Research Article

Appraisal of Target Definition for Salvage Stereotactic Irradiation of Patients with Hypopharyngeal Cancer After Initial Surgery Alone

Selcuk Demiral*, Ferrat Dincoglan, Omer Sager and Murat Beyzadeoglu

Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

Submission: April 09, 2024; Published: May 14, 2024

*Corresponding Address: Selcuk Demiral, Department of Radiation Oncology; University of Health Sciences, Gulhane Medical Faculty, Ankara, Turkey

How to cite this article: Selcuk Demiral*, Ferrat Dincoglan, Omer Sager and Murat Beyzadeoglu. Appraisal of Target Definition for Salvage Stereotactic Irradiation of Patients with Hypopharyngeal Cancer After Initial Surgery Alone. Canc Therapy & Oncol Int J. 2024; 26(5): 556199. DOI:10.19080/CTOIJ.2024.26.556199

Abstract

Objective: Hypopharyngeal cancers may recur after initial therapy. Some patients refuse to undergo multimodality management and prefer surgery as initial treatment. Even after multimodality treatment, local recurrence may develop during the follow-up period. Stereotactic irradiation offers a highly precise radiotherapeutic modality with improved stereotactic localization of well-defined targets under image guidance. In this study, we evaluated target definition for salvage stereotactic irradiation of patients with hypopharyngeal cancer after initial surgery alone.

Materials and methods: We performed a comparative analysis of target definition by Computed Tomography (CT) simulation images for stereotactic RT planning and with Magnetic Resonance Imaging (MRI).

Results: Stereotactic RT planning has aimed at achieving optimal target coverage without violation of normal tissue dose constraints. IGRT techniques including kilovoltage cone beam CT was used, and salvage stereotactic irradiation was performed by Synergy (Elekta, UK) LINAC. As the primary outcome of the study, we found that CT and MRI defined target definition resulted in differences. Taking this into account, we used fused CT and MRI for ground truth target volume definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone.

Conclusion: From the standpoint of radiation oncology, results may have implications for increased adoption of multimodality imaging-based target definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone, however, there is still need for future studies to shed light on this critical issue.

Keywords: Hypopharyngeal cancer; Salvage stereotactic irradiation; Target definition; Computed Tomography (CT); Magnetic Resonance Imaging (MRI)

Abbreviations: CT: Computed Tomography; MRI: Magnetic Resonance Imaging; RT: Radiation Therapy; IGRT: Image Guided RT; IMRT: Intensity Modulated RT; ART: adaptive RT; LINAC: Linear Accelerator

Introduction

Hypopharyngeal cancer remains to be a major public health concern with its critical incidence around the globe [1]. Surgery, radiation therapy (RT), and systemic treatments may be utilized alone or in combination for management of hypopharyngeal cancer with respect to patient, disease, and treatment characteristics [2-7]. The head and neck region are associated with critical body functions. Hypopharyngeal tumors have tendency for lymphatic and systemic spread. Also, the critical localization of these tumors in close association with critical structures poses an important concern for surgical management. Recently, stereotactic irradiation has emerged as a viable treatment technique for management of a variety of cancers throughout the human body. Hypopharyngeal cancers may recur after initial therapy. Some patients refuse to undergo multimodality management and prefer surgery as initial treatment. Even after multimodality treatment, local recurrence may develop during the follow-up period.

Critical advances in technology have occurred during the last decades. Automatic segmentation techniques, molecular imaging methods, Image Guided RT (IGRT), Intensity Modulated RT (IMRT), stereotactic RT, and adaptive RT (ART) techniques have been introduced for improved irradiation results [8-49]. Stereotactic irradiation offers a highly precise radiotherapeutic modality with improved stereotactic localization of well -defined targets under image guidance. High doses of radiation may be delivered in a single fraction or with a limited number of fractions, and highly conformal treatment with steep dose gradients around the target may allow for optimal irradiation with an acceptable toxicity profile. While external beam RT is still widely accepted as a viable treatment modality for hypopharyngeal cancer management, stereotactic irradiation may also be utilized in certain circumstances. In this study, we evaluated target definition for salvage stereotactic irradiation of patients with hypopharyngeal cancer after initial surgery alone.

