An evaluation of adaptive planning by assessing the dosimetric impact of weight loss throughout the course of radiotherapy in bilateral treatment of head and neck cancer patients

Stauch, Zachary; Zoller, Wesley; Tedrick, Kayla; Walston, Steve; Christ, Daniel; Hunzeker, Ashley; Lenards, Nishele; Culp, Lee; Gamez, M.E.; Blakaj, Dukagjin

doi:10.1016/j.meddos.2019.05.003

Cited by 14 publications

(8 citation statements)

References 12 publications

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“…Comparing the effectiveness of ART for both IMRT and VMAT plans, Stauch et al showed that there is no significant difference between the two techniques. However, tissue loss in HNC may have a greater effect on IMRT treatment plans when checking the plan because the number of checkpoints at which measurements are made for the plan verification is lower compared to VMAT [ 11 ]. Thomson et al also did not find significant differences in the robustness of the plan between IMRT and VMAT in the head and neck area of patients that required replanning due to weight loss [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Adaptive Radiotherapy in Head and Neck Cancer Using Volumetric Modulated Arc Therapy

Buciuman

Marcu

2022

JPM

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A dosimetric study was performed to show the importance of adaptive radiotherapy (ART) for head and neck cancer (HNC) patients using volumetric modulated arc therapy (VMAT). A total of 13 patients with HNC who required replanning during radiotherapy were included in this study. All plans succeeded to achieve the set objectives regarding target volume coverage and organ sparing. All target volumes presented a significant decrease with an average of 76.44 cm3 (p = 0.007) for PTVlow risk, 102.81 cm3 (p = 0.021) for PTVintermediate risk, and 47.10 cm3 (p = 0.003) for PTVhigh risk. Additionally, a positive correlation was found between PTV shrinkage and the number of fractions completed before replanning. Significant volume decrease was also observed for the parotid glands. The ipsilateral parotid decreased in volume by a mean of 3.75 cm3 (14.43%) (p = 0.067), while the contralateral decreased by 4.23 cm3 (13.23%) (p = 0.033). For all analyzed organs, a reduction in the final dose received after replanning was found. Our study showed that ART via rescanning, recontouring, and replanning using VMAT is essential whenever anatomical and positional variations occur. Furthermore, comparison with the literature has confirmed that ART using VMAT offers similar results to ART with intensity modulated radiotherapy.

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Section: Discussionmentioning

confidence: 99%

Adaptive Radiotherapy in Head and Neck Cancer Using Volumetric Modulated Arc Therapy

Buciuman

Marcu

2022

JPM

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“…Significant weight loss during treatment can result in ill-fitting masks and therefore risks treatment being stopped and/or re-planned. 28 Therefore, any deficit should be identified early and patients should be reviewed by the dietitian at least once a week, ideally twiceweekly during treatment. 9 Dietitians also support the MDT in encouraging adherence to treatments, such as analgesia, to alleviate side effects and in turn, optimise tolerance to nutrition support.…”

Section: On-treatmentmentioning

confidence: 99%

Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer

2022

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Malnutrition is prevalent in patients with head and neck cancer (HNC) at diagnosis but can occur at any stage of the treatment pathway. The impact of disease burden and treatment side effects can lead to altered anatomy, compromised quality and quantity of saliva and impaired swallowing function, which can result in deleterious effects on nutritional status. Optimising nutrition status is critical, as malnutrition is adversely associated with treatment tolerance and outcomes, wound healing, morbidity, mortality, quality of life and survival. Dietitians are integral members of the HNC multidisciplinary team and are uniquely qualified in the assessment, management and optimisation of nutritional status across the care pathway. This includes providing informational counselling to patients and carers on the short- and long-term nutritional impact of planned treatments alongside multidisciplinary members. Dietitians lead on the recommendation, provision and monitoring of nutrition support, which can be via the oral, enteral or parenteral route. Oral nutrition support includes dietary counselling, nourishing dietary, food fortification advice and high energy/protein oral nutritional supplements. Enteral nutrition support, or tube feeding, can be required on a short- and/or long-term basis and dietitians support appropriate decision-making for the type of tube and timing of placement across the care pathway.

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“…On the other hand, Hunter et al concluded that replanning is unlikely to improve salivary output after treatment in most cases even though replanning can reduce the mean dose to the parotids basically because of the importance of the remaining function of the other salivary glands [ 44 ]. Stauch et al investigated the dosimetric impact of weight loss and anatomical separation difference in head and neck (H&N) patients and examined the effectiveness of adaptive planning and compared VMAT and IMRT adaptive plans [ 45 ]. Despite some differences, were found: the mean weight loss was 9% and the mean anatomical difference measured in nine vectors in levels of C1, C3, and C4/5 was 1.06 cm, the coverage of all targets improved on average regarding both VMAT and IMRT.…”

Section: Hypoxia In Head and Neck Cancersmentioning

confidence: 99%

“…No quantitative method for finding the threshold of anatomical separation difference requiring a replanning was established. Since weight loss is a gradual process and the true overdosing is even smaller than in the time of replanning and the changes in organ dose were marginal, authors conclude that adaptive radiotherapy may not always be necessary when the alignment of bony anatomy and remaining soft tissue is within tolerance and physician judgment and preference is still needed [ 45 ]. Despite the various facts concerning adaptation, its importance stands out even more in the case of further dose intensification.…”

Section: Hypoxia In Head and Neck Cancersmentioning

confidence: 99%

FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer

Doležel

Slavík

Blazek

et al. 2022

JPM

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Concurrent chemoradiotherapy represents one of the most used strategies in the curative treatment of patients with head and neck (HNC) cancer. Locoregional failure is the predominant recurrence pattern. Tumor hypoxia belongs to the main cause of treatment failure. Positron emission tomography (PET) using hypoxia radiotracers has been studied extensively and has proven its feasibility and reproducibility to detect tumor hypoxia. A number of studies confirmed that the uptake of FMISO in the recurrent region is significantly higher than that in the non-recurrent region. The escalation of dose to hypoxic tumors may improve outcomes. The technical feasibility of optimizing radiotherapeutic plans has been well documented. To define the hypoxic tumour volume, there are two main approaches: dose painting by contour (DPBC) or by number (DPBN) based on PET images. Despite amazing technological advances, precision in target coverage, and surrounding tissue sparring, radiation oncology is still not considered a targeted treatment if the “one dose fits all” approach is used. Using FMISO and other hypoxia tracers may be an important step for individualizing radiation treatment and together with future radiomic principles and a possible genome-based adjusting dose, will move radiation oncology into the precise and personalized era.

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An evaluation of adaptive planning by assessing the dosimetric impact of weight loss throughout the course of radiotherapy in bilateral treatment of head and neck cancer patients

Cited by 14 publications

References 12 publications

Adaptive Radiotherapy in Head and Neck Cancer Using Volumetric Modulated Arc Therapy

Adaptive Radiotherapy in Head and Neck Cancer Using Volumetric Modulated Arc Therapy

Malnutrition, nutrition support and dietary intervention: the role of the dietitian supporting patients with head and neck cancer

FMISO-Based Adaptive Radiotherapy in Head and Neck Cancer

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