Background and purpose: To develop and validate an adaptive intervention strategy for radiotherapy of head-and-neck cancer that accounts for systematic deformations by modifying the planning-CT ... Show moreBackground and purpose: To develop and validate an adaptive intervention strategy for radiotherapy of head-and-neck cancer that accounts for systematic deformations by modifying the planning-CT (pCT) to the average misalignments in daily cone beam CT (CBCT) measured with deformable registration (DR). Methods and materials: Daily CBCT scans (808 scans) for 25 patients were retrospectively registered to the pCT with B-spline DR. The average deformation vector field (< DVF >) was used to deform the pCT for adaptive intervention. Two strategies were simulated: single intervention after 10 fractions and weekly intervention with an < DVF > from the previous week.Methods and materials: The model was geometrically validated with the residual misalignment of anatomical landmarks both on bony-anatomy (BA; automatically generated) and soft-tissue (ST; manually identified).Results: Systematic deformations were 2.5/3.4 mm vector length (BA/ST). Single intervention reduced deformations to 1.5/2.7 mm (BA/ST). Weekly intervention resulted in 1.0/2.2 mm (BA/ST) and accounted better for progressive changes. 15 patients had average systematic deformations >2 mm (BA): reductions were 1.1/1.9 mm (single/weekly BA). ST improvements were underestimated due to observer and registration variability.Conclusions: Adaptive intervention with a pCT modified to the average anatomy during treatment successfully reduces systematic deformations. The improved accuracy could possibly be exploited in margin reduction and/or dose escalation. (C) 2013 Elsevier Ireland Ltd. All rights reserved. Show less
Molen, L. van der; Heemsbergen, W.D.; Jong, R. de; Rossum, M.A. van; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M. 2013
Background and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and... Show moreBackground and purpose: Prospective assessment of dysphagia and trismus in chemo-IMRT head and neck cancer patients in relation to dose-parameters of structures involved in swallowing and mastication.Material and methods: Assessment of 55 patients before, 10-weeks (N = 49) and 1-year post-treatment (N = 37). Calculation of dose-volume parameters for swallowing (inferior (IC), middle (MC), and superior constrictors (SC)), and mastication structures (e.g. masseter). Investigation of relationships between dose-parameters and endpoints for swallowing problems (videofluoroscopy-based laryngeal Penetration-Aspiration Scale (PAS), and study-specific structured questionnaire) and limited mouth-opening (measurements and questionnaire), taking into account baseline scores.Results: At 10-weeks, volume of IC receiving >= 60 Gy (V60) and mean dose IC were significant predictors for PAS. One-year post-treatment, reported problems with swallowing solids were significantly related to masseter dose-parameters (mean, V20, V40 and V60) and an inverse relationship (lower dose related to a higher probability) was observed for V60 of the IC. Dose-parameters of masseter and pterygoid muscles were significant predictors of trismus at 10-weeks (mean, V20, and V40). At 1-year, dose-parameters of all mastication structures were strong predictors for subjective mouth-opening problems (mean, max, V20, V40, and V60).Conclusions: Dose-effect relationships exist for dysphagia and trismus. Therefore treatment plans should be optimized to avoid these side effects. (C) 2013 Elsevier Ireland Ltd. All rights reserved. Show less
Graveland, A.P.; Braakhuis, B.J.M.; Eerenstein, S.E.J.; Bree, R. de; Bloemena, E.; Maaker, M. de; ... ; Brakenhoff, R.H. 2012
Objectives. Perceptual judgments and patients' perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer.Study Design. Prospective clinical trial... Show moreObjectives. Perceptual judgments and patients' perception of voice and speech after concurrent chemoradiotherapy (CCRT) for advanced head and neck cancer.Study Design. Prospective clinical trial.Methods. A standard Dutch text and a diadochokinetic task were recorded. Expert listeners rated voice and speech quality (based on Grade, Roughness, Breathiness, Asthenia, and Strain), articulation (overall, [p], [t], [k]), and comparative mean opinion scores of voice and speech at three assessment points calculated. A structured study-specific questionnaire evaluated patients' perception pretreatment (N = 55), at 10-week (N = 49) and 1-year posttreatment (N = 37).Results. At 10 weeks, perceptual voice quality is significantly affected. The parameters overall voice quality (mean, -0.24; P = 0.008), strain (mean, -0.12; P = 