In Silico Analysis of Adjuvant Head and Neck Online Adaptive Radiation Therapy

Overview

Journal Adv Radiat Oncol

Specialty Oncology

Date 2024 Jan 23

PMID 38260220

Authors

Sean All

Xinran Zhong

Byongsu Choi

Jin Sung Kim

Tingliang Zhuang

Vladimir Avkshtol

David Sher

Mu-Han Lin

Dominic H Moon

Affiliations

Soon will be listed here.

Abstract

Purpose: Recently developed online adaptive radiation therapy (OnART) systems enable frequent treatment plan adaptation, but data supporting a dosimetric benefit in postoperative head and neck radiation therapy (RT) are sparse. We performed an in silico dosimetric study to assess the potential benefits of a single versus weekly OnART in the treatment of patients with head and neck squamous cell carcinoma in the adjuvant setting.

Methods And Materials: Twelve patients receiving conventionally fractionated RT over 6 weeks and 12 patients receiving hypofractionated RT over 3 weeks on a clinical trial were analyzed. The OnART emulator was used to virtually adapt either once midtreatment or weekly based on the patient's routinely performed cone beam computed tomography. The planning target volume (PTV) coverage, dose heterogeneity, and cumulative dose to the organs at risk for these 2 adaptive approaches were compared with the nonadapted plan.

Results: In total, 13, 8, and 3 patients had oral cavity, oropharynx, and larynx primaries, respectively. In the conventionally fractionated RT cohort, weekly OnART led to a significant improvement in PTV V100% coverage (6.2%), hot spot (-1.2 Gy), and maximum cord dose (-3.1 Gy), whereas the mean ipsilateral parotid dose increased modestly (1.8 Gy) versus the nonadapted plan. When adapting once midtreatment, PTV coverage improved with a smaller magnitude (0.2%-2.5%), whereas dose increased to the ipsilateral parotid (1.0-1.1 Gy) and mandible (0.2-0.7 Gy). For the hypofractionated RT cohort, similar benefit was observed with weekly OnART, including significant improvement in PTV coverage, hot spot, and maximum cord dose, whereas no consistent dosimetric advantage was seen when adapting once midtreatment.

Conclusions: For head and neck squamous cell carcinoma adjuvant RT, there was a limited benefit of single OnART, but weekly adaptations meaningfully improved the dosimetric criteria, predominantly PTV coverage and dose heterogeneity. A prospective study is ongoing to determine the clinical benefit of OnART in this setting.

Citing Articles

Solution for the External Contour Changes in Cone Beam Computed Tomography-Guided On-demand Online Adaptive Radiotherapy for a Patient With Very Advanced Head and Neck Cancer: A Technical Case Report.

Wang J, Dai X, Qu B, Yan C, Kou Y, Liu X Cureus. 2024; 16(8):e67804.

PMID: 39328634 PMC: 11424223. DOI: 10.7759/cureus.67804.

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