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Unilateral cochlea sparing in locoregionally advanced head and neck cancer: a planning study

Einseitige Schonung der Cochlea bei lokal fortgeschrittenen Kopf-Hals-Tumoren: eine Planungsstudie

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Abstract

Background

Cochlea sparing can reduce late ototoxicity in head and neck cancer patients treated with cisplatin-based radiochemotherapy. In this situation, a mean cochlear dose (MCD) constraint of 10 Gy has been suggested by others based on the dose–effect relationship of clinical data. We aimed to investigate whether this is feasible for primary and postoperative radiochemotherapy in locoregionally advanced tumors without compromising target coverage.

Patients and methods

Ten patients treated with definitive and ten patients treated with adjuvant intensity-modulated radiotherapy (IMRT) and concurrent chemotherapy were investigated. The cochleae and a planning risk volume (PRV) with a 3 mm margin were newly delineated, whereas target volumes and other organs at risk were not changed. The initial plan was recalculated with a constraint of 10 Gy (MCD) on the low-risk side. The quality of the resulting plan was evaluated using the difference in the equivalent uniform dose (EUD).

Results

A unilateral MCD of below 10 Gy could be achieved in every patient. The mean MCD was 6.8 Gy in the adjuvant cohort and 7.6 Gy in the definitive cohort, while the non-spared side showed a mean MCD of 18.7 and 30.3 Gy, respectively. The mean PRV doses were 7.8 and 8.4 Gy for the spared side and 18.5 and 29.8 Gy for the non-spared side, respectively. The mean EUD values of the initial and recalculated plans were identical. Target volume was not compromised.

Conclusion

Unilateral cochlea sparing with an MCD of less than 10 Gy is feasible without compromising the target volume or dose coverage in locoregionally advanced head and neck cancer patients treated with IMRT. A prospective evaluation of the clinical benefit of this approach as well as further investigation of the dose–response relationship for future treatment modification appears promising.

Zusammenfassung

Zielsetzung

Eine Schonung der Cochlea kann die Toxizität bei Patienten mit Kopf-Hals-Tumoren, die mit einer cisplatinbasierten Radiochemotherapie behandelt werden, senken. Eine prospektive klinische Studie errechnete eine mittlere cochleäre Dosis (MCD) von <10 Gy, die in der kombinierten Therapie maximal appliziert werden darf. Wir untersuchen, ob dies sowohl bei primär radiochemotherapierten als auch bei postoperativ radiochemotherapierten Kopf-Hals-Tumorpatienten möglich ist, ohne dass es zu Unterdosierungen im Zielgebiet kommt.

Patienten und Methoden

Bei 10 Patienten, die eine definitive Radiochemotherapie, und bei 10 Patienten, die eine adjuvante intensitätsmodulierte Radiotherapie (IMRT) und eine gleichzeitige Chemotherapie erhielten, wurden die Bestrahlungspläne unter der Prämisse einer einseitigen MCD <10 Gy neu berechnet. Hierfür wurde die Cochlea an sich sowie mit einem 3‑mm-Saum („planning risk volume“, PRV) neu skizziert; andere Risikoorgane und das Zielvolumen wurden nicht verändert. Die Qualität der resultierenden Bestrahlungspläne wurde nach dem Konzept der „equivalent uniform dose“ (EUD) evaluiert.

Ergebnisse

Eine einseitige MCD <10 Gy wurde in allen Fällen erzielt. Die MCD lag bei 6,8 Gy in der adjuvant therapierten und bei 7,6 Gy in der definitiven Kohorte. Die MCD der nichtgeschonten Cochleae wies 18,7 Gy bzw. 30,3 Gy auf. Die mittlere PVR-Dosis betrug 7,8 Gy bzw. 8,4 Gy der geschonten Cochleae und 18,5 Gy bzw. 29,8 Gy der Gegenseite. Die mittlere EUD der neu berechneten und der ursprünglichen Pläne waren identisch.

Schlussfolgerung

Eine einseitige Cochleaschonung mit einer MCD <10 Gy ist mit der IMRT möglich, ohne das Zielvolumen in fortgeschrittenen Kopf-Hals-Tumorpatienten zu kompromittieren. Eine prospektive Studie, die die Dosis-Wirkungs-Beziehung und den klinischen Benefit dieses Ansatzes näher untersucht, scheint vielversprechend.

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Authors and Affiliations

  1. Universitätsklinik für Radioonkologie, Universitätsklinikum Tübingen, Hoppe-Seyler-Straße 3, 72076, Tübingen, Germany

    L. H. Braun, B. Frey, D. Zips & S. Welz

  2. Universitätsklinik für Hals‑, Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Elfriede-Aulhorn-Straße 5, 72076, Tübingen, Germany

    K. Braun, S. M. Wolpert & H. Löwenheim

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  1. L. H. Braun
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Correspondence to K. Braun.

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L.H. Braun, K. Braun, B. Frey, S.M. Wolpert, H. Löwenheim, D. Zips, and S. Welz declare that they have no competing interests.

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Braun, L.H., Braun, K., Frey, B. et al. Unilateral cochlea sparing in locoregionally advanced head and neck cancer: a planning study. Strahlenther Onkol 194, 1124–1131 (2018). https://doi.org/10.1007/s00066-018-1344-9

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