0.012), nasality (mean, -0.08; P = 0.009), roughness (mean, -0.22; P = 0.001), and pitch (mean, -0.03; P = 0.041) improved over time but not beyond baseline levels, except for asthenia at 1-year posttreatment (voice is less asthenic than at baseline; mean, +0.20; P = 0.03). Perceptual analyses of articulation showed no significant differences. Patients judge their voice quality as good (score, 18/20) at all assessment points, but at 1-year posttreatment, most of them (70%) judge their "voice not as it used to be.'' In the 1-year versus 10-week posttreatment comparison, the larynx-hypopharynx tumor group was more strained, whereas nonlarynx tumor voices were judged less strained (mean, -0.33 and +0.07, respectively; P = 0.031). Patients' perceived changes in voice and speech quality at 10-week post-versus pretreatment correlate weakly with expert judgments.Conclusion. Overall, perceptual CCRT effects on voice and speech seem to peak at 10-week posttreatment but level off at 1-year posttreatment. However, at that assessment point, most patients still perceive their voice as different from baseline. Show less
This systematic review addresses the prognostic significance of neck node volume in head and neck cancer. Primary tumor volume evolved as an independent significant factor for survival in head and... Show moreThis systematic review addresses the prognostic significance of neck node volume in head and neck cancer. Primary tumor volume evolved as an independent significant factor for survival in head and neck cancer patients. Besides primary tumor volume, multiple prognostic features related to the regional lymph nodes were studied in literature. In literature, some authors showed the significance of total tumor volume/nodal volume for survival and loco-regional control. Articles reporting prognosis and survival in nodal tumor volumes were collected by systematically reviewing publications listed in the Pubmed and Embase databases. Publications were included when they at least reported on total tumor volume (TTV) or nodal volume and survival.In this systematic review we studied 21 articles. For measurement of nodal volume different formulas were used. Until now, there's no clear statistical evidence for the use of either TTV or nodal volume versus primary tumor volume to predict the individual loco-regional control or survival after treatment.There is wide variety of tumor measuring systems in the literature. The cut-off value for local tumor response also shows large variation. Firstly consensus should be accomplished on standardization of volume measurements, preferably automatic, and secondly large study groups are needed with identical treatment modalities to further unravel the role of neck node volume as separate staging tool. (C) 2011 Elsevier Ltd. All rights reserved. Show less
Molen, L. van der; Rossum, M.A. van; Burkhead, L.M.; Smeele, L.E.; Rasch, C.R.N.; Hilgers, F.J.M. 2011
The aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral... Show moreThe aim of this study was to assess the effect of (preventive) rehabilitation on swallowing and mouth opening after concomitant chemoradiotherapy (CCRT). Forty-nine patients with advanced oral cavity, oropharynx, hypopharynx and larynx, or nasopharynx cancer treated with CCRT were randomized into a standard (S) or an experimental (E) preventive rehabilitation arm. Structured multidimensional assessment (i.e., videofluoroscopy, mouth-opening measurement, structured questionnaires) was performed before and 10 weeks after CCRT. In both S and E arms, feasibility was good (all patients could execute the exercises within a week) and compliance was satisfactory (mean days practiced per week was 4). Nevertheless, mouth opening, oral intake, and weight decreased significantly. Compared to similar CCRT studies at our institute, however, fewer patients were still tube-dependent after CCRT. Furthermore, some functional outcomes seemed less affected than those of studies in the literature that did not incorporate rehabilitation exercises. Patients in the E arm practiced significantly fewer days in total and per week, but they obtained results comparable to the S arm patients. Preventive rehabilitation (regardless of the approach, i.e., experimental or standard) in head and neck cancer patients, despite advanced stage and burdensome treatment, is feasible, and compared with historical controls, it seems helpful in reducing the extent and/or severity of various functional short-term effects of CCRT. Show less
Lamers-Kuijper, E.; Heemsbergen, W.; Mourik, A. van; Rasch, C. 2011
