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OnCampus

 

 

Title:  Gross Tumor Volume (GTV)- Clinical Target Volume (CTV) Match in Patients Undergoing Postoperative Radiotherapy for Head & Neck Squamous Cell Carcinomas: a Pilot Study

 

Investigators:   

Giuseppe  Sanguineti,    Dept of Radiation Oncology

Anna Pou,                   Dept of Head and Neck Surgery

John Bayouth,             Dept of Physics 

Abstract:  The standard of care for patients with advanced head and neck (larynx, pharynx and oral cavity) squamous cell carcinomas is surgery followed by postoperative radiotherapy to 60 Gy. In order to optimize such strategy, this study tests the feasibility and efficacy of planning postoperative radiotherapy based on information acquired before the tumor is removed. Practically, the basic approach with radiotherapy is unchanged, while we have added an extra dose of radiation (“boost”) to the area where the tumor was originally as reconstructed from preoperative CT scan. Patients will be followed for both late radiation reactions (see Appendix) and development of locoregional recurrence. A further validation of our strategy will come from the analysis of pattern of locoregional recurrence (if any) of accrued patients.

 

Eligibility criteria:

  • Age 18-80 yrs;

  • Biopsy-proven SCC of the oral cavity, pharynx and larynx;
     

  • Stage IV according AJCC;
     

  • Eligibility for complete resection of the primary tumor and involved regional nodes;
     

  • Informed consent.

 

Exclusion criteria:

  • Low risk features of locoregional failure on final pathology: pT<4 and pN1 and negative resection margins and no perineural or lymphovascular invasion and no extracapsular lymph node extension;

  • Residual macroscopic disease after surgery;

  • Previous radiotherapy in the same field;

  • Recurrent/persistent tumor in the same region;

  • Patients included in the ongoing RTOG protocol H-0024

 

 

Schema:

PTV50: microscopic, low risk volume; 50 Gy /25 fractions/ 5 weeks;

PTV60: micro high risk; 60 Gy/30 fractions/ 6 weeks;

PTV69: original tumor volume before surgery; 69 Gy/30 fractions/ 6 weeks.

 

 

M

T

W

T

F

S

S

M

T

W

T

F

S

S

M

T

W

T

F

S

S

M

T

W

T

F

S

S

M

T

W

T

F

S

S

M

T

W

T

F

PTV50

x

x

x

x

x

x

X

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

x

 

 

 

 

 

PTV60

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

x

x

x

x

x

PTV69

 

c

 

 

s

 

 

 

c

 

 

s

 

 

 

c

 

 

s

 

 

 

c

 

 

s

 

 

 

c

 

 

s

 

 

 

c

 

 

s

 

X= 2 Gy per fraction

C= +0.5 Gy per fraction

S= +1 Gy per fraction.

 

 

 

 

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