Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer
Abstract
:1. Introduction
2. Results
2.1. Tumor Features
2.2. CNS Necrosis
2.3. Clinical Management and Radiographic Response
3. Discussion
4. Materials and Methods
4.1. Patient Selection
4.2. Treatment Planning and Radiotherapy
4.3. Radiographic and Clinical Evaluation
4.4. Statistics
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
References
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CNS Necrosis | Patients | % |
---|---|---|
Classification | ||
Grade IV | 1 | 2.8 |
Grade III | 5 | 13.9 |
Grade II | 13 | 36.1 |
Grade I | 17 | 47.2 |
Localization | ||
Temporal lobe | 30 | 83.4 |
Frontal lobe | 4 | 11.1 |
Other | 2 | 5.5 |
Radiographic Response * | ||
Grade IV | n.a. | n.a. |
Grade III | 4 | 80.0 |
Grade II | 5 | 29.4 |
Grade I | 4 | 16.0 |
Median | Range | |
Time Interval | ||
Grade IV | n.a. | n.a. |
Grade III | 16.6 | 8.7–32.5 |
Grade II | 10.2 | 2.3–60.5 |
Grade I | 9.2 | 2.8–75.0 |
Patient Characteristics | Patients | % |
---|---|---|
Female/Male | 19/17 | 52.8/47.2 |
ECOG status | ||
0 | 25 | 69.4 |
1 | 11 | 30.6 |
Histology | ||
ACC | 24 | 66.7 |
Adenocarcinoma | 4 | 11.1 |
Acinar cell carcinoma | 3 | 8.3 |
HNSCC | 2 | 5.6 |
Other | 3 | 8.3 |
Tumor Site | ||
Skull base | 17 | 47.2 |
Orbit | 5 | 13.9 |
Temporal bone | 4 | 11.1 |
Cavernous sinus | 3 | 8.3 |
Nasopharynx | 3 | 8.3 |
Other | 4 | 11.1 |
Treatment characteristics | Median | Range |
Initial RT (EQD2) | 70 | 50–81 |
Carbon ion re-irradiation (Gy (RBE)) | 51.0 | 39.0–60.0 |
PTV re-irradiation (ccm) | 85.3 | 13.3–286.5 |
Cumulative Dose (EQD2) | 133.9 | 112.5–152.3 |
RT-Interval (years) | 4.1 | 0.3–46.5 |
Prior tumor-specific treatments | 2 | 1–7 |
Radiotherapy of Head-and-Neck or Brain Cancer | |||
---|---|---|---|
Target volume? | Total dose? | Dose distribution? | Systemic therapy? |
Regular clinical and radiographic follow-up | |||
No symptoms (Grade I) | Moderate (Grade II) | ||
Observation | Corticosteroids | ||
Radiographic or clinical progression | |||
Severe (Grade III) | Life-threatening (Grade IV) | ||
Bevacizumab | Surgery |
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Held, T.; Akbaba, S.; Lang, K.; Harrabi, S.; Bernhardt, D.; Freudlsperger, C.; Kargus, S.; Plinkert, P.; Rieken, S.; Herfarth, K.; et al. Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer. Cancers 2019, 11, 383. https://doi.org/10.3390/cancers11030383
Held T, Akbaba S, Lang K, Harrabi S, Bernhardt D, Freudlsperger C, Kargus S, Plinkert P, Rieken S, Herfarth K, et al. Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer. Cancers. 2019; 11(3):383. https://doi.org/10.3390/cancers11030383
Chicago/Turabian StyleHeld, Thomas, Sati Akbaba, Kristin Lang, Semi Harrabi, Denise Bernhardt, Christian Freudlsperger, Steffen Kargus, Peter Plinkert, Stefan Rieken, Klaus Herfarth, and et al. 2019. "Clinical Management of Blood–Brain Barrier Disruptions after Active Raster-Scanned Carbon Ion Re-Radiotherapy in Patients with Recurrent Head-and-Neck Cancer" Cancers 11, no. 3: 383. https://doi.org/10.3390/cancers11030383