Impact of Adaptive Radiotherapy on Locally Advanced Head and Neck Cancer - A Dosimetric and Volumetric Study

Sharma, SK; Dewan, Abhinav; Srivastava, Himanshu; Rawat, Sheh; Kakria, Anjali; Mishra, M.; Suresh, T; Mehrotra, Krati

doi:10.7314/apjcp.2016.17.3.985

Cited by 32 publications

(31 citation statements)

References 37 publications

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“…Compared with the mean dose delivered with standard IMRT, ART allowed a dose reduction ranging from 0.6 Gy to 4.1 Gy in all studies [11][12][13][14][15]17,31] except one, which did not find a benefit with one replanning session [3] (Table 1). Surprisingly, the parotid glands with a dose decrease without ART have a benefit of ART, which allows further reducing the mean dose by 1.4 Gy [12].…”

Section: Parotid Glandsmentioning

confidence: 97%

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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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Section: Parotid Glandsmentioning

confidence: 97%

“…Three studies reported that ART achieved a dosimetric benefit for the spinal cord, decreasing the spinal cord maximum dose by 0.1 Gy to 4 Gy for several fractions, ranging from one to all fractions [3,11,13]. The benefit of this dosimetric difference is unclear and may not translate into a clinical benefit.…”

Section: Spinal Cordmentioning

confidence: 99%

Adaptive radiotherapy for head and neck cancer

et al. 2018

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“…While some of the patients had 95% or 93% isodose line shifts less than 1 mm due to 1 cm uniform body contour change, some of the patients had 95% or 93% isodose line shifts more than 4 mm. This may explain the fact that although there was literature claiming the target coverage was affected by anatomical changes (e.g., weight loss), others showed that anatomical changes had minimal effect on target coverage …”

Section: Resultsmentioning

confidence: 99%

“…There is evidence showing that weight loss is correlated with body contour changes . Weight loss for H&N patients is well‐known and body contour change due to weight loss has been quantified in some studies. Yang et al .…”

Section: Discussionmentioning

confidence: 99%

“…Examples for prostate patients include weight change, buttock flex, and abdominal position change . Weight change, tumor shrinkage, and shoulder position variations are commonly seen in head and neck (H&N) patients . As a result, the patient's body contour on the treatment day can deviate from the p‐CT and this can be clearly visualized on the volumetric images (e.g., cone‐beam CTs) taken on the treatment day.…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric effect of body contour changes for prostate and head and neck volumetric modulated arc therapy plans

Sun

Kirkby

Smith

2019

J Applied Clin Med Phys

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Body contour changes are commonly seen in prostate and head and neck (H&N) patients undergoing volumetric modulated arc therapy (VMAT) treatments, which may cause a discrepancy between the planned dose and the delivered dose. Dosimetrists, radiation oncologists or medical physicists sometimes are required to visually assess the dosimetric impact of body contour changes and make a judgment call on whether further re‐assessment of the plan is needed. However, an intuitive judgment cannot always be made in a timely manner due to the complexity of VMAT plans as well as the complicated forms of body contour changes. This study evaluated the dosimetric effect of body contour changes for prostate and H&N patients to help with clinical decision‐making. By analyzing the one‐dimensional spatial dose profiles from the original body and the body with different body contour deformations, rules of thumb for dose percentage change and isodose line shift due to body contour changes were ascertained. Moreover, based on dose distribution comparison using three‐dimensional gamma analysis, the response of the clinical prostate and H&N VMAT plans to body contour changes was assessed. Within center specific dose deviation tolerances, prostate patients who had less than 2 cm single side body contour change or less than 1 cm uniform body contour change were unlikely to need plan re‐assessment; H&N VMAT plans with less than 1 cm uniform body contour change or less than 1 cm shoulder superior–inferior positional change were also unlikely to trigger further evaluation. Dose percentage change and isodose line shift were considered independently from the problem of volume changes in this study, but clinically, both aspects must be considered.

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Weekly Adaptive Radiotherapy vs Standard Intensity-Modulated Radiotherapy for Improving Salivary Function in Patients With Head and Neck Cancer

et al. 2023

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ImportanceXerostomia is a major toxic effect associated with intensity-modulated radiotherapy (IMRT) for oropharyngeal cancers.ObjectiveTo assess whether adaptive radiotherapy (ART) improves salivary function compared with IMRT in patients with head and neck cancer.Design, Setting, and ParticipantsThis phase 3 randomized clinical trial was conducted in 11 French centers. Patients aged 18 to 75 years with stage III-IVB squamous cell oropharyngeal cancer treated with chemoradiotherapy were enrolled between July 5, 2013, and October 1, 2018. Data were analyzed from November 2021 to May 2022.InterventionsThe patients were randomly assigned (1:1) to receive standard IMRT (without replanning) or ART (systematic weekly replanning).Main Outcomes and MeasuresThe primary end point was the frequency of xerostomia, measured by stimulating salivary flow with paraffin. Secondary end points included salivary gland excretory function measured using technetium-99m pertechnetate scintigraphy, patient-reported outcomes (Eisbruch xerostomia-specific questionnaire and the MD Anderson Symptom Inventory for Head and Neck Cancer questionnaire), early and late toxic effects, disease control, and overall and cancer-specific survival.ResultsA total of 132 patients were randomized, and after 1 exclusion in the ART arm, 131 were analyzed: 66 in the ART arm (mean [SD] age at inclusion, 60 [8] years; 57 [86.4%] male) and 65 in the standard IMRT arm (mean [SD] age at inclusion, 60 [8] years; 57 [87.7%] male). The median follow-up was 26.4 months (IQR, 1.2-31.3 months). The mean (SD) salivary flow (paraffin) at 12 months was 630 (450) mg/min in the ART arm and 584 (464) mg/min in the standard arm (P = .64). The mean (SD) excretory function of the parotid gland at 12 months, measured by scintigraphy, improved in the ART arm (48% [17%]) compared with the standard arm (41% [17%]) (P = .02). The 2-year-overall survival was 76.9% (95% CI, 64.7%-85.4%) in both arms.Conclusions and RelevanceThis randomized clinical trial did not demonstrate a benefit of ART in decreasing xerostomia compared with standard IMRT. No significant differences were found in secondary end points except for parotid gland excretory function, as assessed by scintigraphy, or in survival rates.Trial RegistrationClinicalTrials.gov Identifier: NCT01874587

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Impact of Adaptive Radiotherapy on Locally Advanced Head and Neck Cancer - A Dosimetric and Volumetric Study

Cited by 32 publications

References 37 publications

Adaptive radiotherapy for head and neck cancer

Adaptive radiotherapy for head and neck cancer

Dosimetric effect of body contour changes for prostate and head and neck volumetric modulated arc therapy plans

Weekly Adaptive Radiotherapy vs Standard Intensity-Modulated Radiotherapy for Improving Salivary Function in Patients With Head and Neck Cancer

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