT for all 15 patients and enabled statistically significant increases in dose conformity (R50% reduced by 1.2 ± 2.1, p < 0.05) and mean PTV and GTV doses (by 15.7 ± 4.9 Gy, p < 0.01 and 17.1 ± 6.0 Gy, p < 0.01, respectively). The average HyperArc delivery was 2.8 min longer than conventional VMAT (p < 0.01), and the mean intrafraction motion was ≤ 0.5 ± 0.4 mm and ≤0.3 ± 0.1°. With a median follow-up of 12 months, treatment-related toxicity was minimal (only one grade 3 acute toxicity above baseline) and patient-reported QOL metrics were favorable. HyperArc enabled superior dosimetry and significant target dose escalation compared to conventional VMAT planning, and treatment delivery was feasible, safe, and well-tolerated by patients.

Keywords: HyperArc; SBRT; non-coplanar VMAT; recurrent head and neck cancer; reirradiation.

PubMed Disclaimer

Conflict of interest statement

A.U.K., J.V.H., M.L.S., R.K.C. and M.C. report personal fees and grants from Varian Medical Systems, ViewRay, VisionRT, and/or ASTRO outside the submitted work.

Figures

Figure A1
Figure A1
Patient-reported quality of life scores based on the UW-QOL questionnaire at baseline and at 1, 3, 6, 9 and 12 months after treatment. (A) Health-related QOL scores; (B) Overall QOL scores.
Figure 1
Figure 1
Target volume locations and beam arrangements for treatment planning. (A) PTV centroids illustrated for all 15 patients, localized with respect to the Qfix Encompass head frame used for all patients; (B) Beam arrangements for the cVMAT and HyperArc plans for one representative patient in the study (Patient 12).
Figure 2
Figure 2
Dose comparison between HyperArc and cVMAT plans for one representative patient in the study (Patient 12). (A) Isodose distributions in color wash (GTV shown in orange and PTV shown in blue); (B) Dose volume histograms for the HyperArc (solid line) and cVMAT (dashed line) plans.
Figure 3
Figure 3
Clinician-reported early (≤3 months after start of treatment) and late (>3 months after start of treatment) toxicity, classified according to Common Terminology Criteria for Adverse Events criteria.
Figure 4
Figure 4
FACT H&N subdomain and total scores at baseline and at each follow-up time post-treatment.
See this image and copyright information in PMC

References

    1. Hall S.F., Groome P.A., Irish J., O’Sullivan B. The natural history of patients with squamous cell carcinoma of the hypopharynx. Laryngoscope. 2008;118:1362–1371. doi: 10.1097/MLG.0b013e318173dc4a. - DOI - PubMed
    1. Brockstein B., Haraf D.J., Rademaker A.W., Kies M.S., Stenson K.M., Rosen F., Mittal B.B., Pelzer H., Fung B.B., Witt M.E., et al. Patterns of failure, prognostic factors and survival in locoregionally advanced head and neck cancer treated with concomitant chemoradiotherapy: A 9-year, 337-patient, multi-institutional experience. Ann. Oncol. 2004;15:1179–1186. doi: 10.1093/annonc/mdh308. - DOI - PubMed
    1. National Comprehensive Cancer Network Clinical Practice Guidelines in Oncology: Head and Neck Cancers (Version 3.2021) [(accessed on 11 February 2022)]. Available online: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.
    1. Janot F., de Raucourt D., Benhamou E., Ferron C., Dolivet G., Bensadoun R.J., Hamoir M., Géry B., Julieron M., Castaing M., et al. Randomized trial of postoperative reirradiation combined with chemotherapy after salvage surgery compared with salvage surgery alone in head and neck carcinoma. J. Clin. Oncol. 2008;26:5518–5523. doi: 10.1200/JCO.2007.15.0102. - DOI - PubMed
    1. Haraf D.J., Weichselbaum R.R., Vokes E.E. Re-irradiation with concomitant chemotherapy of unresectable recurrent head and neck cancer: A potentially curable disease. Ann. Oncol. 1996;7:913–918. doi: 10.1093/oxfordjournals.annonc.a010793. - DOI - PubMed