Stefan Janssen

Risk-adapted partial larynx and/or carotid artery sparing modulated radiation therapy of glottic cancer

BackgroundTo evaluate outcome in patients with glottic cancer treated with intensity-modulated radiotherapy (IMRT) and to show effectiveness of partial laryngeal- and/or carotid artery sparing in low to intermediate risk tumors.Study designRetrospective analysis.Material and methodsFrom 01/2004 to 03/2013 77 consecutive patients presenting with glottic cancer were treated in our department with IMRT as definitive treatment. T-stages distributed as follows: T1: nu2009=u200917, T2: nu2009=u200924, T3: nu2009=u200915, T4: nu2009=u200913 and recurrences: 8 patients. Concomitant systemic therapy was applied in 39 patients consisting of either cisplatin or cetuximab.ResultsMean/median follow-up (FU) time was 32.2/28xa0months (range: 4–98.7). Three year local control (LC), ultimate LRC and laryngectomy free survival rate was 77%, 92% and 80%, respectively. Three year overall survival of the entire cohort was 81%. Three year local control for T1/T2, T3/T4, and recurred tumors was 95%, 65%, and 38%, respectively. Three year overall survival was 86% for T1-4 stages, 55% for recurred disease, respectively. Partial laryngeal/carotid artery sparing was performed in all T1 patients (nu2009=u200917) and 17/22 T2N0 patients. Rate of late sequels was low.ConclusionIMRT for glottic cancer shows high control rates. In low to intermediate risk tumors an individualized treatment volume with partial larynx +/- carotid artery sparing is effective and holds the potential to reduce long term toxicity. The therapeutic outcome was not compromised.

Clinical experience of SIB-IMRT in anal cancer and selective literature review

PurposeTo evaluate feasibility and outcome of our institutional SIB-IMRT schedule in patients with anal cancer and to selectively review the literature on different SIB-IMRT schedules.Patients and methodsBetween 01/08-06/13 25 patients with biopsy proven squamous cell anal cancer were treated in our institution with IMRT. Radiotherapy was delivered in two series using a SIB-IMRT schedule of 45 Gy/1.8 Gy to the primary tumor and adjacent pelvic lymph nodes and 38 Gy/1.52 Gy to elective nodes followed by an IMRT boost of 7×2 Gyu2009=u200914 Gy to the primary tumor and involved nodes (cumulative prescription dose: 59 Gy).ResultsMean follow-up was 20xa0months (range: 4-68). The 2-year-local control, colostomy-free survival, distant metastases-free survival and overall survival rates were 92%, 92%, 92%, and 88%, respectively. Grade 3 acute skin toxicity was observed in 6 patients (24%). No high grade gastrointestinal or urinary acute toxicity occurred. Four patients required more than one day of treatment interruption due to acute toxicity. No grade 3 or higher late sequelae were observed.ConclusionWe present our institutional SIB-IMRT experience treating patients with anal cancer in two series using moderate single doses from 1.5-2.0 Gy. Our results, in terms of loco-regional outcome and toxicity, were comparable to other studies. The incidence of treatment interruptions was very low. Therefore this schedule appears to be safe for clinical use.

Hypofractionated radiotherapy for breast cancer acceleration of the START A treatment regime: intermediate tolerance and efficacy

