A review of Image Guided Radiation Therapy in head and neck cancer from 2009–2019 – Best Practice Recommendations for RTTs in the Clinic

Abstract

Radiation therapy (RT) is beneficial in Head and Neck Cancer (HNC) in both the definitive and adjuvant setting. Highly complex and conformal planning techniques are becoming standard practice in delivering increased doses in HNC. A sharp falloff in dose outside the high dose area is characteristic of highly complex techniques and geometric uncertainties must be minimised to prevent under dosage of the target volume and possible over dosage of surrounding critical structures. CTV-PTV margins are employed to account for geometric uncertainties such as set up errors and both interfraction and intrafraction motion. Robust immobilisation and Image Guided Radiation Therapy (IGRT) is also essential in this group of patients to minimise discrepancies in patient position during the treatment course. IGRT has evolved with increased 2-Dimensional (2D) and 3-Dimensional (3D) IGRT modalities available for geometric verification. 2D and 3D IGRT modalities are both beneficial in geometric verification while 3D imaging is a valuable tool in assessing volumetric changes that may have dosimetric consequences for this group of patients. IGRT if executed effectively and efficiently provides clinicians with confidence to reduce CTV-PTV margins thus limiting treatment related toxicities in patients. Accumulated exposure dose from IGRT vary considerably and may be incorporated into the treatment plan to avoid excess dose. However, there are considerable variations in the application of IGRT in RT practice. This paper aims to summarise the advances in IGRT in HNC treatment and provide clinics with recommendations for an IGRT strategy for HNC in the clinic.

Development of a customisable 3D-printed intra-oral stent for head-and-neck radiotherapy

“…Safe clinical use of this customisable stent should also involve the use of rigid external fixation via a thermoplastic mask, such as should be used for any modulated head-and-neck radiotherapy treatment [32] . A hole can be cut in the mask to accommodate and easily remove the stent, and the mask should ideally have easy-release clips so that the patient can be speedily released if they begin to feel uncomfortable or unwell during treatment.…”

Dosimetric Importance of the Implementation of Daily Image Guidance in Radiotherapy Practice

“…Image-guided radiotherapy [IGRT] is a step ahead of IMRT and it has played an important role throughout radiotherapy history as its introduction and subsequent innovations have revolutionized cancer treatment. The IGRT uses advanced imaging modalities for accounting and thereby adjusting the target motion uncertainties and positional uncertainties (Kearney et al, 2020).…”

Image-Guided Radiation Therapy for Squamous Cell Cancer of the Head and Neck in a Specialized Peruvian Public Hospital

“…The second branch, called image-guided radiotherapy (IGRT), involves using precision imaging at treatment sessions to eliminate errors in patient positioning and identifying patients that might need RT replanning due to changes in the size and relative position of the tumor [ 10 , 11 ]. In developed countries, such as in Europe, nearly all patients benefit from a combined IMRT/IGRT approach using recently-proposed best-practice recommendations [ 10 ]. IGRT usually involves taking a 2D or 3D cone-beam CT (CBCT) image before RT sessions to confirm patient, tumor, and organ at risk (OAR) positioning interspersed with RT replanning sessions if necessary.…”

“…IGRT usually involves taking a 2D or 3D cone-beam CT (CBCT) image before RT sessions to confirm patient, tumor, and organ at risk (OAR) positioning interspersed with RT replanning sessions if necessary. Using IGRT daily has allowed for the reduction of margin size and increasing fraction dose (hypofractionation) while maintaining local control [ 8 , 10 ]. This reduces the risk of patient toxicity.…”