A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer

Jensen, Alexandra D; Nill, Simeon; Huber, Peter E.; Bendl, Rolf; Debus, Jürgen; Münter, Marc W.

doi:10.1016/j.ijrobp.2010.10.072

Cited by 56 publications

(61 citation statements)

References 34 publications

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“…For the OARs, parotid glands have also been shown to shrink during RT partially due to weight reduction and partially due to subcutaneous fat loss. [62][63][64][65] Although GTV shrinkage does not necessarily indicate elimination of microscopic disease within and surrounding the original GTV, online ART may address the geometric shifting of tumors, deformation of local tissue bearing microscopic disease, and shifting of nodal targets due to tissue changes during treatment. Tumor regression is due to both geometric and biologic factors; …”

Section: Head-and-neck (Handn)mentioning

confidence: 99%

Online Adaptive Radiation Therapy

Lim‐Reinders

Keller

Al-Ward

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

167

135

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Section: Head-and-neck (Handn)mentioning

confidence: 99%

Online Adaptive Radiation Therapy

Lim‐Reinders

Keller

Al-Ward

et al. 2017

International Journal of Radiation Oncology*Biology*Physics

167

135

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“…2, Table S1-S3) mainly by cone beam CT (CBCT), helical repeat CT and megavoltage CT (MVCT), but also by in-room CT [14,17,44,51] and MR imaging [52]. Two studies applied repeat MR imaging in addition to the repeat CT scans [15,16].…”

Section: Reported Organs At Riskmentioning

confidence: 99%

“…Most of the studies reported on multiple time points during radiotherapy. Fourteen studies performed at least weekly repeat imaging [7,12,17,18,37,[43][44][45][46]51,53,62,63,65 ]. Three of these studies had daily MVCT imaging at their disposal [18,45,46], and one performed daily in-room CT imaging [7].…”

Section: Reported Organs At Riskmentioning

confidence: 99%

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Identifying patients who may benefit from adaptive radiotherapy: Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help?

Brouwer

Steenbakkers

Langendijk

et al. 2015

Radiotherapy and Oncology

147

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In the last decade, many efforts have been made to characterize anatomic changes of head and neck organs at risk (OARs) and the dosimetric consequences during radiotherapy. This review was undertaken to provide an overview of the magnitude and frequency of these effects, and to investigate whether we could find criteria to identify head and neck cancer patients who may benefit from adaptive radiotherapy (ART). Possible relationships between anatomic and dosimetric changes and outcome were explicitly considered. A literature search according to PRISMA guidelines was performed in MEDLINE and EMBASE for studies concerning anatomic or dosimetric changes of head and neck OARs during radiotherapy. Fifty-one eligible studies were found. The majority of papers reported on parotid gland (PG) anatomic and dosimetric changes. In some patients, PG mean dose differences between planning CT and repeat CT scans up to 10 Gy were reported. In other studies, only minor dosimetric effects (i.e. <1 Gy difference in PG mean dose) were observed as a result of significant anatomic changes. Only a few studies reported on the clinical relevance of anatomic and dosimetric changes in terms of complications or quality of life. Numerous potential selection criteria for anatomic and dosimetric changes during radiotherapy were found and listed. The heterogeneity between studies prevented unambiguous conclusions on how to identify patients who may benefit from ART in head and neck cancer. Potential pre-treatment selection criteria identified from this review include tumour location (nasopharyngeal carcinoma), age, body mass index, planned dose to the parotid glands, the initial parotid gland volume, and the overlap volume of the parotid glands with the target volume. These criteria should be further explored in well-designed and well-powered prospective studies, in which possible relationships between anatomic and dosimetric changes and outcome need to be established.

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“…1 Another milestone in delivery technique occurred in the 1990s with intensity modulated radiotherapy (IMRT), which dramatically improved dose conformality, maximized tumor coverage, and increased sparing of normal tissues. 2 A more recent advance in treatment planning and delivery has been the use of image guidance to monitor for volume changes in target and organs at risk (OARs) to potentially ''adapt'' these plans as needed during the course of treatment. This process is called adaptive radiotherapy (ART).…”

Section: Introductionmentioning

confidence: 99%

Decision Trees Predicting Tumor Shrinkage for Head and Neck Cancer

Sürücü

Shah

Mescioglu

et al. 2015

Technol Cancer Res Treat

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Objective: To develop decision trees predicting for tumor volume reduction in patients with head and neck (H&N) cancer using pretreatment clinical and pathological parameters. Methods: Forty-eight patients treated with definitive concurrent chemoradiotherapy for squamous cell carcinoma of the nasopharynx, oropharynx, oral cavity, or hypopharynx were retrospectively analyzed. These patients were rescanned at a median dose of 37.8 Gy and replanned to account for anatomical changes. The percentages of gross tumor volume (GTV) change from initial to rescan computed tomography (CT; %GTVD) were calculated. Two decision trees were generated to correlate %GTVD in primary and nodal volumes with 14 characteristics including age, gender, Karnofsky performance status (KPS), site, human papilloma virus (HPV) status, tumor grade, primary tumor growth pattern (endophytic/exophytic), tumor/nodal/group stages, chemotherapy regimen, and primary, nodal, and total GTV volumes in the initial CT scan. The C4.5 Decision Tree induction algorithm was implemented. Results: The median %GTVD for primary, nodal, and total GTVs was 26.8%, 43.0%, and 31.2%, respectively. Type of chemotherapy, age, primary tumor growth pattern, site, KPS, and HPV status were the most predictive parameters for primary %GTVD decision tree, whereas for nodal %GTVD, KPS, site, age, primary tumor growth pattern, initial primary GTV, and total GTV volumes were predictive. Both decision trees had an accuracy of 88%. Conclusions: There can be significant changes in primary and nodal tumor volumes during the course of H&N chemoradiotherapy. Considering the proposed decision trees, radiation oncologists can select patients predicted to have high %GTVD, who would theoretically gain the most benefit from adaptive radiotherapy, in order to better use limited clinical resources.

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A Clinical Concept for Interfractional Adaptive Radiation Therapy in the Treatment of Head and Neck Cancer

Cited by 56 publications

References 34 publications

Online Adaptive Radiation Therapy

Online Adaptive Radiation Therapy

Identifying patients who may benefit from adaptive radiotherapy: Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help?

Decision Trees Predicting Tumor Shrinkage for Head and Neck Cancer

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