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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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References

Wu, Q, Chi, Y, Chen, PY, et al. Adaptive replanning strategies accounting for shrinkage in head and neck IMRT. Int J Radiat Oncol Biol Phys 2009; 75: 924–932.10.1016/j.ijrobp.2009.04.047CrossRefGoogle ScholarPubMed
Castelli, J, Simon, A, Louvel, G, et al. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia. Radiat Oncol 2015; 10: 6.10.1186/s13014-014-0318-zCrossRefGoogle ScholarPubMed
Ahn, PH, Chen, CC, Ahn, AI, et al. Adaptive planning in intensity-modulated radiation therapy for head and neck cancers: single-institution experience and clinical implications. Int J Radiat Oncol Biol Phys 2011; 80: 677–685.10.1016/j.ijrobp.2010.03.014CrossRefGoogle ScholarPubMed
Hunter, KU, Fernandes, LL, Vineberg, KA, et al. Parotid glands dose-effect relationships based on their actually delivered doses: implications for adaptive replanning in radiation therapy of head-and-neck cancer. Int J Radiat Oncol Biol Phys 2013; 87: 676–682.10.1016/j.ijrobp.2013.07.040CrossRefGoogle ScholarPubMed
Van Kranen, S, Hamming-Vrieze, O, Sonke, J, et al. Head and neck margin reduction with adaptive radiation therapy: robustness of treatment plans against anatomy changes. Int J Radiat Oncol Biol Phys 2016; 96: 653–660.10.1016/j.ijrobp.2016.07.011CrossRefGoogle ScholarPubMed
Liu, Q, Liang, J, Yan, D, et al. Dosimetric evaluation of incorporating patient geometric variations into adaptive plan optimization through probabilistic treatment planning in head and neck cancers. Int J Radiat Oncol Biol Phys 2018; 101: 985–997.10.1016/j.ijrobp.2018.03.062CrossRefGoogle ScholarPubMed
Surucu, M, Shah, KK, Roeske, JC, Choi, M, Small, W, Emami, B. Adaptive radiotherapy for head and neck cancer: implications for clinical and dosimetry outcomes. Technol Cancer Res Treat 2017; 16 (2): 218–223. doi: 10.1177/1533034616662165.CrossRefGoogle Scholar
Gros, SA, Xu, W, Surucu, M, et al. A novel surrogate to identify anatomical changes during radiotherapy of head and neck cancer patients. Med Phys 2017; 44: 924–934.10.1002/mp.12067CrossRefGoogle ScholarPubMed
Ho, F, Marchant, T, Slevin, N, et al. Monitoring dosimetric impact of weight loss with kilovoltage (kV) cone beam CT (CBCT) during parotid-sparing IMRT and concurrent chemotherapy. Int J Radiat Oncol Biol Phys 2012; 82: e375–e382.10.1016/j.ijrobp.2011.07.004CrossRefGoogle ScholarPubMed
Lee, IK, Koom, W, Cha, I, et al. Risk factors and dose–effect relationship for mandibular osteoradionecrosis in oral and oropharyngeal cancer patients. Int J Radiat Oncol Biol Phys 2009; 75: 1084–1091.10.1016/j.ijrobp.2008.12.052CrossRefGoogle ScholarPubMed
Sanguineti, G, Ricchetti, F, Wu, B, et al. Volumetric change of human papillomavirus-related neck lymph nodes before, during, and shortly after intensity-modulated radiation therapy. Head Neck 2012; 34: 1640–1647.10.1002/hed.21981CrossRefGoogle ScholarPubMed
Chera, BS, Amdur, RJ, Tepper, J, et al. Phase 2 trial of de-intensified chemoradiation therapy for favorable-risk human papillomavirus-associated oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys 2015; 93: 976–985.10.1016/j.ijrobp.2015.08.033CrossRefGoogle ScholarPubMed
Marur, S, Li, S, Cmelak, AJ, et al. E1308: a phase II trial of induction chemotherapy followed by reduced-dose radiation and weekly cetuximab in patients with HPV-associated resectable squamous cell carcinoma of the oropharynx—ECOG-ACRIN Cancer Research Group. J Clin Oncol 2017; 35: 490–497.10.1200/JCO.2016.68.3300CrossRefGoogle ScholarPubMed
Chen, A, Felix, C, Wang, P, et al. Reduced-dose radiotherapy for human papillomavirus-associated squamous-cell carcinoma of the oropharynx: a single-arm, phase 2 study. Lancet Oncol 2017; 18: 803–811.10.1016/S1470-2045(17)30246-2CrossRefGoogle ScholarPubMed
Lee, N, Chan, K, Bekelman, JE, et al. Salvage re-irradiation for recurrent head and neck cancer. Int J Radiat Oncol Biol Phys 2007; 68: 731–740.10.1016/j.ijrobp.2006.12.055CrossRefGoogle ScholarPubMed
Kostrzewa, JP, Lancaster, WP, Iseli, TA, et al. Outcomes of salvage surgery with free flap reconstruction for recurrent oral and oropharyngeal cancer. Laryngoscope 2010; 120: 267–272.Google ScholarPubMed
Tan, HK, Giger, R, Auperin, A, et al. Salvage surgery after concomitant chemoradiation in head and neck squamous cell carcinomas - stratification for postsalvage survival. Head Neck 2010; 32: 139–147.Google ScholarPubMed