Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice

Figen, Metin; Öksüz, Didem Çolpan; Duman, Evrim; Prestwich, R.; Dyker, K.; Cardale, K.; Ramasamy, S.; Murray, P.; Şen, Mehmet

doi:10.3389/fonc.2020.579917

Cited by 33 publications

(37 citation statements)

References 43 publications

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“…Tumor shrinkage, weight loss, and changes in the parotid glands are three common reasons for performing ART. When indicated, replanning is vital; otherwise, there is a high risk of inappropriate target irradiation and OAR overdosing [ 7 , 10 , 33 , 34 ]. In a study of 31 HNSCC patients who underwent replanning (10.6% of the sample), Figen et al [ 34 ] found that the most common reasons for replanning were tumor shrinkage (35.5%) and weight loss (35.5%).…”

Section: Discussionmentioning

confidence: 99%

“…When indicated, replanning is vital; otherwise, there is a high risk of inappropriate target irradiation and OAR overdosing [ 7 , 10 , 33 , 34 ]. In a study of 31 HNSCC patients who underwent replanning (10.6% of the sample), Figen et al [ 34 ] found that the most common reasons for replanning were tumor shrinkage (35.5%) and weight loss (35.5%). In addition, in line with our findings, most of the patients (62%) had stage IV disease.…”

Section: Discussionmentioning

confidence: 99%

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Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol “Best for Adaptive Radiotherapy” in Head and Neck Cancer

Bąk

Skrobała

Adamska

et al. 2022

Life

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No clear criteria have yet been established to guide decision-making for patient selection and the optimal timing of adaptive radiotherapy (ART) based on image-guided radiotherapy (IGRT). We have developed a novel protocol—the Best for Adaptive Radiotherapy (B-ART) protocol—to guide patient selection for ART. The aim of the present study is to describe this protocol, to evaluate its validity in patients with head and neck (HN) cancer, and to identify the anatomical and clinical predictors of the need for replanning. We retrospectively evaluated 82 patients with HN cancer who underwent helical tomotherapy (HT) and subsequently required replanning due to soft tissue changes upon daily MVCT. Under the proposed criteria, patients with anatomical changes >3 mm on three to four consecutive scans are candidates for ART. We compared the volumes on the initial CT scan (iCT) and the replanning CT (rCT) scan for the clinical target volumes (CTV1, referring to primary tumor or tumor bed and CTV2, metastatic lymph nodes) and for the parotid glands (PG) and body contour (B-body). The patients were stratified by primary tumor localization, clinical stage, and treatment scheme. The main reasons for replanning were: (1) a planning target volume (PTV) outside the body contour (n = 70; 85.4%), (2) PG shrinkage (n = 69; 84.1%), (3) B-body deviations (n = 69; 84.1%), and (4) setup deviations (n = 40; 48.8%). The replanning decision was made, on average, during the fourth week of treatment (n = 47; 57.3%). The mean reductions in the size of the right and left PG volumes were 6.31 cc (20.9%) and 5.98 cc (20.5%), respectively (p < 0.001). The reduction in PG volume was ≥30% in 30 patients (36.6%). The volume reduction in all of the anatomical structures was statistically significant. Four variables—advanced stage disease (T3–T4), chemoradiation, increased weight loss, and oropharyngeal localization—were significantly associated with the need for ART. The B-ART protocol provides clear criteria to eliminate random errors, and to allow for an early response to relevant changes in target volumes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol “Best for Adaptive Radiotherapy” in Head and Neck Cancer

Bąk

Skrobała

Adamska

et al. 2022

Life

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“…Therefore, making broad recommendations as to what criteria a patient must have to benefit from ART and re-planning has proven difficult. It has been estimated that only 10%-20% SCCHN patients require re-planning after mid-treatment imaging [ 24 , 25 ]. A separate study found that positional deviation that remains after correcting the actual positioning to the planned position was observed to be greater than 5 mm in 10% of patients if imaging is performed daily, and in 33% of patients submitted to weekly imaging [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

“…A separate study found that positional deviation that remains after correcting the actual positioning to the planned position was observed to be greater than 5 mm in 10% of patients if imaging is performed daily, and in 33% of patients submitted to weekly imaging [ 8 ]. Different factors such as weight loss, disease progression, the timing of the second image, location of the primary tumor, nutritional intervention, functional impairment, immobilization-related factors, shrinkage or deformation of the treatment volume, displacement of the lymph nodes and medial parotid gland and type of treatment have all been evaluated as triggers for re-planning [ 8 , 25 , 26 ]. Other studies report more frequent changes to weight, neck, OAR, and tumor shape and position than those observed here.…”

Section: Discussionmentioning

confidence: 99%

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

Fernández-Rodríguez¹,

Arens-Benites²,

Maldonado³

2022

Cureus

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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.

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“…Adaptive radiotherapy acknowledges the fact that the patient as they present for treatment is not identical to the patient at the time of treatment planning and dose prescription. It uses image guidance as a basis to assess and correct for that and several different adaptation approaches can be taken ranging from offline 72 to online 73 and real‐time 68 applications.…”

Section: Treatment Delivery: Technology and Techniquesmentioning

confidence: 99%

Quality management in radiotherapy treatment delivery

et al. 2022

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Radiation Oncology continues to rely on accurate delivery of radiation, in particular where patients can benefit from more modulated and hypofractioned treatments that can deliver higher dose to the target while optimising dose to normal structures. These deliveries are more complex, and the treatment units are more computerised, leading to a re-evaluation of quality assurance (QA) to test a larger range of options with more stringent criteria without becoming too time and resource consuming. This review explores how modern approaches of risk management and automation can be used to develop and maintain an effective and efficient QA programme. It considers various tools to control and guide radiation delivery including image guidance and motion management. Links with typical maintenance and repair activities are discussed, as well as patient-specific quality control activities. It is demonstrated that a quality management programme applied to treatment delivery can have an impact on individual patients but also on the quality of treatment techniques and future planning. Developing and customising a QA programme for treatment delivery is an important part of radiotherapy. Using modern multidisciplinary approaches can make this also a useful tool for department management.

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Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice

Cited by 33 publications

References 43 publications

Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol “Best for Adaptive Radiotherapy” in Head and Neck Cancer

Criteria for Verification and Replanning Based on the Adaptive Radiotherapy Protocol “Best for Adaptive Radiotherapy” in Head and Neck Cancer

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

Quality management in radiotherapy treatment delivery

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