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

Published on Nov 12, 2020in Frontiers in Oncology4.848
· DOI :10.3389/FONC.2020.579917
Metin Figen2
Estimated H-index: 2
,
Didem Çolpan Öksüz10
Estimated H-index: 10
(Istanbul University)
+ 6 AuthorsMehmet Şen1
Estimated H-index: 1
Sources
Abstract
Purpose and Objective: A proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require ad hoc treatment replanning. The aim of this retrospective study is to analyse the patients who required ad hoc replanning and identify factors which may predict need for replanning. Materials and Methods: A single centre evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January-December 2016 was undertaken. Patients who underwent ad hoc replanning during the treatment were identified in electronic records. Reasons of re-planning were categorized as: weight loss, tumour shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumour site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated. Results: 31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy were required replanning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for replanning were tumour shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumour/treatment factors, nasopharyngeal primary site (p=0.013) and use of concurrent chemotherapy with radiotherapy (p=0.034) were found to be significantly correlated to the need for replanning. Conclusion: Effective on-treatment verification schedules and close followed up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualised triggered approach to ART rather than scheduled strategies since it is likely to be more feasible in terms of utilization of workload and economic resources.
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Abstract Purpose The POP-ART RT study aims to determine to what extent and how intrafractional real-time respiratory motion management (RRMM), and plan adaptation for interfractional anatomical changes (ART) are used in clinical practice and to understand barriers to implementation. Here we report on part II: ART using more than one plan per target per treatment course. Materials and methods A questionnaire on the current practice of ART, wishes for expansion or implementation, and barriers to i...
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Abstract Introduction During a course of radiotherapy for head-and-neck-cancer (HNC), non-rigid anatomical changes can be observed on daily Cone Beam CT (CBCT). To objectify responses to these changes, we use a decision support system (traffic light protocol). Action levels orange and red may lead to re-planning. The purpose of this study was to evaluate how often re-planning was done for non-rigid anatomical changes, which anatomical changes led to re-planning and in which subgroups of patients...
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For early-stage head and neck cancer (HNC), surgery (S) or radiotherapy (RT) is a standard treatment. The multidisciplinary approach, which includes multimodality treatment with S followed by RT, with or without chemotherapy (CT) or concurrent chemoradiotherapy (CRT), is required for locally advanced head and neck cancer (LAHNC). CRT improves prognosis, locoregional control (LRC), and organ function in LAHNC, compared to RT alone. Prognosis in recurrent/metastatic HNC (R/M HNC) is dismal. Platin...
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Our previous study suggested that some pulmonary artery (PA) dosimetric parameters were associated with mortality in unresectable non-small cell lung cancer (NSCLC) treated with definitive radiotherapy. The present study aims to analyze the impact of both PA and heart dosimetric parameters on survival of patients with NSCLC treated with definitive conventional fractionated radiotherapy (CFRT) in another independent research center and further determine whether the PA should be considered a dose-...
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