Objective: Laryngeal cancers are among the most common of head and neck tumours which may cause
considerable morbidity and mortality worldwide [1-7]. Nevertheless, successful results may be achieved
by a multidisciplinary therapeutic approach. Surgery, chemotherapy, and radiation therapy (RT) may
be utilized for laryngeal cancer management with respect to disease extent. Herein, we assessed target
definition for recurrent cancers of the supraglottic larynx to explore the utility of multimodality imaging.
Materials and Methods: Objective of this study has been to assess target definition for recurrent
supraglottic laryngeal cancer irradiation based on CT only or fused CT-MRI. We performed a comparative
analysis evaluation of target definition by CT simulation images only or by incorporation of MRI. Besides
assessment of integrated multimodality imaging for target definition, we also evaluated normal tissue
delineation, interobserver and interobservers variations.
Results: Ground truth target volume has been utilized as the reference for comparative assessment, and
our results have demonstrated that utilization of fused CT-MRI based target definition was identical with
ground truth target definition in the selected group of patients with recurrent supraglottic laryngeal cancer.
Conclusion: Incorporation of MRI in RT target definition may be suggested for patients with recurrent
supraglottic laryngeal cancers despite the need for further supporting evidence.
Abbreviations: RT: Radiation Therapy; MRI: Magnetic Resonance Imaging; IGRT: Image Guided RT; IMRT: Intensity Modulated RT; ART: Adaptive RT; CT: Computed Tomography; AAPM: American Association of Physicists in Medicine; ICRU: International Commission on Radiation Units and Measurements
Laryngeal cancers are among the most common of head
and neck tumours which may cause considerable morbidity and
mortality worldwide [1-7]. Nevertheless, successful results may
be achieved by a multidisciplinary therapeutic approach. Surgery,
chemotherapy, and radiation therapy (RT) may be utilized for
laryngeal cancer management with respect to disease extent. Surgery
may offer favourable outcomes; however, adverse effects of surgical
interventions should be considered. RT may be used as the single
management modality or as part of multidisciplinary management
for laryngeal cancers. It has also been proposed that laryngeal
preservation strategies could be followed according to patient,
tumor, and treatment characteristics. RT may also have a role as
salvage treatment for recurrent disease. Advances in technology may
obviously result in improved therapeutic outcomes for cancer in the
millennium era.
Considering the critical location of laryngeal cancers in close
vicinity of vital neurovascular structures, it is a priority to individualize
patient management with multidisciplinary collaboration. Both
the tumor and administered treatments may cause quality of life impairment in affected patients, and adverse effects of management should be considered at the outset. Quality of life issues and normal
tissue sparing must be considered as critical aspects of contemporary
radiotherapeutic strategies. integration of modernized treatment
approaches and technologies such as molecular imaging methods,
automatic segmentation techniques, Image Guided RT (IGRT),
Intensity Modulated RT (IMRT), stereotactic RT, and adaptive RT
(ART) may clearly result in improved radiotherapeutic outcomes [8-
49]. However, improvements in target definition must be considered
as an indispensable component of sophisticated RT protocols. In
the meantime, widely adopted practice includes use of Computed
Tomography (CT) simulation for acquisition of radiation treatment
planning images, nevertheless, incorporation of other imaging
modalities such as Magnetic Resonance Imaging (MRI) may admittedly
add to the precision of target definition as suggested by other studies
[50-96]. Herein, we assessed target definition for recurrent cancers of
the supraglottic larynx to explore the utility of multimodality imaging.
We have been treating a huge patient population from several
places from Turkey and abroad at Department of Radiation Oncology
at Gulhane Medical Faculty, University of Health Sciences as a tertiary
cancer center. In this context, variety of benign and malignant
tumours are irradiated at our center for decades. Objective of this
study has been to assess target definition for recurrent supraglottic
laryngeal cancer irradiation based on CT only or fused CT-MRI. We
performed a comparative analysis evaluation of target definition
by CT simulation images only or by incorporation of MRI. Besides
assessment of integrated multimodality imaging for target definition,
we also evaluated normal tissue delineation, interobserver and
interobservers variations. Ground truth target volume was used
for comparative analysis, and it has been defined by board certified
radiation oncologists following meticulous assessment of all
imaging and relevant data with thorough colleague peer review and
consensus. Decision making process for optimal patient management
has involved multidisciplinary input from experts on surgical
oncology, radiation oncology, and medical oncology. Individualized
patient assessment included consideration of patient, disease,
and treatment related factors. Patient age, previous treatments,
symptomatology, lesion size, performance status, lesion localization
and association with normal tissues, expected results of proposed
treatment alternatives, patient preferences and logistical issues were
also considered. Linear Accelerator (LINAC) with the capability of
sophisticated IGRT techniques was used for irradiation. After rigid
patient immobilization, planning CT images have been acquired
at CT simulator for RT planning. Afterwards, acquired RT planning
images were sent to the contouring workstation by the network.
