The future of personalised radiotherapy for head and neck cancer

Abstract

Radiotherapy has long been the mainstay of treatment for patients with head and neck cancer and has traditionally involved a stage-dependent strategy whereby all patients with the same TNM stage receive the same therapy. We believe there is a substantial opportunity to improve radiotherapy delivery beyond just technological and anatomical precision. In this Series paper, we explore several new ideas that could improve understanding of the phenotypic and genotypic differences that exist between patients and their tumours. We discuss how exploiting these differences and taking advantage of precision medicine tools-such as genomics, radiomics, and mathematical modelling-could open new doors to personalised radiotherapy adaptation and treatment. We propose a new treatment shift that moves away from an era of empirical dosing and fractionation to an era focused on the development of evidence to guide personalisation and biological adaptation of radiotherapy. We believe these approaches offer the potential to improve outcomes and reduce toxicity.

Diffusional kurtosis imaging in head and neck cancer: On the use of trace‐weighted images to estimate indices of non‐Gaussian water diffusion

“…24 We note the emerging role of precise and personalized oncology, which could greatly improve the clinical outcomes of therapies, integrating the biological differences between tumor phenotypes, based on a large dataset of genomics and radiomics biomarkers. 40,41 In this regard, functional MRI techniques, such as diffusion-as well as perfusion-MRI, could have an important role, as they can provide several quantitative indices strictly related to tissue cellular density, vascular perfusion, and tumor heterogeneity. 42 These indices represent distinctive tumor signatures with radiobiological relevance that could guide treatment optimization and personalization.…”

Radiomics in radiotherapy: Applications and future challenges

“…In head and neck cancer, such as oropharyngeal head and neck squamous cell carcinoma and non‐oropharyngeal head and neck squamous cell carcinoma, different cell sublines have different radiosensitivity factors and different resistance to radiation. Radiomics can also identify sublines (subregions) of radioresistant cells in the tumor, so that individual therapeutic protocols can be developed to selectively increase the dose of radiation to these sublines of cells 19 . In a 2014 study, Aerts et al.…”

“…Radiomics can also identify sublines (subregions) of radioresistant cells in the tumor, so that individual therapeutic protocols can be developed to selectively increase the dose of radiation to these sublines of cells. 19 In a 2014 study, Aerts et al showed that a radiomic signature composed of four features models can provide prognostic information about intratumoral heterogeneity and can be used to predict survival, pathological grading, and gene expression typing. 20 In addition to these studies, in head and neck cancer radiotherapy, the parotid gland usually receives a higher dose of radiation.…”

Exploring the rationale for combining ionizing radiation and immune checkpoint blockade in head and neck cancer

“…Greater than two-thirds of all patients with HNSCC will receive IR at some point during their treatment (6) . Significant pre-clinical data suggests that IR is additive or synergistic with different forms of immunotherapy, including checkpoint inhibition.…”