Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹,...
-
Upload
marjorie-melton -
Category
Documents
-
view
220 -
download
0
Transcript of Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹,...
![Page 1: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/1.jpg)
Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent
Laryngeal Cancer
Haapaniemi A¹, Kankaanranta L², Saat R3, Koivunoro H², Saarilahti K², Mäkitie A¹, Atula T¹, Joensuu H²
Departments of ¹Otorhinolaryngology – Head and Neck Surgery,
²Oncology and 3Radiology, Helsinki University Central Hospital and University of Helsinki, Helsinki, Finland
ICNCT-16, 14.-19.6.2014, Helsinki, Finland
![Page 2: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/2.jpg)
Laryngeal cancer
• 157 000 new cases/year (Globocan 2012)• Surgery -> oncological treatment• Recurrence/persistense after treatment 27 %
(Finland 2001-2005) • Treatment of recurrence
– Salvage surgery (total laryngectomy)– Reirradiation
How to preserve the larynx?
![Page 3: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/3.jpg)
Rationale for BNCT
• Short range radiation effect -> local therapy• Appears safe in previously irradiated patients
Pictures: www.vtt.fi
![Page 4: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/4.jpg)
BNCT for recurrent laryngeal SCC
1. Safety?2. Efficacy?3. Preservation of functional larynx?
![Page 5: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/5.jpg)
Patients
• Review of patient data• 2005-2012, n=9, all with SCC• Age: 51-81 years• Sex: 1 female, 8 male
![Page 6: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/6.jpg)
Primary tumor
• Primary tumour: – 7 glottic, 1 supraglottic, 1 subglottic– T1-T3, N0-2, M0-1
• Previous RT or CRT– Median radiation dose 66 Gy (37.8-72 Gy )– Median time from last RT 17 mo (1-151 mo)
![Page 7: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/7.jpg)
Status before BNCT
• 6 recurrent, 3 persistent– 8 local, rT2-4a– 1 regional, N2b
• Reason for BNCT– Inoperable, n=2– Refusal of total laryngectomy / functional reasons,
n=7
![Page 8: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/8.jpg)
Treatment at FiR 1• Number of sessions
– 1, n=6– 2, n=3
• L-BPA-F 400mg/kg over 2h• Average tumor dose 29 Gy
(W) (range, 22-38 Gy)• Average blood boron
concentration at neutron irradiation 18 μg/g (range, 13-22 μg/g)
![Page 9: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/9.jpg)
Response assessment
• Toxicity : National Cancer Institute Common Terminology Criteria for Adverse Events (CTC) version 3.0.
• Response : Clinical assessment + Radiological assessment (RECIST v. 1.1, 2009)
• One patient died 1 month after BNCT (pneumonia)
![Page 10: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/10.jpg)
Toxicity
• Early toxicity– Grade III, n=5 (62.5%)– stomatitis, mucositis, dysphagia, oral cavity pain
and fatigue • Late toxicity
– Grade III, n=3 (37.5%)– stomatitis and mucositis
• No gr IV-V toxicity, nor soft tissue or osteoradionecrosis was observed
![Page 11: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/11.jpg)
ResultsResponse rate 78%
Initial responses (3 months post BNCT)•CR, n=2•PR, n=5•PD, n=1
•One patient died of pneumonia 1 mo after BNCT–T3N2M1, persistense after CRT–No response assessment, clinical signs of response
![Page 12: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/12.jpg)
• 2 patiens (CR) with no progression, 1 is alive
• Time to progression 6.6 months– 2 patients (PR) refused total laryngectomy, died of
progression– 3 patients (PR) underwent laryngectomy, 1 is alive– 1 patient (PR) died with pulmonary metastasis
![Page 13: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/13.jpg)
• Median OS 13 months after BNCT• 1 year OS 56%, 2 year OS 22%• 2 patients alive and disease-free 27 and 55
months after BNCT
![Page 14: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/14.jpg)
Laryngectomy after BNCT
• 3 patients– 2 patients with fistula– 1 patient with normal healing
• Fistula rate comparable to that reported in the literature after CRT
![Page 15: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/15.jpg)
Glottic rT2, CRresponse duration 55+ months (ongoing)
Copyright Riste Saat
![Page 16: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/16.jpg)
Before BNCT6 weeks after BNCT
Supraglottic rT3, PRresponse duration 7.4 mo
Copyright Aaro Haapaniemi
![Page 17: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/17.jpg)
Glottic rT2, PRresponse duration 5.8 mo
Before BNCT 4 months after BNCT
Copyright Aaro Haapaniemi
![Page 18: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/18.jpg)
Copyright Leena Kankaanranta
rN2b, PRresponse duration 8.3 mo
![Page 19: Boron Neutron Capture Therapy (BNCT) in the Management of Recurrent Laryngeal Cancer Haapaniemi A¹, Kankaanranta L², Saat R 3, Koivunoro H², Saarilahti.](https://reader035.fdocuments.us/reader035/viewer/2022062519/56649e865503460f94b88c43/html5/thumbnails/19.jpg)
Conclusions
• BNCT appears to be safe in recurrent LSCC• No severe side-effects• High initial response rate (78%)• Modest cure rate with BNCT alone (1 patient)• Future considerations:
– Patient selection– Treatment intensification