PurposeProspective evaluation of accelerated hypofractionated radiotherapy (RT) in breast cancer patients treated with 41.6 Gy in 13 fractions plus boost delivered five times a week.Patients and methodsBetween 03/2009 and 10/2012 98 consecutive patients aged >55xa0years presenting with breast cancer (invasive cancer: nu2009=u200995, ductal carcinoma in situ (DCIS): nu2009=u20093) after breast conserving surgery were treated in our institution with the following schedule: 41.6 Gy in 13 fractions 4 times a week and 9 or 12 Gy boost in 3 or 4 fractions (on day 5 each week), cumulative dose: 50.6 Gy in 3.2xa0weeks or 53.6 Gy in 3.4xa0weeks, respectively depending on resection status. 56 patients had a T1 tumor, 39 a T2 tumor. N-status was as follows: N0: nu2009=u200971, N1: nu2009=u200925, N2/3: nu2009=u20092. 23 patients (24%) received chemotherapy before RT. A prospectively planned follow-up (FU) visit with objective and subjective assessment of treatment tolerance (questionnaires) was performed 0 and 8xa0weeks after RT completion, and one, two and four years later, respectively.ResultsMean/median follow-up was 32/28 months (range: 12-56). After 2 years local control, loco-regional control and disease-free survival was 100%, 100%, and 98%, respectively. Overall survival was 96% at 2 years. Cosmetic outcome was very good with patients being satisfied or very satisfied in 99% (n = 86/87), 97% (n = 55/57) and 100% (n = 25/25) after one, two and four years after RT, respectively. No grade ≥u20092 pain was described in the 25 patients with a FU of at least 4 years. Fibrosis, telangiectasia and edema were found in 7-15%, 0-22% and 0-11% at one, two, and four years, respectively, and are comparable to other trials.ConclusionThe applied hypofractionated RT regime with single doses of 3.2 Gy plus boost doses of 9-12 Gy in 3–4 fractions applied in 5 sessions a week was effective and well tolerated on intermediate term FU.

Individualized IMRT treatment approach for cervical lymph node metastases of unknown primary

PurposeThe goal of the present study was to evaluate the outcome of risk-adapted planning treatment volumes (PTVs) in patients with cervical lymph node metastases of unknown primary cancer (UPC) treated with intensity-modulated radiotherapy (IMRT).Patients and materialBetween January 2006 and November 2012, 28 patients with cervical lymph node metastases of UPC were treated in our institution with IMRT either postoperatively (nu2009=u200920) or as definitive treatment (nu2009=u20098). Nodal involvement distributed as follows: N1 (nu2009=u20092), N2a (8), N2b (10), N2c (4), and N3 (4). Systemic therapy with cisplatin or cetuximab was added concomitantly in 20 of 28xa0patients (71u2009%). Radiotherapy using simultaneously integrated boost (SIB-IMRT) was carried out with 2.0 or 2.11xa0Gy single doses up to 66/70xa0Gy.ResultsMean/median follow-up was 31.6/30.5xa0months (range 3–78xa0months). In all, 15 of 28xa0patients were treated with unilateral SIB-IMRT (54u2009%). An elective PTV to the contralateral oropharynx and contralateral levelxa0II–III lymph nodes was carried out in 8xa0patients with PET-CT suspected but not histologically proven involvement, recurrences or former tumor of the oropharynx. More extended treatment fields were reserved for patients with N2c or bilaterally N3 status (nu2009=u20095). The 3-year overall survival, mucosal control, neck control and distant metastasis-free survival rates were 76, 100, 93, and 88u2009%, respectively. No patient suffered from a locoregional recurrence. Two patients treated with radiotherapy alone had persistent nodal disease. No gradexa0II or higher late sequel has been observed.ConclusionOur single center approach to treat patients with cervical lymph node metastases of UPC with individualized, risk-adapted SIB-IMRT resulted in high locoregional tumor control and was well tolerated.ZusammenfassungZielEvaluation von intensitätsmodulierter Radiotherapie (IMRT) mit risikoadaptierten Planungszielvolumina („planning treatment volumes“, PTVs) bei Patienten mit zervikalen Lymphknotenmetastasen bei unbekanntem Primarius („unknown primary cancer“, UPC).Patienten und MethodenZwischen Januar 2006 und November 2012 wurden 28xa0Patienten mit zervikalen Lymphknotenmetastasen eines UPC in unserer Abteilung mit IMRT entweder postoperativ (nu2009=u200920) oder definitiv (nu2009=u20098) behandelt. Das Ausmaß des Lymphknotenbefalls stellte sich folgendermaßen dar: N1 (nu2009=u20092), N2a (nu2009=u20098), N2b (nu2009=u200910), N2c (nu2009=u20094) und N3 (nu2009=u20094). Bei 20/28xa0Patienten (71u2009%) wurde eine simultane Systemtherapie mit Cisplatin oder Cetuximab appliziert. Die Bestrahlung mit integriertem Boost (SIB-IMRT) erfolgte in Einzeldosen von 2,0 oder 2,11xa0Gy bis zu einer Gesamtdosis von 66 bis 70xa0Gy.ErgebnisseDie durchschnittliche/mediane Nachbeobachtungszeit betrug 31,6/30,5xa0Monate (Spanne 3–78xa0Monate). Von 28xa0Patienten wurden 15 mit einer unilateralen SIB-IMRT behandelt (54u2009%). Bei 8xa0Patienten mit histologisch nicht bestätigten, suspekten Befunden im PET-CT, Rezidiven oder Zustand nach Oropharynxtumoren wurde eine elektive Bestrahlung des kontralateralen Oropharynx und der kontralateralen Level-II- bis Level-III-Lymphknoten durchgeführt. Darüberhinausgehende Erweiterungen des PTV wurden bei Patienten mit N2c- oder bilateralem N3-Status durchgeführt (nu2009=u20095). Das Gesamtüberleben, die Mukosakontrolle, die lokale Tumorkontrolle und das fernmetastasenfreie Überleben nach 3xa0Jahren betrugen 76, 100, 93 und 88u2009%. Kein Patient erlitt ein lokoregionäres Rezidiv. Bei 2xa0Patienten persistierte der Lymphknotenbefund nach definitiver Radiotherapie. Gradxa0II oder höhergradige Spätnebenwirkungen wurden nicht beobachtet.SchlussfolgerungDie Behandlung von Patienten mit zervikalen Lymphknotenmetastasen eines UPC mit einer individualisierten, risikoadaptierten SIB-IMRT führt zu einer hohen lokoregionären Tumorkontrolle und ist gut tolerabel.

