Adaptive Radiotherapy for Head-and-neck Cancer: Initial Clinical Outcomes from a Prospective Trial

Overview

Journal Int J Radiat Oncol Biol Phys

Specialties Oncology
Radiology

Date 2011 Dec 6

PMID 22138459

Citations 102

Authors

David L Schwartz

Adam S Garden

Jimmy Thomas

Yipei Chen

Yongbin Zhang

Jan Lewin

Mark S Chambers

Lei Dong

Affiliations

Soon will be listed here.

Abstract

Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma.

Methods And Materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy.

Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated.

Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

Citing Articles

A systematic review of the role of artificial intelligence in automating computed tomography-based adaptive radiotherapy for head and neck cancer.

Mastella E, Calderoni F, Manco L, Ferioli M, Medoro S, Turra A Phys Imaging Radiat Oncol. 2025; 33:100731.

PMID: 40026912 PMC: 11871500. DOI: 10.1016/j.phro.2025.100731.

Conference Report: Review of Clinical Implementation of Advanced Quantitative Imaging Techniques for Personalized Radiotherapy.

Vinogradskiy Y, Bahig H, Bucknell N, Buchsbaum J, Shu H Tomography. 2024; 10(11):1798-1813.

PMID: 39590941 PMC: 11598114. DOI: 10.3390/tomography10110132.

CT-guided online adaptive stereotactic body radiotherapy for pancreas ductal adenocarcinoma: Dosimetric and initial clinical experience.

Lee A, Pasetsky J, Lavrova E, Wang Y, Sedor G, Li F Clin Transl Radiat Oncol. 2024; 48:100813.

PMID: 39149753 PMC: 11324999. DOI: 10.1016/j.ctro.2024.100813.

Does adaptive radiotherapy for head and neck cancer favorably impact dosimetric, clinical, and toxicity outcomes?: A review.

Simopoulou F, Kyrgias G, Georgakopoulos I, Avgousti R, Armpilia C, Skarlos P Medicine (Baltimore). 2024; 103(26):e38529.

PMID: 38941415 PMC: 11466102. DOI: 10.1097/MD.0000000000038529.

Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view.

Nuyts S, Bollen H, Eisbruch A, Strojan P, Mendenhall W, Ng S Cancer Med. 2024; 13(8):e7192.

PMID: 38650546 PMC: 11036082. DOI: 10.1002/cam4.7192.

References

Lee N, Harris J, Garden A, Straube W, Glisson B, Xia P . Intensity-modulated radiation therapy with or without chemotherapy for nasopharyngeal carcinoma: radiation therapy oncology group phase II trial 0225. J Clin Oncol. 2009; 27(22):3684-90. PMC: 2720082. DOI: 10.1200/JCO.2008.19.9109. View

Wu Q, Chi Y, Chen P, Krauss D, Yan D, Martinez A . Adaptive replanning strategies accounting for shrinkage in head and neck IMRT. Int J Radiat Oncol Biol Phys. 2009; 75(3):924-32. DOI: 10.1016/j.ijrobp.2009.04.047. View

Feng F, Kim H, Lyden T, Haxer M, Feng M, Worden F . Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007; 68(5):1289-98. DOI: 10.1016/j.ijrobp.2007.02.049. View

Zhang L, Garden A, Lo J, Ang K, Ahamad A, Morrison W . Multiple regions-of-interest analysis of setup uncertainties for head-and-neck cancer radiotherapy. Int J Radiat Oncol Biol Phys. 2006; 64(5):1559-69. DOI: 10.1016/j.ijrobp.2005.12.023. View

Wang H, Garden A, Zhang L, Wei X, Ahamad A, Kuban D . Performance evaluation of automatic anatomy segmentation algorithm on repeat or four-dimensional computed tomography images using deformable image registration method. Int J Radiat Oncol Biol Phys. 2008; 72(1):210-9. PMC: 2593788. DOI: 10.1016/j.ijrobp.2008.05.008. View

van Kranen S, van Beek S, Rasch C, Van Herk M, Sonke J . Setup uncertainties of anatomical sub-regions in head-and-neck cancer patients after offline CBCT guidance. Int J Radiat Oncol Biol Phys. 2009; 73(5):1566-73. DOI: 10.1016/j.ijrobp.2008.11.035. View

