Assessing the need for adaptive radiotherapy in head and neck cancer patients using an automatic planning tool
Abstract
BACKGROUND: Unbiased analysis of the impact of adaptive radiotherapy (ART) is necessary to evaluate dosimetric benefit and optimize clinics’ workflows. The aim of the study was to assess the need for adaptive radiotherapy (ART) in head and neck (H&N) cancer patients using an automatic planning tool in a retrospective planning study.
MATERIALS AND METHODS: Thirty H&N patients treated with adaptive radiotherapy were analysed. Patients had a CT scan for treatment planning and a verification CT during treatment according to the clinic’s protocol. Considering these images, three plans were retrospectively generated using the iCycle tool to simulate the scenarios with and without adaptation: 1) the optimized plan based on the planning CT; 2) the optimized plan based on the verification CT (ART-plan); 3) the plan obtained by considering treatment plan 1 re-calculated in the verification CT (non-ART plan). The dosimetric endpoints for both target volumes and OAR were compared between scenarios 2 and 3 and the SPIDERplan used to evaluate plan quality.
RESULTS: The most significant impact of ART was found for the PTVs, which demonstrated decreased D98% in the non-ART plan. A general increase in the dose was observed for the OAR but only the spinal cord showed a statistical significance. The SPIDERplan analysis indicated an overall loss of plan quality in the absence of ART.
CONCLUSION: These results confirm the advantages of ART in H&N patients, especially for the coverage of target volumes. The usage of an automatic planning tool reduces planner-induced bias in the results, guaranteeing that the observed changes derive from the application of ART.
Keywords: radiotherapyadaptive radiotherapyautomatic planninghead and neck cancer
References
- Bray F, Ferlay J, Soerjomataram I, et al. Global cancer statistics 2018: GLOBOCAN estimates of incidence and mortality worldwide for 36 cancers in 185 countries. CA Cancer J Clin. 2018; 68(6): 394–424.
- Chin D, Boyle GM, Porceddu S, et al. Head and neck cancer: past, present and future. Expert Rev Anticancer Ther. 2006; 6(7): 1111–1118.
- Morgan HE, Sher DJ. Adaptive radiotherapy for head and neck cancer. Cancers Head Neck. 2020; 5: 1.
- Castadot P, Lee JA, Geets X, et al. Adaptive radiotherapy of head and neck cancer. Semin Radiat Oncol. 2010; 20(2): 84–93.
- Barker JL, Garden AS, Ang KK, et al. 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. 2004; 59(4): 960–970.
- Yousuf A, Qureshi B, Hussain A, et al. SU-E-J-81: Adaptive Radiotherapy for IMRT Head & Neck Patient in AKUH. Med Phys. 2015; 42(6 Part 8): 3282–3282.
- Yan Di, Lockman D, Martinez A, et al. Computed tomography guided management of interfractional patient variation. Semin Radiat Oncol. 2005; 15(3): 168–179.
- Brouwer CL, Steenbakkers RJ, Langendijk JA, et al. Identifying patients who may benefit from adaptive radiotherapy: Does the literature on anatomic and dosimetric changes in head and neck organs at risk during radiotherapy provide information to help? Radiother Oncol. 2015; 115(3): 285–294.
- Böck M. On adaptation cost and tractability in robust adaptive radiation therapy optimization. Med Phys. 2020; 47(7): 2791–2804.
- Green OL, Henke LE, Hugo GD. Practical Clinical Workflows for Online and Offline Adaptive Radiation Therapy. Semin Radiat Oncol. 2019; 29(3): 219–227.
- Bhide SA, Davies M, Burke K, et al. 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. 2010; 76(5): 1360–1368.
- Mnejja W, Daoud H, Fourati N, et al. Dosimetric impact on changes in target volumes during intensity-modulated radiotherapy for nasopharyngeal carcinoma. Rep Pract Oncol Radiother. 2020; 25(1): 41–45.
- Ahn 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. 2011; 80(3): 677–685.
- Castadot P, Geets X, Lee JA, et al. Adaptive functional image-guided IMRT in pharyngo-laryngeal squamous cell carcinoma: is the gain in dose distribution worth the effort? Radiother Oncol. 2011; 101(3): 343–350.
- O'Daniel JC, Garden AS, Schwartz DL, et al. Parotid gland dose in intensity-modulated radiotherapy for head and neck cancer: is what you plan what you get? Int J Radiat Oncol Biol Phys. 2007; 69(4): 1290–1296.
- Wu Q, Chi Y, Chen PY, et al. Adaptive replanning strategies accounting for shrinkage in head and neck IMRT. Int J Radiat Oncol Biol Phys. 2009; 75(3): 924–932.
- Breedveld S, Storchi PRM, Voet PWJ, et al. iCycle: Integrated, multicriterial beam angle, and profile optimization for generation of coplanar and noncoplanar IMRT plans. Med Phys. 2012; 39(2): 951–963.
- Ventura T, Rocha H, da Costa Ferreira B, et al. Comparison of two beam angular optimization algorithms guided by automated multicriterial IMRT. Phys Med. 2019; 64: 210–221.
- Ventura T, Lopes M, Ferreira B, et al. SPIDERplan: A tool to support decision-making in radiation therapy treatment plan assessment. Rep Pract Oncol Radiother. 2016; 21(6): 508–516.
- Zhang P, Simon A, Rigaud B, et al. Optimal adaptive IMRT strategy to spare the parotid glands in oropharyngeal cancer. Radiother Oncol. 2016; 120(1): 41–47.
- Castelli J, Simon A, Rigaud B, et al. Adaptive radiotherapy in head and neck cancer is required to avoid tumor underdose. Acta Oncol. 2018; 57(9): 1267–1270.
- Hansen EK, Bucci MK, Quivey JM, et al. Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2006; 64(2): 355–362.
- Chitapanarux I, Chomprasert K, Nobnaop W, et al. A dosimetric comparison of two-phase adaptive intensity-modulated radiotherapy for locally advanced nasopharyngeal cancer. J Radiat Res. 2015; 56(3): 529–538.
- Breedveld S, Craft D, Haveren Rv, et al. Multi-criteria optimization and decision-making in radiotherapy. Eur J Operat Res. 2019; 277(1): 1–19.
- Batumalai V, Jameson MG, Forstner DF, et al. How important is dosimetrist experience for intensity modulated radiation therapy? A comparative analysis of a head and neck case. Pract Radiat Oncol. 2013; 3(3): e99–e9e106.