Local control and intermediate-term cosmetic outcome following IMRT for nasal tumors

AbstractObjectiveThis study aims to evaluate local control and intermediate-term cosmetic outcome in patients with cancer of the nose treated with intensity-modulated radiotherapy (IMRT).MethodsFrom Junexa02008 to Septemberxa02015, 36xa0consecutive patients presenting with nasal cavity, ala of the nose, orn nasal vestibule tumors were treated at the Department of Radiation Oncology, University Hospital Zurich eithern postoperatively (nxa0= 14; 3/14xa0with nasal ablation) or with definitive IMRTn (nxa0= 22). Of these 36 patients, 8 presented with recurrent disease after surgery only and 1/36xa0with N1xa0disease. Concurrent systemic therapy was administered in 18/36xa0patients (50%). Nasal follow-up (FU) imaging documentation of 13xa0patients with preserved organ and >6xa0months FU offers axa0pre/post IMRT FU comparison. In addition, these patients’ subjective evaluation of cosmesis was assessed.ResultsMean/median FU was 41/33xa0months (range 5–92xa0months). Salvage ablation with curative intent was undergone by 3xa0patients with local relapse after definitive (nxa0= 2) and postoperative (nxa0= 1) IMRT. The 3‑year local control, ultimate local control, and overall survival rates were 90, 97, and 90u2009%, respectively. Subjective and objective cosmetic outcome after IMRT is very satisfying so far.ConclusionIMRT for nasal tumors was found to be effective and well tolerated. Intermediate-term cosmetic results are good. Radical surgical procedures may be saved for curative salvage treatment.ZusammenfassungZielEvaluation der Lokalkontrolle und des mittelfristigen kosmetischen Resultats nach intensitätsmodulierter Radiotherapie (IMRT) von Patienten mit Nasentumoren.MethodenVon Juni 2008 bis September 2015 wurden an der Klinik für RadioOnkologie am UniversitätsSpital Zürich 36 konsekutive Patienten mit Tumoren der Nasenhöhle, der Nasenflügel oder des Vestibulum nasi postoperativ (nxa0= 14; 3/14 nach Nasenablation) oder definitiv IMRT-bestrahlt (nxa0= 22). Von diesen 36 Patienten zeigten 8 ein Lokalrezidiv nach alleiniger vorangegangener Chirurgie und ein Patient einen N1-Status. Eine simultane systemische Therapie erfolgte bei 18/36xa0Patienten (50u2009%). Eine Bilddokumentation des kosmetischen Verlaufs konnte vor und nach Bestrahlung bei 13xa0Patienten mit erhaltenem Organ, einer Nachbeobachtungszeit (FU) von mindestens 6xa0Monaten und lokaler Tumorkontrolle erstellt werden. Zudem wurde von diesen Patienten eine subjektive Beurteilung der kosmetischen Ergebnisse erfragt.ErgebnisseDas mittlere/mediane FU betrug 41/33xa0Monate (Spanne 5–92xa0Monate). Einer Salvage-Ablation in kurativer Absicht mussten sich 3xa0Patienten mit Lokalrezidiv nach definitiver (nxa0= 2) und postoperativer (nxa0= 1) IMRT unterziehen. Die 3‑Jahres-Lokalkontrolle, die ultimative Lokalkontrolle und die Gesamtüberlebensrate betrugen jeweils 90, 97 und 90%. Die objektive sowie die subjektive Beurteilung des kosmetischen Resultats nach IMRT ist bislang sehr befriedigend.ZusammenfassungIMRT für Nasentumoren ist effektiv und gut verträglich bei mittelfristig guten kosmetischen Ergebnissen. Die radikale chirurgische Behandlung kann als kurative Salvage-Option reserviert werden.

