This prospective study of weekly CT scanning and plan adaption during H&N IMRT reports on the frequency of plan adaptations based on dosimetric differences between original and re-optimised IMRT plans. The volumetric and geometric change occurring in target volumes and salivary glands is also described. Ten H&N cancer patients underwent weekly planning CT imaging and re-optimisation of the IMRT plan if PTV or OAR coverage was unacceptable. Comparisons of PTV and parotid gland dosimetry between the original and adaptive plans were made. Parotid and submandibular gland volume changes and shift were calculated. Eight of ten patients required one or more plan adaptations, with 41% of adaptations occurring by fraction ten. Salivary glands reduced in volume, with a medial shift of the lateral border of the parotid gland and a superior shift of the submandibular gland. Change in PTV coverage did not correlate with weight loss or nutritional score. Inadequate PTV coverage, requiring plan adaptation, occurs early in the course of IMRT. A weekly Adaptive RT (ART) protocol results in significant improvement of PTV coverage. Implementation of a clinical ART protocol should include imaging and dose calculation within the first ten fractions.
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Ezzell GA et al (2003) Guidance document on delivery, treatment planning, and clinical implementation of IMRT: report of the IMRT subcommittee of the AAPM radiation therapy committee. Med Phys 30(8):2089
Barker JL Jr et al (2004) 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 59(4):960–970
Hansen EK, Bucci MK, Quivey JM, Weinberg V, Xia P (2006) Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer. Int J Radiat Oncol 64(2):355–362
Ahn PH et al (2011) Adaptive planning in intensity-modulated radiation therapy for head and neck cancers: single-institution experience and clinical implications. Int J Radiat Oncol 80(3):677–685
Cheng HCY et al (2012) A prospective study on volumetric and dosimetric changes during intensity-modulated radiotherapy for nasopharyngeal carcinoma patients. Radiother Oncol 104(3):317–323
Bando R et al (2013) Changes of tumor and normal structures of the neck during radiation therapy for head and neck cancer requires adaptive strategy. J Med Invest 60(1.2):46–51
Brouwer CL, Steenbakkers RJHM, Langendijk JA, Sijtsema NM (2015) 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 115(3):285–294
Ricchetti F et al (2011) Volumetric change of selected organs at risk during IMRT for oropharyngeal cancer. Int J Radiat Oncol 80(1):161–168
Bhide SA et al (2010) 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 76(5):1360–1368
Bhandari V, Patel P, Gurjar O, Gupta K (2014) Impact of repeat computerized tomography replans in the radiation therapy of head and neck cancers. J Med Phys 39(3):164
Deasy JO, Moiseenko V, Marks L, Chao KC, Nam J, Eisbruch A (2010) Radiotherapy dose-volume effects on salivary gland function. Int J Radiat Oncol Biol Phys 76(3):S58–S63
Rancati T et al (2010) Radiation dose–volume effects in the larynx and pharynx. Int J Radiat Oncol Biol Phys 76(3):S64–S69
Dornfeld K et al (2007) Radiation doses to structures within and adjacent to the larynx are correlated with long-term diet- and speech-related quality of life. Int J Radiat Oncol 68(3):750–757
Lin A, Kim HM, Terrell JE, Dawson LA, Ship JA, Eisbruch A (2003) Quality of life after parotid-sparing IMRT for head-and-neck cancer: a prospective longitudinal study. Int J Radiat Oncol 57(1):61–70
Castadot P, Lee JA, Geets X, Grégoire V (2010) Adaptive radiotherapy of head and neck cancer. Semin Radiat Oncol 20:84–93
Zhao L, Wan Q, Zhou Y, Deng X, Xie C, Wu S (2011) The role of replanning in fractionated intensity modulated radiotherapy for nasopharyngeal carcinoma. Radiother Oncol 98(1):23–27
Zhang P et al (2016) Optimal adaptive IMRT strategy to spare the parotid glands in oropharyngeal cancer. Radiother Oncol 120(1):41–47
Wang X et al (2010) Anatomic and dosimetric changes during the treatment course of intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma. Med Dosim 35(2):151–157
Schwartz DL et al (2012) Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial. Int J Radiat Oncol 83(3):986–993
Wu Q, Chi Y, Chen PY, Krauss DJ, Yan D, Martinez A (2009) Adaptive replanning strategies accounting for shrinkage in head and neck IMRT. Int J Radiat Oncol 75(3):924–932
