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Journal of Radiation Oncology

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01-06-2018 | Original Research

Image-guided adaptive radiotherapy improves acute toxicity during intensity-modulated radiation therapy for head and neck cancer

Authors: Allen M. Chen, Taeko Yoshizaki, Sophia Hsu, Argin Mikaeilian, Minsong Cao

Published in: Journal of Radiation Oncology | Issue 2/2018

Abstract

Purpose

The purpose of this study was to evaluate the impact of an image-guided adaptive re-planning strategy on patients treated by intensity-modulated radiotherapy (IMRT) for head and neck cancer.

Methods and materials

Among 198 patients with head and neck cancer comprising the primary study population, 79 (40%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment.

Results

The incidence of grade 3+ acute skin toxicity was 15 and 35% among patients treated with and without adaptive radiotherapy, respectively (p = 0.01). The incidence of grade 3+ oral mucositis was 15 and 29%, respectively (p = 0.03). There was no significant difference in the 2-year rates of local-regional control or overall survival between the two cohorts (p > 0.05, for both).

Conclusion

The use of an image-guided adaptive radiotherapy strategy reduced the incidence of high-grade skin toxicity and oral mucositis in the acute setting. Further studies are needed to better define which subset of patients may benefit the most.

Beltran M, Ramos M, Rovira JJ et al (2012) Dose variations in tumor volumes and organs during IMRT for head-and-neck cancer. J Appl Clin Med Phys 13:3723–3727PubMed

Bhide S, Davies M, Burke K et al (2010) Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer: a prospective observational study. Int J Radiat Oncol Biol Phys 76(5):1360–1368. https://doi.org/10.1016/j.ijrobp.2009.04.005 CrossRefPubMed

Huang H, Lu H, Feng G, Jiang H, Chen J, Cheng J, Pang Q, Lu Z, Gu J, Peng L, Deng S, Mo Y, Wu D, Wei Y (2015) Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy. Radiat Oncol 10(1):192. https://doi.org/10.1186/s13014-015-0498-1 CrossRefPubMedPubMedCentral

Barker JL, Garden AS, Ang KK et al (2004) Quantification of volumetric and geometric changes occurring during fractionated radiotherapy for head-and-neck cancer using an integrated CT/linear accelerator system. Int J Radiat Oncol Biol Phys 59(4):960–970. https://doi.org/10.1016/j.ijrobp.2003.12.024 CrossRefPubMed

Woodford C, Yartesv S, Dar AR et al (2007) Adaptive radiotherapy planning on decreasing gross tumor volumes as seen on megavoltage computed tomography images. Int J Radiat Oncol Biol Phys 69(4):1316–1322. https://doi.org/10.1016/j.ijrobp.2007.07.2369 CrossRefPubMed

Chen AM, Farwell DG, Luu Q, Donald PJ, Perks J, Purdy JA (2011) Evaluation of the planning target volume in the treatment of head and neck cancer with intensity-modulated radiotherapy: what is the appropriate expansion margin in the setting of daily image guidance? Int J Radiat Oncol Biol Phys 81(4):943–949. https://doi.org/10.1016/j.ijrobp.2010.07.017 CrossRefPubMed

Hansen EK, Bucci MK, Quivey JM, Weinberg V, Xia P (2006) Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys 64(2):355–362. https://doi.org/10.1016/j.ijrobp.2005.07.957 CrossRefPubMed

Lu J, Ma Y, Chen J, Wang L, Zhang G, Zhao M, Yin Y (2014) Assessment of anatomical and dosimetric changes by a deformable registration method during the course of intensity-modulated radiotherapy for nasopharyngeal carcinoma. J Radiat Res 55(1):97–104. https://doi.org/10.1093/jrr/rrt076 CrossRefPubMed

Lee N, Chuang C, Quivey JM, Phillips TL, Akazawa P, Verhey LJ, Xia P (2002) Skin toxicity due to intensity-modulated radiotherapy for head and neck carcinoma. Int J Radiat Oncol Biol Phys 53(3):630–637. https://doi.org/10.1016/S0360-3016(02)02756-6 CrossRefPubMed

10.

