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Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges

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Abstract

Modern radiation therapy techniques are characterized by high conformality to tumor volumes and steep dose gradients to spare normal organs. These techniques require accurate clinical target volume definitions and rigorous assessment of set up uncertainties using image guidance, a concept called image-guided radiation therapy. Due to alteration of patient anatomy, changes in tissue density/volumes and tumor shrinkage over the course of treatment, treatment accuracy may be challenged. This may result in excessive irradiation of organs at risk/healthy tissues and undercoverage of target volumes with a significant risk of locoregional failure. Adaptive radiation therapy (ART) is a concept allowing the clinician to reconsider the planned dose based on potential changes to accurately delivering the remaining radiation dose to the tumor while optimally minimizing irradiation of healthy tissues. There is little consensus on how to apply this concept in clinical practice. The current review investigates the current ART issues, including patient selection, clinical/dosimetric criteria and timing for re-planning, and practical technical issues. A practical algorithm is proposed for patient management in cases where ART is required.

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Author information

Authors and Affiliations

  1. Oncology Radiotherapy, Centre Henri Becquerel, Rouen, France

    Ovidiu Veresezan

  2. Oncology Radiotherapy Pitié Salepêtrière, 47-83 boulevard de l’Hôpital, 75013, Paris, France

    Idriss Troussier

  3. Centre d’imagerie Médicale, 47, Boulevard du Pont Rouge, 15000, Aurillac, France

    Alexis Lacout

  4. Medical Oncology Radiotherapy, Georges Pompidou European Hospital, Paris Descartes University, Paris, France

    Sarah Kreps

  5. Department Head and Neck, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307-59020, Lille Cedex, France

    Sophie Maillard

  6. Saint Michel Centre, Rue du Dr Schweitzer, 17000, La Rochelle, France

    Aude Toulemonde

  7. Department of Radiology, Centre Lacassagne, 33 Av de la Lanterne, 06189, Nice, France

    Pierre-Yves Marcy

  8. CHU Tenon, 75020, Paris, France

    Florence Huguet

  9. Department of Radiation Oncology/Institut Universitaire de la Face et du Cou-Cancer Centre Antoine-Lacassagne, University Nice Sophia-Antipolis, 33 Av. Valombrose, 06189, Nice Cedex 2, France

    Juliette Thariat

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  1. Ovidiu Veresezan
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  9. Juliette Thariat
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Correspondence to Alexis Lacout.

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The authors have no financial conflict of interest and hereby waive their copyright.

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Veresezan, O., Troussier, I., Lacout, A. et al. Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges. Jpn J Radiol 35, 43–52 (2017). https://doi.org/10.1007/s11604-016-0604-9

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  • DOI: https://doi.org/10.1007/s11604-016-0604-9

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