PURPOSE: To conduct a clinical trial evaluating adaptive head and neck radiotherapy (ART). METHODS: Patients with locally advanced oropharyngeal cancer were prospectively enrolled. Daily CT-guided setup and deformable image registration permitted mapping of dose to avoidance structures and CTVs. We compared four planning scenarios: (1) original IMRT plan aligned daily to marked isocenter (BB); (2) original plan aligned daily to bone (IGRT); (3) IGRT with one adaptive replan (ART1); and (4) actual treatment received by each study patient (IGRT with one or two adaptive replans, ART2). RESULTS: All 22 study patients underwent one replan (ART1); eight patients had two replans (ART2). ART1 reduced mean dose to contralateral parotid by 0.6 Gy or 2.8% (paired t-test; p=0.003) and ipsilateral parotid by 1.3 Gy (3.9%) (p=0.002) over the IGRT alone. ART2 further reduced the mean contralateral parotid dose by 0.8 Gy or 3.8% (p=0.026) and ipsilateral parotid by 4.1 Gy or 9% (p=0.001). ART significantly reduced integral body dose. CONCLUSIONS: This pilot trial suggests that head and neck ART dosimetrically outperforms IMRT. IGRT that leverages conventional PTV margins does not improve dosimetry. One properly timed replan delivers the majority of achievable dosimetric improvement. The clinical impact of ART must be confirmed by future trials.
PURPOSE: To conduct a clinical trial evaluating adaptive head and neck radiotherapy (ART). METHODS:Patients with locally advanced oropharyngeal cancer were prospectively enrolled. Daily CT-guided setup and deformable image registration permitted mapping of dose to avoidance structures and CTVs. We compared four planning scenarios: (1) original IMRT plan aligned daily to marked isocenter (BB); (2) original plan aligned daily to bone (IGRT); (3) IGRT with one adaptive replan (ART1); and (4) actual treatment received by each study patient (IGRT with one or two adaptive replans, ART2). RESULTS: All 22 study patients underwent one replan (ART1); eight patients had two replans (ART2). ART1 reduced mean dose to contralateral parotid by 0.6 Gy or 2.8% (paired t-test; p=0.003) and ipsilateral parotid by 1.3 Gy (3.9%) (p=0.002) over the IGRT alone. ART2 further reduced the mean contralateral parotid dose by 0.8 Gy or 3.8% (p=0.026) and ipsilateral parotid by 4.1 Gy or 9% (p=0.001). ART significantly reduced integral body dose. CONCLUSIONS: This pilot trial suggests that head and neck ART dosimetrically outperforms IMRT. IGRT that leverages conventional PTV margins does not improve dosimetry. One properly timed replan delivers the majority of achievable dosimetric improvement. The clinical impact of ART must be confirmed by future trials.
Authors: Michael Baumann; Mechthild Krause; Jens Overgaard; Jürgen Debus; Søren M Bentzen; Juliane Daartz; Christian Richter; Daniel Zips; Thomas Bortfeld Journal: Nat Rev Cancer Date: 2016-03-18 Impact factor: 60.716
Authors: Brigid A McDonald; Sastry Vedam; Jinzhong Yang; Jihong Wang; Pamela Castillo; Belinda Lee; Angela Sobremonte; Sara Ahmed; Yao Ding; Abdallah S R Mohamed; Peter Balter; Neil Hughes; Daniela Thorwarth; Marcel Nachbar; Marielle E P Philippens; Chris H J Terhaard; Daniel Zips; Simon Böke; Musaddiq J Awan; John Christodouleas; Clifton D Fuller Journal: Int J Radiat Oncol Biol Phys Date: 2020-12-16 Impact factor: 7.038
Authors: Julie Schatteman; Dirk Van Gestel; Dieter Berwouts; Werner De Gersem; Geert De Kerf; Wilfried De Neve; Bie De Ost; Ana Maria Luiza Olteanu; Sylvie Rottey; Tom Vercauteren; Ingeborg Goethals; Fréderic Duprez Journal: Strahlenther Onkol Date: 2018-03-19 Impact factor: 3.621