Rosenthal D, Chambers M, Fuller C, Rebueno N, Garcia J, Kies M . Beam path toxicities to non-target structures during intensity-modulated radiation therapy for head and neck cancer. Int J Radiat Oncol Biol Phys. 2008; 72(3):747-55. PMC: 9627578. DOI: 10.1016/j.ijrobp.2008.01.012. View

Jaffray D, Siewerdsen J, Wong J, Martinez A . Flat-panel cone-beam computed tomography for image-guided radiation therapy. Int J Radiat Oncol Biol Phys. 2002; 53(5):1337-49. DOI: 10.1016/s0360-3016(02)02884-5. View

de Arruda F, Puri D, Zhung J, Narayana A, Wolden S, Hunt M . Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 2005; 64(2):363-73. DOI: 10.1016/j.ijrobp.2005.03.006. View

10.

Clark C, Miles E, Urbano M, Bhide S, Bidmead A, Harrington K . Pre-trial quality assurance processes for an intensity-modulated radiation therapy (IMRT) trial: PARSPORT, a UK multicentre Phase III trial comparing conventional radiotherapy and parotid-sparing IMRT for locally advanced head and neck cancer. Br J Radiol. 2009; 82(979):585-94. DOI: 10.1259/bjr/31966505. View

11.

Eisbruch A, Harris J, Garden A, Chao C, Straube W, Harari P . Multi-institutional trial of accelerated hypofractionated intensity-modulated radiation therapy for early-stage oropharyngeal cancer (RTOG 00-22). Int J Radiat Oncol Biol Phys. 2009; 76(5):1333-8. PMC: 2846217. DOI: 10.1016/j.ijrobp.2009.04.011. View

12.

Eisbruch A, Levendag P, Feng F, Teguh D, Lyden T, Schmitz P . Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007; 69(2 Suppl):S40-2. PMC: 2801073. DOI: 10.1016/j.ijrobp.2007.04.083. View

13.

Garden A, Morrison W, Wong P, Tung S, Rosenthal D, Dong L . Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006; 67(2):438-44. PMC: 4125020. DOI: 10.1016/j.ijrobp.2006.08.078. View

14.

Wang H, Dong L, ODaniel J, Mohan R, Garden A, Ang K . Validation of an accelerated 'demons' algorithm for deformable image registration in radiation therapy. Phys Med Biol. 2005; 50(12):2887-905. DOI: 10.1088/0031-9155/50/12/011. View

15.

Yao M, Karnell L, Funk G, Lu H, Dornfeld K, Buatti J . Health-related quality-of-life outcomes following IMRT versus conventional radiotherapy for oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2007; 69(5):1354-60. DOI: 10.1016/j.ijrobp.2007.05.003. View

16.

Barker Jr J, Garden A, Ang K, ODaniel J, Wang H, Court L . 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):960-70. DOI: 10.1016/j.ijrobp.2003.12.024. View

17.

Overgaard J, Sand Hansen H, Specht L, Overgaard M, Grau C, Andersen E . Five compared with six fractions per week of conventional radiotherapy of squamous-cell carcinoma of head and neck: DAHANCA 6 and 7 randomised controlled trial. Lancet. 2003; 362(9388):933-40. DOI: 10.1016/s0140-6736(03)14361-9. View

18.

Hansen E, Bucci M, Quivey J, Weinberg V, Xia P . Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005; 64(2):355-62. DOI: 10.1016/j.ijrobp.2005.07.957. View

19.

ODaniel J, Garden A, Schwartz D, Wang H, Ang K, Ahamad A . 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):1290-6. PMC: 2288571. DOI: 10.1016/j.ijrobp.2007.07.2345. View

20.

Schubert L, Westerly D, Tome W, Mehta M, Soisson E, Mackie T . A comprehensive assessment by tumor site of patient setup using daily MVCT imaging from more than 3,800 helical tomotherapy treatments. Int J Radiat Oncol Biol Phys. 2009; 73(4):1260-9. PMC: 2749998. DOI: 10.1016/j.ijrobp.2008.11.054. View