Nishi T, Nishimura Y, Shibata T, Tamura M, Nishigaito N, Okumura M (2013) Volume and dosimetric changes and initial clinical experience of a two-step adaptive intensity modulated radiation therapy (IMRT) scheme for head and neck cancer. Radiother Oncol 106(1):85–89
Yang H, Hu W, Wang W, Chen P, Ding W, Luo W (Jan. 2013) Replanning during intensity modulated radiation therapy improved quality of life in patients with nasopharyngeal carcinoma. Int J Radiat Oncol 85(1):e47–e54
Chen AM, Daly ME, Cui J, Mathai M, Benedict S, Purdy JA (2014) Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning: adaptive replanning for head and neck cancer. Head Neck 36(11):1541–1546
Wang W et al (2010) Clinical study of the necessity of replanning before the 25th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Int J Radiat Oncol 77(2):617–621
Zhang X et al (2012) Dosimetric variations of target volumes and organs at risk in nasopharyngeal carcinoma intensity-modulated radiotherapy. Br J Radiol 85(1016):e506–e513
Brown E et al (2015) Predicting the need for adaptive radiotherapy in head and neck cancer. Radiother Oncol 116(1):57–63
Fiorentino A et al (2012) Parotid gland volumetric changes during intensity-modulated radiotherapy in head and neck cancer. Br J Radiol 85(1018):1415–1419
Huang H et al (2015) Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy. Radiat Oncol 10(1):192
Grégoire V et al (2003) CT-based delineation of lymph node levels and related CTVs in the node-negative neck: DAHANCA, EORTC, GORTEC, NCIC,RTOG consensus guidelines. Radiother Oncol 69(3):227–236
International Commission on Radiation Units and Measurements (1999) ICRU Report 62: prescribing, recording and reporting photon beam therapy (Supplement to ICRU Report 50). ICRU, Bethesda
Bauer JD et al (2006) Evidence based practice guidelines for the nutritional management of cancer cachexia. Nutr Diet 63(s2):S3–S32
Castelli J et al (2015) Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia. Radiat Oncol 10(1):6
Delana A et al (2009) Impact of residual setup error on parotid gland dose in intensity-modulated radiation therapy with or without planning organ-at-risk margin. Strahlenther Onkol 185(7):453–459
Lee C et al. (2008) Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration. Int J Radiat Oncol 71(5):1563–1571
Hamming-Vrieze O et al (2017) Analysis of GTV reduction during radiotherapy for oropharyngeal cancer: implications for adaptive radiotherapy. Radiother Oncol 122(2):224–228
Budach W et al (2011) Evaluation of time, attendance of medical staff, and resources during radiotherapy for head and neck cancer patients: the DEGRO-QUIRO trial. Strahlenther Onkol 187(8):449–460
Castelli J et al (2016) A Nomogram to predict parotid gland overdose in head and neck IMRT. Radiat Oncol 11(1):79
Bissonnette J-P et al (2012) Quality assurance for image-guided radiation therapy utilizing CT-based technologies: a report of the AAPM TG-179: QA for image-guided radiation therapy utilizing CT-based technologies. Med Phys 39(4):1946–1963
Boda-Heggemann J, Lohr F, Wenz F, Flentje M, Guckenberger M (2011) kV Cone-Beam CT-Based IGRT: a clinical review. Strahlenther Onkol 187(5):284–291
Ho KF et al (2012) Monitoring dosimetric impact of weight loss with kilovoltage (KV) cone beam CT (CBCT) during parotid-sparing IMRT and concurrent chemotherapy. Int J Radiat Oncol 82(3):e375–e382
Peroni M et al (2012) Automatic segmentation and Online virtualCT in head-and-neck adaptive radiation therapy. Int J Radiat Oncol 84(3):e427–e433
Anthony Arnold, Justin Dixon and Stephen Jones for planning assistance throughout the study, Michael Bailey for data management assistance and Lois Holloway for strategic guidance. This research has been conducted with the support of the Australian Government Research Training Program Scholarship.
Conflict of interest
The authors declare that they have no conflict of interest.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
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Aly, F., Miller, A.A., Jameson, M.G. et al. A prospective study of weekly intensity modulated radiation therapy plan adaptation for head and neck cancer: improved target coverage and organ at risk sparing. Australas Phys Eng Sci Med 42, 43–51 (2019). https://doi.org/10.1007/s13246-018-0707-y
- Adaptive radiotherapy
- Head and neck cancer
- Intensity-modulated radiotherapy
- Anatomic change