Narayan S, Lehmann J, Coleman MA, Vaughan A, Yang CC, Enepekides D, Farwell G, Purdy JA, Laredo G, Nolan K, Pearson FS, Vijayakumar S (2008) Prospective evaluation to establish a dose response for clinical oral mucositis in patients undergoing head and neck conformal radiotherapy. Int J Radiat Oncol Biol Phys 72(3):756–762. https://doi.org/10.1016/j.ijrobp.2008.01.060 CrossRefPubMed

11.

Rosenthal DI, Chambers MS, Fuller CD, Rebueno NCS, Garcia J, Kies MS, Morrison WH, Ang KK, Garden AS (2008) Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys 72(3):747–755. https://doi.org/10.1016/j.ijrobp.2008.01.012 CrossRefPubMed

12.

Yang H, Hu W, Wang W, Chen P, Ding W, Luo W (2013) Replanning during intensity-modulated radiation therapy improved quality of life in patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 85(1):e47–e54. https://doi.org/10.1016/j.ijrobp.2012.09.033 CrossRefPubMed

13.

Schwartz DL, Garden AS, Thomas J, Chen Y, Zhang Y, Lewin J, Chambers MS, Dong L (2012) Adaptive radiotherapy for head-and-neck cancer: initial clinical results from a prospective trial. Int J Radiat Oncol Biol Phys 83(3):986–993. https://doi.org/10.1016/j.ijrobp.2011.08.017 CrossRefPubMed

14.

Schwartz DL, Garden AS, Shah SJ, Chronowski G, Sejpal S, Rosenthal DI, Chen Y, Zhang Y, Zhang L, Wong PF, Garcia JA, Kian Ang K, Dong L (2013) Adaptive radiotherapy for head and neck cancer—dosimetric results from a prospective clinical trial. Radiother Oncol 106(1):80–84. https://doi.org/10.1016/j.radonc.2012.10.010 CrossRefPubMed

15.

Chen AM, Daly ME, Cui J, Mathai M, Benedict S, Purdy JA (2014) Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning. Head Neck 36(11):1541–1546. https://doi.org/10.1002/hed.23477 CrossRefPubMed

16.

Wang W, Yang H, Hu W, Shan G, Ding W, Yu C, Wang B, Wang X, Xu Q (2010) Clinical study of the necessity of replanning before the 25th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 77(2):617–621. https://doi.org/10.1016/j.ijrobp.2009.08.036 CrossRefPubMed

17.

You SH, Kim SY, Lee CG et al (2012) Is there a clinical benefit to adaptive planning during tomotherapy in patients with head and neck cancer at risk for xerostomia? Am J Clin Oncol 35:262–266

18.

Ahn P (2011) PH, Chen CC, Ahn AI, et al. adaptive planning in intensity-modulated radiation therapy for head and neck cancers: single-institution experience and clinical implications. Int J Radiat Oncol Biol Phys 80(3):677–685. https://doi.org/10.1016/j.ijrobp.2010.03.014 CrossRefPubMed

19.

Moteabbed M, Sharp GC, Wang Y, Trofimov A, Efstathiou JA, Lu HM (2015) Validation of a deformable image registration technique for cone beam CT-based dose verification. Med Phys 42(1):196–205. https://doi.org/10.1118/1.4903292 CrossRefPubMed

20.

Veiga C, McClelland J, Moinuddin S, Lourenço A, Ricketts K, Annkah J, Modat M, Ourselin S, D'Souza D, Royle G (2014) Toward adaptive radiotherapy for head and neck patients: feasibility study on using CT-to-CBCT deformable registration for “dose of the day” calculations. Med Phys 41(3):031703. https://doi.org/10.1118/1.4864240 CrossRefPubMed

21.

Raghavan G, Kishan AU, Cao M, Chen AM (2016) Anatomic and dosimetric changes in patients with head and neck cancer treated with an integrated MRI-tri-Co teletherapy device. Br J Radiol 89(1067):20160624. https://doi.org/10.1259/bjr.20160624 CrossRefPubMedPubMedCentral

Title: Image-guided adaptive radiotherapy improves acute toxicity during intensity-modulated radiation therapy for head and neck cancer
Authors: Allen M. Chen
Taeko Yoshizaki
Sophia Hsu
Argin Mikaeilian
Minsong Cao
Publication date: 01-06-2018
Publisher: Springer Berlin Heidelberg
Published in: Journal of Radiation Oncology / Issue 2/2018
Print ISSN: 1948-7894
Electronic ISSN: 1948-7908
DOI: https://doi.org/10.1007/s13566-017-0336-1

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