IMRT for Nasal Tumors – Local Control and Cosmetic Outcome

Background: To evaluate local control and cosmetic outcome in patients with cancer in the nasal cavity/vestibule treated with intensity-modulated radiotherapy (IMRT). n Methods: From 06/2008 – 11/2012 15 consecutive patients presenting nasal cavity (n=5), ala of the nose (n=5) or nasal vestibule tumors (n=5) were treated in our institution either postoperatively (n=8) or as definitive treatment (n=7). n Results: Mean/median follow-up (FU) was 30/22 months (range 17-62). Two patients suffered from a local relapse. As a salvage therapy an ablatio nasi was carried out in curative intention in both patients. Thereafter no failure was reported. Local control rate, ultimate local control and overall survival after 2 years were 87%, 100% and 100%, respectively. None of the patients developed grade II or higher late sequels. Cosmetic outcome after RT was very satisfying so far. n Conclusion: IMRT for nasal tumors is effective and well tolerated. Radical surgical procedures can be saved for curative salvage treatment.

IMRT for Nasal Tumors â Local Control and Cosmetic Outcome

Background: To evaluate local control and cosmetic outcome in patients with cancer in the nasal cavity/vestibule treated with intensity-modulated radiotherapy (IMRT). n Methods: From 06/2008 – 11/2012 15 consecutive patients presenting nasal cavity (n=5), ala of the nose (n=5) or nasal vestibule tumors (n=5) were treated in our institution either postoperatively (n=8) or as definitive treatment (n=7). n Results: Mean/median follow-up (FU) was 30/22 months (range 17-62). Two patients suffered from a local relapse. As a salvage therapy an ablatio nasi was carried out in curative intention in both patients. Thereafter no failure was reported. Local control rate, ultimate local control and overall survival after 2 years were 87%, 100% and 100%, respectively. None of the patients developed grade II or higher late sequels. Cosmetic outcome after RT was very satisfying so far. n Conclusion: IMRT for nasal tumors is effective and well tolerated. Radical surgical procedures can be saved for curative salvage treatment.

IMRT for Nasal Tumors â Local Control and Cosmetic Outcome

Background: To evaluate local control and cosmetic outcome in patients with cancer in the nasal cavity/vestibule treated with intensity-modulated radiotherapy (IMRT). n Methods: From 06/2008 – 11/2012 15 consecutive patients presenting nasal cavity (n=5), ala of the nose (n=5) or nasal vestibule tumors (n=5) were treated in our institution either postoperatively (n=8) or as definitive treatment (n=7). n Results: Mean/median follow-up (FU) was 30/22 months (range 17-62). Two patients suffered from a local relapse. As a salvage therapy an ablatio nasi was carried out in curative intention in both patients. Thereafter no failure was reported. Local control rate, ultimate local control and overall survival after 2 years were 87%, 100% and 100%, respectively. None of the patients developed grade II or higher late sequels. Cosmetic outcome after RT was very satisfying so far. n Conclusion: IMRT for nasal tumors is effective and well tolerated. Radical surgical procedures can be saved for curative salvage treatment.