A systematic review and proportional meta-analysis of image-based pattern of loco-regional failure analyses outcomes in head and neck squamous cell carcinoma
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View abstract on PubMed
Summary
This summary is machine-generated.Most head and neck cancer failures after radiotherapy occur within the high-dose region, suggesting radioresistance is a key factor. Future research should focus on biomarkers to personalize treatment and improve loco-regional control.
Area Of Science
- Oncology
- Radiation Oncology
- Medical Imaging
Background
- Loco-regional failure after primary radiotherapy for head and neck squamous cell carcinoma (HNSCC) carries a poor prognosis.
- Tumor radioresistance is hypothesized as a primary driver of treatment failure.
- Image-based pattern of failure (POF) analysis aids in understanding failure locations relative to radiation dose.
Purpose Of The Study
- To systematically review and meta-analyze the proportion of loco-regional failures occurring within the high-dose region after primary radiotherapy for HNSCC.
- To evaluate the hypothesis that failures are predominantly a consequence of tumor radioresistance.
Main Methods
- Systematic database search from 2000 to 2023 for image-based loco-regional POF studies in HNSCC post-primary radiotherapy.
- Proportional meta-analyses were conducted on failures located volumetrically in-field, at the point of origin within high-dose targets, or covered by curative doses.
- Analysis included both patient numbers and failure site numbers; study registered on Prospero (CRD42023412545).
Main Results
- Analysis of 56 studies encompassing 1,161 patients and 658 failure sites.
- A high proportion of failures occurred within the high-dose region: 84% (volumetric), 82% (point of origin), and 84% (CTV1 dose coverage).
- A trend towards an increasing proportion of failures outside the high-dose region was observed in more recently treated patients.
Conclusions
- The majority of loco-regional failures in HNSCC treated with primary radiotherapy are associated with the high-dose radiation volume.
- This finding supports the role of intrinsic tumor radioresistance in treatment failure.
- Development of biomarkers predicting individual tumor radiosensitivity is crucial for intensifying treatment and improving loco-regional control.
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