Materials and Methods

Department of Radiation Oncology at University of Health Sciences, Gulhane Medical Faculty serves as a tertiary cancer center for patients from Turkey and abroad. A wide spectrum of benign and malignant tumors is irradiated at our department by using contemporary RT approaches. For of this study, the endpoint was targeting definition for salvage stereotactic irradiation of patients with hypopharyngeal cancer after initial surgery alone. All included patients have been referred to Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone. We performed a comparative analysis of target definition by Computed Tomography (CT) simulation images for stereotactic RT planning and with Magnetic Resonance Imaging (MRI). CT simulations of the patients have been done at the CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our institution. Also, MRI of patients have been acquired and utilized for comparative analysis.

A Linear Accelerator (LINAC) with the capability of sophisticated IGRT techniques was used for stereotactic irradiation. Following rigid patient immobilization, planning CT images have been acquired at CT-simulator for stereotactic RT planning. Afterwards, acquired stereotactic RT planning images were sent to the delineation workstation via the network. Target volumes and critical structures have been defined on these images and structure sets were generated. Also, target definition was also performed on MRI for comparison purposes. All patients underwent stereotactic RT at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone.

Results

In this study, we investigated target definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone. Stereotactic irradiation procedures were carried out at our Radiation Oncology Department of Gulhane Medical Faculty at University of Health Sciences. Prior to salvage stereotactic RT, all included patients are thoroughly assessed by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology. Stereotactic RT planning has aimed at achieving optimal target coverage without violation of normal tissue dose constraints. IGRT techniques including kilovoltage cone beam CT was used, and salvage stereotactic irradiation was performed by Synergy (Elekta, UK) LINAC. As the primary outcome of the study, we found that CT and MRI defined target definition resulted in differences. Taking this into account, we used fused CT and MRI for ground truth target volume definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone.

Discussion

Hypopharyngeal cancer remains to be a major public health concern with its critical incidence around the globe [1]. Surgery, RT, and systemic treatments may be utilized alone or in combination for management of hypopharyngeal cancer with respect to patient, disease, and treatment characteristics [2- 7]. The head and neck region are associated with critical body functions. Hypopharyngeal tumors have tendency for lymphatic and systemic spread. Also, the critical localization of these tumors in close association with critical structures poses an important concern for surgical management. Recently, stereotactic irradiation has emerged as a viable treatment technique for management of a variety of cancers throughout the human body. Hypopharyngeal cancers may recur after initial therapy. Some patients refuse to undergo multimodality management and prefer surgery as initial treatment. Even after multimodality treatment, local recurrence may develop during the follow-up period.

Critical advances in technology have occurred during the last decades. Automatic segmentation techniques, molecular imaging methods, IGRT, IMRT, stereotactic RT, and ART techniques have been introduced for improved irradiation results [8-49]. Stereotactic irradiation offers a highly precise radiotherapeutic modality with improved stereotactic localization of well-defined targets under image guidance. High doses of radiation may be delivered in a single fraction or with a limited number of fractions, and highly conformal treatment with steep dose gradients around the target may allow for optimal irradiation with an acceptable toxicity profile. While external beam RT is still widely accepted as a viable treatment modality for hypopharyngeal cancer management, stereotactic irradiation may also be utilized in certain circumstances. In this study, we evaluated target definition for salvage stereotactic irradiation of patients with hypopharyngeal cancer after initial surgery alone.

Department of Radiation Oncology at University of Health Sciences, Gulhane Medical Faculty serves as a tertiary cancer center for patients from Turkey and abroad. A wide spectrum of benign and malignant tumors is irradiated at our department by using contemporary RT approaches. For of this study, the endpoint was targeting definition for salvage stereotactic irradiation of patients with hypopharyngeal cancer after initial surgery alone. All included patients have been referred to Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone. We performed a comparative analysis of target definition by CT simulation images for stereotactic RT planning and with MRI. CT simulations of the patients have been done at the CT-simulator (GE Lightspeed RT, GE Healthcare, Chalfont St. Giles, UK) available at our institution. Also, MRI of patients have been acquired and utilized for comparative analysis.

A Linear Accelerator (LINAC) with the capability of sophisticated IGRT techniques was used for stereotactic irradiation. Following rigid patient immobilization, planning CT images have been acquired at CT-simulator for stereotactic RT planning. Afterwards, acquired stereotactic RT planning images were sent to the delineation workstation via the network. Target volumes and critical structures have been defined on these images and structure sets were generated. Also, target definition was also performed on MRI for comparison purposes. All patients underwent stereotactic RT at Department of Radiation Oncology at Gulhane Medical Faculty, University of Health Sciences for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone.

