Assessment of the probability of local control of the tongue root cancer depending on fractionation
E.S. Sukhikh1,2, D.M. Podoplekin1, L.G. Sukhikh2, I.N. Sheino 3, P.V. Izhevsky3
1 Tomsk Regional Oncology Center, Tomsk
2 National Research Tomsk Polytechnic University, Tomsk
3 State Research Center Burnasyan Federal Medical Biophysical Center, Moscow
Aim: to study the dependence of local tumor control probability (TCP) on the total radiation dose (TRD) and fraction dose (FD) values for the head and neck tumors, and to radiobiologically estimate irradiation plans using intensity-modulated radiotherapy for hypofractionated irradiation in patients with cancer of the root of the tongue.
Patients and Methods: this study is based on the data of four patients diagnosed with “Second to third stage of the tongue cancer (T2N0M0–T3N2M0)” with squamous cell carcinoma of high, medium and low degree of differentiation. Topometric preparation was performed in a supine position on a spiral computer tomograph Toshiba Aquilion (Toshiba, Japan) with a cut thickness of 2 mm. The assessment of irradiation plans was carried out on the basis of the ICRU 83 international protocol on the criteria of conformance, homogeneity and dose distribution in the volume using dose-volume histograms for the target and critical organs. In the Wolfram Mathematica environment, we wrote a code for calculating TCP parameters.
Results and Discussion: there was a sharp decrease in the TCP value during the transition from 35 to 36 stages, which is caused by the fact that 35 stages equal to 47 full days of treatment, and the 36th stage begins after the weekend on the 50th day. In general, the doses delivered to the tumor, exceed the prescribed TRD=70 Gy, but it is not over limits of 120% that can be considered satisfactory.
Conclusions: the use of irradiation with simultaneous integrated fraction dose escalation for the head and neck region using such modern dose delivery techniques, as volumetric modulated arc therapy, is fully feasible and satisfies all international radiation criteria (maximum target coverage (98%) and radiation loads on critical organs that do not exceed tolerant levels). This opens the prospect of increasing the effectiveness of radiation therapy (RT) by increasing the dose per fraction with a relative homogeneity of dose distribution in the target volume and reducing the total irradiation time (TIT), thereby compensating for proliferation. The use of the standard fractionation protocol (FD=2Gy) for the second and third stages of tumor development requires an increase in TRD from 70G to 78Gy or more in order to bring the TCP level to 95%. Therefore, with the RT of head and neck tumors, the optimal strategy is to maximize the TIT reduction.
For citation: Sukhikh E.S., Podoplekin D.M., Sukhikh L.G. et al. Assessment of the probability of local control of the tongue root cancer depending on fractionation // RMJ. Medical Review. 2018. № 6. P. 13–18.
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