Risk of carotid blowout after reirradiation with particle therapy

Jon Espen Dale, Silvia Molinelli, Elisa Ciurlia, Mario Ciocca, Maria Bonora, Viviana Vitolo, Alfredo Mirandola, Stefania Russo, Roberto Orecchia, Olav Dahl, Piero Fossati

Research output: Contribution to journalArticle

Abstract

Purpose Carotid blowout (CB) is a serious complication in retreatment of neoplasms in the head and neck (H&N) region. Rates seem to increase in hypofractionated or accelerated hyperfractionated regimens. In this study, we investigate the CB rate and the cumulative doses received by the carotid artery (CA) in a cohort of patients who were reirradiated at CNAO with particle therapy in the H&N region. Methods and materials The dosimetric information, medical records, and tumor characteristics of 96 patients were analyzed. For 49 of these patients, the quality of dosimetric information was sufficient to calculate the cumulative doses to the CA. The corresponding biological equivalent dose in 2 Gy fractions (EQD2) was calculated with an α/β-ratio of 3. Results In the final reirradiation at CNAO, 17 patients (18%) had been treated with protons and 79 (82%) with carbon ions. Two patients experienced profuse oronasal bleeding, of which one case was confirmed to be caused by CB. If attributing both cases to CB, we found an actuarial CB rate of 2.7%. Interestingly, there were no CB cases in the carbon ion group even though this was the large majority of patients and they generally were treated more aggressively in terms of larger fraction doses and higher cumulative EQD2. Conclusions The current practice of particle reirradiation at CNAO for recurrent neoplasms in the H&N region results in acceptable rates of CB.

Original languageEnglish
Pages (from-to)465-474
Number of pages10
JournalAdvances in Radiation Oncology
Volume2
Issue number3
DOIs
Publication statusPublished - Jul 1 2017

Fingerprint

Carotid Arteries
Therapeutics
Carbon
Ions
Retreatment
Head and Neck Neoplasms
Medical Records
Re-Irradiation
Protons
Neoplasms
Hemorrhage

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging

Cite this

Dale, J. E., Molinelli, S., Ciurlia, E., Ciocca, M., Bonora, M., Vitolo, V., ... Fossati, P. (2017). Risk of carotid blowout after reirradiation with particle therapy. Advances in Radiation Oncology, 2(3), 465-474. https://doi.org/10.1016/j.adro.2017.05.007

Risk of carotid blowout after reirradiation with particle therapy. / Dale, Jon Espen; Molinelli, Silvia; Ciurlia, Elisa; Ciocca, Mario; Bonora, Maria; Vitolo, Viviana; Mirandola, Alfredo; Russo, Stefania; Orecchia, Roberto; Dahl, Olav; Fossati, Piero.

In: Advances in Radiation Oncology, Vol. 2, No. 3, 01.07.2017, p. 465-474.

Research output: Contribution to journalArticle

Dale, JE, Molinelli, S, Ciurlia, E, Ciocca, M, Bonora, M, Vitolo, V, Mirandola, A, Russo, S, Orecchia, R, Dahl, O & Fossati, P 2017, 'Risk of carotid blowout after reirradiation with particle therapy', Advances in Radiation Oncology, vol. 2, no. 3, pp. 465-474. https://doi.org/10.1016/j.adro.2017.05.007
Dale JE, Molinelli S, Ciurlia E, Ciocca M, Bonora M, Vitolo V et al. Risk of carotid blowout after reirradiation with particle therapy. Advances in Radiation Oncology. 2017 Jul 1;2(3):465-474. https://doi.org/10.1016/j.adro.2017.05.007
Dale, Jon Espen ; Molinelli, Silvia ; Ciurlia, Elisa ; Ciocca, Mario ; Bonora, Maria ; Vitolo, Viviana ; Mirandola, Alfredo ; Russo, Stefania ; Orecchia, Roberto ; Dahl, Olav ; Fossati, Piero. / Risk of carotid blowout after reirradiation with particle therapy. In: Advances in Radiation Oncology. 2017 ; Vol. 2, No. 3. pp. 465-474.
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AU - Bonora, Maria

AU - Vitolo, Viviana

AU - Mirandola, Alfredo

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AU - Dahl, Olav

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N2 - Purpose Carotid blowout (CB) is a serious complication in retreatment of neoplasms in the head and neck (H&N) region. Rates seem to increase in hypofractionated or accelerated hyperfractionated regimens. In this study, we investigate the CB rate and the cumulative doses received by the carotid artery (CA) in a cohort of patients who were reirradiated at CNAO with particle therapy in the H&N region. Methods and materials The dosimetric information, medical records, and tumor characteristics of 96 patients were analyzed. For 49 of these patients, the quality of dosimetric information was sufficient to calculate the cumulative doses to the CA. The corresponding biological equivalent dose in 2 Gy fractions (EQD2) was calculated with an α/β-ratio of 3. Results In the final reirradiation at CNAO, 17 patients (18%) had been treated with protons and 79 (82%) with carbon ions. Two patients experienced profuse oronasal bleeding, of which one case was confirmed to be caused by CB. If attributing both cases to CB, we found an actuarial CB rate of 2.7%. Interestingly, there were no CB cases in the carbon ion group even though this was the large majority of patients and they generally were treated more aggressively in terms of larger fraction doses and higher cumulative EQD2. Conclusions The current practice of particle reirradiation at CNAO for recurrent neoplasms in the H&N region results in acceptable rates of CB.

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