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Dosimetric changes achieved and changes in target and parotid volumes in patients undergoing adaptive planning during chemoradiation therapy with helical delivery of treatment

Published online by Cambridge University Press:  03 June 2019

Michael A. Cummings Open the ORCID record for Michael A. Cummings [Opens in a new window] ,
Paul Youn ,
Rami Abu-Aita ,
Amy Herman ,
Mary Z. Hare ,
Hong Zhang ,
Yuhchyau Chen  and
Deepinder P. Singh
Michael A. Cummings*
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Paul Youn
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Rami Abu-Aita
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Amy Herman
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Mary Z. Hare
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Hong Zhang
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Yuhchyau Chen
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
Deepinder P. Singh
Affiliation:
Department of Radiation Oncology, University of Rochester Medical Center, Rochester, NY, USA
*
Author for correspondence: Michael A. Cummings, Department of Radiation Oncology, University of Rochester Medical Center, 601 Elmwood Ave Box 647, Rochester, NY 14642, USA. Tel: 585-276-3245. Fax: 585-275-1531. E-mail: michael_cummings@urmc.rochester.edu
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Abstract

Aim:

Re-planning mid-treatment, with the adjustment of target volumes, has been performed as part of the normal workflow at our institution. We sought to quantify the benefit of this approach and identify factors to optimise plan adaptive strategies.

Materials and methods:

Patients with locally advanced oropharyngeal cancer treated to 70 Gy with concurrent chemoradiation (CCRT) on TomoTherapy® who underwent re-planning during the treatment were eligible. Survival and prognostic factors were evaluated with Kaplan–Meier and Cox proportional hazards, two-side p-value <0·05 significant.

Results:

Forty-two patients were identified with Stage III (n = 5), IVA (n = 34) and IVB (n = 3) [AJCC 7th] disease. Median re-planning dose was 40 Gy (14–60 Gy). Median change in mean total parotid dose was reduction of 1 Gy (range –7·5 Gy to +13·9 Gy). The volume of PTV70 and PTV60 receiving 99% of the prescribed (V99) dose was increased by 2·2% (–3·3 to +16·6%) and 1·9% (–11·5 to +12·6%) by re-planning. As a continuous variable, increasing per cent nodal regression was associated with the improved disease control in a multivariate model including stage, pack years smoking and human papilloma viral (HPV) status (HR: 0·85, 0·71–0·99, p = 0·05).

Findings:

Adaptive planning generates a superior plan for the majority of patients, but there is modest overall parotid gland sparing.

Keywords

plan adaptivetomotherapyhead and neck cancer
Type
Original Article
Information
Journal of Radiotherapy in Practice , Volume 18 , Issue 4 , December 2019 , pp. 329 - 335
Copyright
© Cambridge University Press 2019 

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