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

Abstract

Squamous cell cancer of the head and neck (SCCHN) often requires adjuvant radiotherapy. Radiotherapy for SCCHN is a challenge because the head and neck contain several critical organs that should receive minimal doses of radiation. These organs include the eyes, parotid glands, brainstem, spinal cord, mandible, and thyroid gland. Approaches like image-guided radiotherapy (IGRT) combined with volumetric modulated arc therapy hold the promise to focus radiation to the planning target volume and spare nearby structures while observing potential changes to patient anatomy during treatment to determine whether replanning is required. IGRT, however, requires the frequent imaging of patients to update the treatment plan. In this retrospective study, we present our findings of SCCHN patients treated in a public hospital in Peru. The patients reflected overall demographic trends associated with SCCHN. Each patient was imaged using computed tomography once before radiotherapy and once by cone-beam computed tomography (CBCT) during treatment, for a total of two images. Tumor displacement, planning target volume, gross tumor volume, and neck diameter were compared between the two images. Among the measurements, only a small statistically significant increase in gross tumor volume was observed between the images. However, a minority of patients did experience changes to anatomy, which highlights the need for continued research into criteria to determine which patients are likely to benefit from treatment replanning due to intratreatment anatomical changes. Alternatively, a lack of frequent CBCT imaging before each session, due to high patient flows and limited staff resources, made it difficult to observe transient changes and trends in each patient. We conclude that the treatment and outcome improvements associated with IGRT are likely associated with frequent imaging during radiotherapy and properly selecting which patients will benefit most from this resource-intensive technique.

Image Guided Radiotherapy (IGRT) and Delta (Δ) Radiomics—An Urgent Alliance for the Front Line of the War against Head and Neck Cancers

“…Both the use of the CT simulator and the integrated on-board imaging (OBI) system, an imaging-based system that improves the patient’s radiation therapy setup accuracy, are included in the concept of IGRT. The displacement of internal organs between radiotherapy fractions, but also the position variation for target volumes and OARs during a treatment fraction, are the causes of possible uncertainties mentioned by Fernández-Rodríguez et al [ 33 ].…”

Procjena terapijske tačnosti radioterapije karcinoma glave i vrata vođene kompjuterizovanom tomografijom konusnog snopa

“…IGRT je evoluirao sa povećanim 2-dimenzionalnim (2D) i 3-dimenzionalnim (3D) slikovnim modalitetima dostupnim za procjenu geometrijske verifikacije. IGRT tehnike zasnovane na kompjuteriziranoj tomografiji konusnog snopa (CBCT) značajno smanjuju vrijeme postavljanja i omogućavaju 50% smanjenje kliničkog ciljnog volumena na PTV margine što bi moglo olakšati eskalaciju doze i poboljšano smanjenje toksičnosti (4). U svakodnevnoj kliničkoj praksi od slikovnih metoda ističe se kilovoltni (kV)-CBCT imidžing koji pruža uvid u mekotkivne strukture, odnosno u odnos terapijskog položaja pacijenta, lokalizacije ciljnog volumena i organa od rizika.…”