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Radiation Oncology
Published in: Radiation Oncology 1/2016

Open Access 01-12-2016 | Research

Methodology for analysis and reporting patterns of failure in the Era of IMRT: head and neck cancer applications

Authors: Abdallah S. R. Mohamed, David I. Rosenthal, Musaddiq J. Awan, Adam S. Garden, Esengul Kocak-Uzel, Abdelaziz M. Belal, Ahmed G. El-Gowily, Jack Phan, Beth M. Beadle, G. Brandon Gunn, Clifton D. Fuller

Published in: Radiation Oncology | Issue 1/2016

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Abstract

Background

The aim of this study is to develop a methodology to standardize the analysis and reporting of the patterns of loco-regional failure after IMRT of head and neck cancer.

Material and Methods

Twenty-one patients with evidence of local and/or regional failure following IMRT for head-and-neck cancer were retrospectively reviewed under approved IRB protocol. Manually delineated recurrent gross disease (rGTV) on the diagnostic CT documenting recurrence (rCT) was co-registered with the original planning CT (pCT) using both deformable (DIR) and rigid (RIR) image registration software. Subsequently, mapped rGTVs were compared relative to original planning target volumes (TVs) and dose using a centroid-based approaches. Failures were then classified into five types based on combined spatial and dosimetric criteria; A (central high dose), B (peripheral high dose), C (central elective dose), D (peripheral elective dose), and E (extraneous dose).

Results

A total of 26 recurrences were identified. Using DIR, recurrences were assigned to more central TVs compared to RIR as detected using the spatial centroid-based method (p = 0.0002). rGTVs mapped using DIR had statistically significant higher mean doses when compared to rGTVs mapped rigidly (mean dose 70 vs. 69 Gy, p = 0.03). According to the proposed classification 22 out of 26 failures were of type A (central high dose) as assessed by DIR method compared to 18 out of 26 for the RIR because of the tendencey of RIR to assign failures more peripherally.

Conclusions

RIR tends to assigns failures more peripherally. DIR-based methods showed that the vast majority of failures originated in the high dose target volumes and received full prescribed doses suggesting biological rather than technology-related causes of failure. Validated DIR-based registration is recommended for accurate failure characterization and a novel typology-indicative taxonomy is recommended for failure reporting in the IMRT era.
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Metadata
Title
Methodology for analysis and reporting patterns of failure in the Era of IMRT: head and neck cancer applications
Authors
Abdallah S. R. Mohamed
David I. Rosenthal
Musaddiq J. Awan
Adam S. Garden
Esengul Kocak-Uzel
Abdelaziz M. Belal
Ahmed G. El-Gowily
Jack Phan
Beth M. Beadle
G. Brandon Gunn
Clifton D. Fuller
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Radiation Oncology / Issue 1/2016
Electronic ISSN: 1748-717X
DOI
https://doi.org/10.1186/s13014-016-0678-7

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