Clinical outcomes of adaptive radiotherapy in head and neck cancers

Kataria, Tejinder; Gupta, Deepak; Goyal, Shikha; Bisht, Shyam Singh; Basu, Trinanjan; Agarwal, Abhishek; Narang, Kushal; Banerjee, Susovan; Nasreen, Samia; Sambasivam, Sasikumar; Dhyani, Aruj

doi:10.1259/bjr.20160085

Cited by 38 publications

(52 citation statements)

References 16 publications

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“…In the literature we found two studies [22,23] in which a repeat CT was made in the fifth week of treatment. Ahn et al preformed scheduled rescans mid-treatment and used CBCT scans to examine if the variations (systematic or random) were consistent by checking the position of the spinal cord, skull and upper neck [24].…”

Section: Discussionmentioning

confidence: 99%

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Beek¹,

Jonker²,

Hamming‐Vrieze

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

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Introduction: During a course of radiotherapy for head-and-neck-cancer (HNC), non-rigid anatomical changes can be observed on daily Cone Beam CT (CBCT). To objectify responses to these changes, we use a decision support system (traffic light protocol). Action levels orange and red may lead to replanning. The purpose of this study was to evaluate how often re-planning was done for non-rigid anatomical changes, which anatomical changes led to re-planning and in which subgroups of patients treatment adaptation was deemed necessary. Materials and methods: A consecutive series of 388 HNC patients were retrospectively selected using the digital log of CBCT scans. The logs were analyzed for the number of new plans on an original planning CT scan (O-pCT) or a new pCT scan (N-pCT). Reasons for re-planning were categorized into: target volume increase/decrease, body contour decrease/increase and local shift of target volume. Subgroup analysis was performed to investigate relative differences of re-planning between treatment modalities. Results: For 33 patients the treatment plan was adapted due to anatomical changes, resulting in 37 new plans in total. Re-planning on a N-pCT with complete re-delineation was done 22 times. In fifteen cases a new plan was created after adjustment of contours on the O-pCT. Main reasons for re-planning were target volume increase, body contour decrease and local shifts of target volume. Most re-planning (23%) was seen in patients treated with chemoradiotherapy. Conclusion: Visual detection of anatomical changes on CBCT during treatment of HNC, results in replanning in 1 out of 10 patients.

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Section: Discussionmentioning

confidence: 99%

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Beek¹,

Jonker²,

Hamming‐Vrieze

et al. 2019

Technical Innovations & Patient Support in Radiation Oncolo

View full text Add to dashboard Cite

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“…The median follow-up ranged from 29 to 38 months. Tumors were located primarily in the oropharynx [16,18,38] or the nasopharynx [17,19]. The dose delivered to the high-risk volume ranged from 66 to 76 Gy.…”

Section: Clinical Benefits Of Artmentioning

confidence: 99%

“…A 3-5 mm 3D margin around the CTV was used to generate the PTV. Replanning was performed either at a specific time point in two studies [18,19] or based on the decision of the radiation oncologist [16,17,20]. A large majority of patients (197 patients) had only one replanning session, while 31 patients had two replanning sessions.…”

Section: Clinical Benefits Of Artmentioning

confidence: 99%

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Adaptive radiotherapy for head and neck cancer

et al. 2018

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Introduction: Large anatomical variations can be observed during the treatment course intensitymodulated radiotherapy (IMRT) for head and neck cancer (HNC), leading to potential dose variations. Adaptive radiotherapy (ART) uses one or several replanning sessions to correct these variations and thus optimize the delivered dose distribution to the daily anatomy of the patient. This review, which is focused on ART in the HNC, aims to identify the various strategies of ART and to estimate the dosimetric and clinical benefits of these strategies. Material and methods: We performed an electronic search of articles published in PubMed/MEDLINE and Science Direct from January 2005 to December 2016. Among a total of 134 articles assessed for eligibility, 29 articles were ultimately retained for the review. Eighteen studies evaluated dosimetric variations without ART, and 11 studies reported the benefits of ART. Results: Eight in silico studies tested a number of replanning sessions, ranging from 1 to 6, aiming primarily to reduce the dose to the parotid glands. The optimal timing for replanning appears to be early during the first two weeks of treatment. Compared to standard IMRT, ART decreases the mean dose to the parotid gland from 0.6 to 6 Gy and the maximum dose to the spinal cord from 0.1 to 4 Gy while improving target coverage and homogeneity in most studies. Only five studies reported the clinical results of ART, and three of those studies included a non-randomized comparison with standard IMRT. These studies suggest a benefit of ART in regard to decreasing xerostomia, increasing quality of life, and increasing local control. Patients with the largest early anatomical and dose variations are the best candidates for ART. Conclusion: ART may decrease toxicity and improve local control for locally advanced HNC. However, randomized trials are necessary to demonstrate the benefit of ART before using the technique in routine practice.

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“…21,22 Adaptive radiotherapy studies with CT have already demonstrated the benefit of such an approach in reducing cumulative dose to normal tissues throughout the radiotherapy without compromising long-term outcome. [23][24][25] MRI is naturally the imaging modality of choice for this approach owing to lack of additional radiation exposure and better soft-tissue contrast. Current imaging modalities available in the treatment room such as cone-beam CT or in-room CT provide limited soft-tissue contrast which precludes precise tumour tracking.…”

Section: Anatomical Mri Sequencesmentioning

confidence: 99%

The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective

Wong

Panek

Bhide

et al. 2017

The British Journal of Radiology

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Head and neck cancer (HNC) is a challenging tumour site for radiotherapy delivery owing to its complex anatomy and proximity to organs at risk (OARs) such as the spinal cord and optic apparatus. Despite significant advances in radiotherapy planning techniques, radiation-induced morbidities remain substantial. Further improvement would require high-quality imaging and tailored radiotherapy based on intratreatment response. For these reasons, the use of MRI in radiotherapy planning for HNC is rapidly gaining popularity. MRI provides superior soft-tissue contrast in comparison with CT, allowing better definition of the tumour and OARs. The lack of additional radiation exposure is another attractive feature for intratreatment monitoring. In addition, advanced MRI techniques such as diffusion-weighted, dynamic contrast-enhanced and intrinsic susceptibility-weighted MRI techniques are capable of characterizing tumour biology further by providing quantitative functional parameters such as tissue cellularity, vascular permeability/perfusion and hypoxia. These functional parameters are known to have radiobiological relevance, which potentially could guide treatment adaptation based on their changes prior to or during radiotherapy. In this article, we first present an overview of the applications of anatomical MRI sequences in head and neck radiotherapy, followed by the potentials and limitations of functional MRI sequences in personalizing therapy. INTRODUCTIONRadical radiotherapy (RT) is integral to the management of head and neck cancer (HNC) in both the primary and adjuvant settings. Advances in computer-assisted radiological techniques over the past two decades have in turn revolutionized radiotherapy planning. Development of advanced radiotherapy planning techniques such as intensity-modulated radiotherapy (IMRT) and volumetricmodulated arc therapy have allowed for better dose conformation to the tumour target and sparing of surrounding normal tissues. HNC was one of the first tumour sites where IMRT was widely implemented owing to a significant reduction in radiation-induced xerostomia in comparison with three-dimensional conformal planning.

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Clinical outcomes of adaptive radiotherapy in head and neck cancers

Cited by 38 publications

References 16 publications

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Protocolised way to cope with anatomical changes in head & neck cancer during the course of radiotherapy

Adaptive radiotherapy for head and neck cancer

The emerging potential of magnetic resonance imaging in personalizing radiotherapy for head and neck cancer: an oncologist's perspective

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