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A prospective study of weekly intensity modulated radiation therapy plan adaptation for head and neck cancer: improved target coverage and organ at risk sparing

Abstract

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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Acknowledgements

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.

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Correspondence to F. Aly.

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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

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Keywords

  • Adaptive radiotherapy
  • Head and neck cancer
  • Intensity-modulated radiotherapy
  • Anatomic change
  • Dosimetry