Purpose: To find parameters that predict which head and neck patients benefit from a sequentially delivered boost treatment plan compared to a simultaneously delivered plan, with the aim to spare... Show morePurpose: To find parameters that predict which head and neck patients benefit from a sequentially delivered boost treatment plan compared to a simultaneously delivered plan, with the aim to spare the salivary glands.Methods and materials: We evaluated 50 recently treated head and neck cancer patients. Apart from the clinical plan with a sequentially (SEQ) given boost using an Intensity Modulated Radiotherapy Technique (IMRT), a simultaneous integrated boost (SIB) technique plan was constructed with the same beam setup. The mean dose to the parotid glands was calculated and compared. The elective nodal areas were bilateral in all cases, with a boost on either one side or both sides of the neck.Results: When the parotid gland volume and the Planning Target Volume (PTV) for the boost overlap there is on average a lower dose to the parotid gland with a SIB technique (-1.2 Gy), which is, however, not significant (p = 0.08).For all parotid glands with no boost PTV overlap, there is a benefit from a SEQ technique compared to a SIB technique for the gland evaluated (on average a 2.5 Gy lower dose to the parotid gland, p < 0.001). When the distance between gland and PTV is 0-1 cm, this difference is on average 0.8 Gy, for 1-2 cm distance 2.9 Gy and for glands with a distance greater than 2 cm, 3.3 Gy. When the lymph nodes on the evaluated side are also included in the boost PTV, however, this relationship between the distance and the gain of a SEQ seems less clear.Conclusions: A sequentially delivered boost technique results in a better treatment plan for most cases, compared to a simultaneous integrated boost IMRT technique, if the boost PTV is more than 1 cm away from at least one parotid gland. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 98 (2011) 51-56 Show less
Jong, M.C. de; Pramana, J.; Knegjens, J.L.; Balm, A.J.M.; Brekel, M.W.M. van den; Hauptmann, M.; ... ; Rasch, C.R.N. 2010
Purpose: The purpose of this study was to combine gene expression profiles and clinical factors to provide a better prediction model of local control after chemoradiotherapy for advanced head and... Show morePurpose: The purpose of this study was to combine gene expression profiles and clinical factors to provide a better prediction model of local control after chemoradiotherapy for advanced head and neck cancer.Material and methods: Gene expression data were available for a series of 92 advanced stage head and neck cancer patients treated with primary chemoradiotherapy. The effect of the Chung high-risk and Slebos HPV expression profiles on local control was analyzed in a model with age at diagnosis, gender, tumor site, tumor volume, T-stage and N-stage and HPV profile status.Results: Among 75 patients included in the study, the only factors significantly predicting local control were tumor site (oral cavity vs. Pharynx, hazard ratio 4.2 [95% CI 1.4-12.5]), Chung gene expression status (high vs. Low risk profile, hazard ratio 4.4 [95% CI 1.5-13.3]) and HPV profile (negative vs. Positive profile, hazard ratio 6.2 [95% CI 1.7-22.5]).Conclusions: Chung high-risk expression profile and a negative HPV expression profile were significantly associated with increased risk of local recurrence after chemoradiotherapy in advanced pharynx and oral cavity tumors, independent of clinical factors. (C) 2010 Elsevier Ireland Ltd. All rights reserved. Radiotherapy and Oncology 95 (2010) 365-370 Show less
The general aim of this thesis is to determine and compare disease and voice outcome for T1 glottic carcinoma treated with radiotherapy or laser surgery. The findings show similar oncological and... Show moreThe general aim of this thesis is to determine and compare disease and voice outcome for T1 glottic carcinoma treated with radiotherapy or laser surgery. The findings show similar oncological and functional results for radiotherapy and laser surgery in __superficial midcord T1a glottic carcinoma__. This outcome supports the Dutch national guideline __Treatment of Laryngeal Carcinoma__ which was published during the life-time of this thesis. In this guideline laser surgery is labeled treatment of choice in these lesions because of the shorter treatment duration, lower costs and the possibility for repeated treatments and/or additional radiotherapy. For larger T1 lesions, our literature review concludes that more comparative data, especially on functional results, are needed before definite conclusions can be drawn as to the role of laser surgery in these lesions. These studies are now being perform ed in a collaboration between the Leiden University Medical Center and the Eramus Medical Center, Rotterdam. Show less