Target volumes and critical structures were defined on these images
and structure sets were generated. Either CT simulation images only
or fused CT-MR images were utilized for evaluation and comparative
analysis of data.
We have designed this original research article to evaluate the
use of multimodality imaging with incorporation of MRI for RT target
definition in a selected group of patients with recurrent supraglottic
laryngeal cancer. Treatment of patients has been performed at our
Radiation Oncology Department of Gulhane Medical Faculty at
University of Health Sciences, Ankara. Before irradiation, patients
have been assessed individually by a multidisciplinary team of
experts from surgical oncology, medical oncology, and radiation
oncology. Briefly, we carried out a comparative analysis based on
either CT only imaging or by fused CT-MRI to assess the utility of
this contemporary approach. Optimal RT planning process included
consideration of lesion sizes, localization, and association with
surrounding normal tissues. Radiation physicists have been included
in RT planning procedure with consideration of reports by American
Association of Physicists in Medicine (AAPM) and International
Commission on Radiation Units and Measurements (ICRU). Accurate
RT planning procedure included consideration of electron density,
tissue heterogeneity, CT number and HU values in CT images. Main
goal of RT planning was to accomplish optimal encompassing of
target volumes with minimal exposure of surrounding normal
tissues. Ground truth target volume has been utilized as the reference
for comparative assessment, and our results have demonstrated that
utilization of fused CT-MRI based target definition was identical with
ground truth target definition in the selected group of patients with
recurrent supraglottic laryngeal cancer.
Laryngeal cancers account for a significant proportion among
head and neck tumours and may cause considerable morbidity and
mortality worldwide [1-7]. However, optimal therapeutic outcomes
can be achieved by a multidisciplinary and collaborative treatment
strategy. Surgery, chemotherapy, and RT can be used for laryngeal
cancer management with regards to disease extent and other
characteristics. Surgery can offer favourable treatment results in a
considerable proportion of affected patients, nevertheless, untoward
toxicity of surgical interventions must always be considered. RT can
serve as the single treatment modality in certain circumstances and
may also be utilized as part of multidisciplinary treatment of laryngeal
cancers. Also, it has also proposed that laryngeal preservation
strategies might be followed with respect to patient, tumor, and
treatment characteristics. RT can also play a role as salvage treatment
for recurrent cancer. Unprecedented improvements in technology
can apparently lead to better treatment results for cancer in the
millennium era. Considering the critical localization of laryngeal
cancers in close neighbourhood of vital neurovascular structures,
it should be considered as a priority to individualize patient
management with multidisciplinary collaboration. Both tumour and
utilized treatments can lead to quality-of-life deterioration in affected
patients, and adverse effects of management should be considered at the outset. Quality of life considerations and critical organ protection should be considered as pertinent aspects of sophisticated RT
approaches. Incorporation of contemporary therapeutic strategies
and technologies such as molecular imaging methods, automatic
segmentation techniques, IGRT, IMRT, stereotactic RT, and ART can
lead to better RT results [8-49]. Nevertheless, improvements in
target definition must be considered as an indispensable component
of sophisticated RT protocols. Nowadays, more common practice
includes use of CT simulation for acquisition of RT planning images,
however, integration of other imaging modalities such as MRI can
possibly add to the accuracy of target definition as suggested by
other studies [50-96]. o conclude, incorporation of MRI in RT target
definition may be suggested for patients with recurrent supraglottic
laryngeal cancers despite the need for further supporting evidence.
Beyzadeoglu M, Dincoglan F, Demiral S, Sager O (2023) An Original Article Revisiting the Utility of Multimodality Imaging For Refined Target Volume Determination Of Recurrent Kidney Carcinoma. Canc Therapy & Oncol Int J 23(5): 556122.
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.
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.