In this study, we investigated target definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone. Stereotactic irradiation procedures were carried out at our Radiation Oncology Department of Gulhane Medical Faculty at University of Health Sciences [50-106]. Prior to salvage stereotactic RT, all included patients are thoroughly assessed by a multidisciplinary team of experts from surgical oncology, radiation oncology, and medical oncology. Stereotactic RT planning has aimed at achieving optimal target coverage without violation of normal tissue dose constraints. IGRT techniques including kilovoltage cone beam CT was used, and salvage stereotactic irradiation was performed by Synergy (Elekta, UK) LINAC. As the primary outcome of the study, we found that CT and MRI defined target definition resulted in differences. Taking this into account, we used fused CT and MRI for ground truth target volume definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone.

From the standpoint of radiation oncology, results may have implications for increased adoption of multimodality imagingbased target definition for salvage stereotactic irradiation of hypopharyngeal cancer after initial surgery alone, however, there is still need for future studies to shed light on this critical issue.

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71. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2020) Evaluation of Target Volume Determination for Irradiatıon of Pilocytic Astrocytomas: An Original Article. ARC J Cancer Sci 6: 1-5.
72. Demiral S, Beyzadeoglu M, Dincoglan F, Sager O (2020) Evaluation of Radiosurgery Target Volume Definition for Tectal Gliomas with Incorporation of Magnetic Resonance Imaging (MRI): An Original Article. Biomed J Sci & Techn Res (BJSTR) 27: 20543-20547.
73. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2021) Assessment of Multimodality Imaging for Target Definition of Intracranial Chondrosarcomas. Canc Therapy Oncol Int J 18(2): 1-5.
74. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2021) Impact of Multimodality Imaging to Improve Radiation Therapy (RT) Target Volume Definition for Malignant Peripheral Nerve Sheath Tumor (MPNST). Biomed J Sci Tech Res 34: 26734-26738.
75. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2021) Multimodality Imaging Based Treatment Volume Definition for Reirradiation of Recurrent Small Cell Lung Cancer (SCLC). Arch Can Res 9(1): 1-5.
76. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2021) Radiation Therapy (RT) Target Volume Definition for Peripheral Primitive Neuroectodermal Tumor (PPNET) by Use of Multimodality Imaging: An Original Article. Biomed J Sci & Tech Res 34: 26970-26974.
77. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2021) Evaluation of Target Definition for Management of Myxoid Liposarcoma (MLS) with Neoadjuvant Radiation Therapy (RT). Biomed J Sci Tech Res 33: 26171-26174.
78. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Radiation Therapy (RT) target determination for irradiation of bone metastases with soft tissue component: Impact of multimodality imaging. J Surg Surgical Res 7: 42-46.
79. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2021) Evaluation of Changes in Tumor Volume Following Upfront Chemotherapy for Locally Advanced Non-Small Cell Lung Cancer (NSCLC). Glob J Cancer Ther 7: 31-34.
80. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2021) Assessment of posterior fossa target definition by multimodality imaging for patients with medulloblastoma. J Surg Surgical Res 7: 37-41.
81. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2021) Assessment of the role of multimodality imaging for treatment volume definition of intracranial ependymal tumors: An original article. Glob J Cancer Ther 7: 43-45.
82. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2022) Assessment of Target Definition for Extramedullary Soft Tissue Plasmacytoma: Use of Multımodalıty Imaging for Improved Targetıng Accuracy. Canc Therapy & Oncol Int J 22(4): 556095.
83. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Target Volume Determination for Recurrent Uterine Carcinosarcoma: An Original Research Article Revisiting the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 22(3): 556090.
84. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Reappraisal of Computed Tomography (CT) And Magnetic Resonance Imaging (MRI) Based Target Definition for Radiotherapeutic Management of Recurrent Anal Squamous Cell Carcinoma (ASCC): An Original Article. Canc Therapy & Oncol Int J 22(2): 556085.
85. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2022) An Original Article for Assessment of Multimodality Imaging Based Precise Radiation Therapy (Rt) in the Management of Recurrent Pancreatic Cancers. Canc Therapy & Oncol Int J 22(1): 556078.
86. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2022) Assessment of Target Volume Definition for Precise Radiotherapeutic Management of Locally Recurrent Biliary Tract Cancers: An Original Research Article. Biomed J Sci & Tech Res 46(1): 37054-37059.
87. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M. (2022) Radiation Therapy (RT) Target Volume Determination for Locally Advanced Pyriform Sinus Carcinoma: An Original Research Article Revisiting the Role of Multimodality Imaging. Biomed J Sci & Tech Res 45(1): 36155-36160.
88. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2022) Improved Target Volume Definition for Radiotherapeutic Management of Parotid Gland Cancers by use of Multimodality Imaging: An Original Article. Canc Therapy & Oncol Int J 21(3): 556062.
89. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Reappraisal of multimodality imaging for improved Radiation Therapy (RT) target volume determination of recurrent Oral Squamous Cell Carcinoma (OSCC): An original article. J Surg Surgical Res 8: 4-8.
90. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2022) Multimodality imaging-based treatment volume definition for recurrent Rhabdomyosarcomas of the head and neck region: An original article. J Surg Surgical Res 8(2): 13-18.
91. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2022) Appraisal of Target Definition for Management of Paraspinal Ewing Tumors with Modern Radiation Therapy (RT): An Original Article. Biomed J Sci & Tech Res 44(4): 35691-35696.
92. Beyzadeoglu M, Sager O, Demiral S, Dincoglan F (2022) Assessment of Target Volume Definition for Contemporary Radiotherapeutic Management of Retroperitoneal Sarcoma: An Original Article. Biomed J Sci & Tech Res 44(5): 35883-35887.
93. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) Appraisal of Target Definition for Anaplastic Thyroid Carcinoma (ATC): An Original Article Addressing the Utility of Multimodality Imaging. Canc Therapy & Oncol Int J 24(4): 556143.
94. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Parametrial Boosting in Patients with Locally Advanced Cervical Cancer. Canc Therapy & Oncol Int J 24(5): 556148.
95. Demiral S, Sager O, Dincoglan F, Beyzadeoglu M (2023) Tumor Size Changes after Neoadjuvant Systemic Therapy for Advanced Oropharyngeal Squamous Cell Carcinoma. Canc Therapy & Oncol Int J 24(5): 556147.
96. Demiral S, Dincoglan F, Sager O, Beyzadeoglu M (2023) Assessment of Changes in Tumor Volume Following Chemotherapy for Nodular Sclerosıng Hodgkin Lymphoma (NSHL). Canc Therapy & Oncol Int J 24(5): 556146.
97. Sager O, Demiral S, Dincoglan F, Beyzadeoglu M (2023) Evaluation of Volumetric Changes in Transglottic Laryngeal Cancers After Induction Chemotherapy. Biomed J Sci & Tech Res 51(4): 43026-43031.
98. Dincoglan F, Sager O, Demiral S, Beyzadeoglu M (2023) An Original Research Article for Evaluation of Changes in Tumor Size After Neoadjuvant Chemotherapy in Borderline Resectable Pancreatic Ductal Adenocarcinoma. Biomed J Sci & Tech Res 52(1): 43253-43255.
99. Sager O, Dincoglan F, Demiral S, Beyzadeoglu M (2023) Assessment of Tumor Size Changes After Neoadjuvant Chemotherapy in Locally Advanced Esophageal Cancer: An Original Article. Biomed J Sci & Tech Res 52(2): 43491-43493.
100. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Evaluation of Target Definition for Radiotherapeutic Management of Recurrent Merkel Cell Carcinoma (MCC). Canc Therapy & Oncol Int J 24(2): 556133.
101. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2023) Reappraisal of Treatment Volume Determination for Recurrent Gastroesophageal Junction Carcinoma (GJC). Biomed J Sci & Tech Res 50(5): 42061-42066.
102. Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2023) An Original Article Revisiting the Utility of Multimodality Imagıng for Refıned Target Volume Determinatıon Of Recurrent Kidney Carcinoma. Canc Therapy & Oncol Int J 23(5): 556122.
103. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2023) Appraisal of Target Definition for Recurrent Cancers of the Supralottic Larynx. Biomed J Sci & Tech Res 50 (5): 42131-42136.
104. Dincoglan F, Demiral S, Sager O, Beyzadeoglu M (2024) Assessment of Changes in Tumor Size After Induction Systemic Therapy for Locally Advanced Cervical Squamous Cell Carcinoma Running title: Tumor size changes in cervical carcinoma. Cancer Ther Oncol Int J 26(1): 1-7.
105. Beyzadeoglu M, Demiral S, Dincoglan F, Sager O (2024) Reappraisal of Target Definition for Sacrococcygeal Chordoma: Comparative Assessment with Computed Tomography (CT) and Magnetic Resonance Imaging (MRI). Biomed J Sci & Tech Res 55(1): 46686-46692.
106. Dincoglan F, Beyzadeoglu M, Demiral S, Sager O (2024) Appraisal of Changes in Tumor Volume After Neoadjuvant Systemic Therapy for Hepatocellular Carcinoma (HCC). Cancer Ther Oncol Int J 26(2): 1-4.