Adaptive planning in intensity-modulated radiation therapy for head and neck cancers: Single-institution experience and clinical implications

Peter H. Ahn, Chin Cheng Chen, Andrew I. Ahn, Linda Hong, Paola G. Scripes, Jin Shen, Chen Chiao Lee, Ekeni Miller, Shalom Kalnicki, Madhur K. Garg

Research output: Contribution to journalArticle

68 Citations (Scopus)

Abstract

Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

Original languageEnglish (US)
Pages (from-to)677-685
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume80
Issue number3
DOIs
StatePublished - Jul 1 2011

Fingerprint

Head and Neck Neoplasms
planning
radiation therapy
Radiotherapy
tomography
cancer
Tomography
Tumor Burden
tumors
Image-Guided Radiotherapy
Organs at Risk
Patient Positioning
dosage
spinal cord
skull
spine
avoidance
anatomy
Mandible
Skull

Keywords

  • Anatomic change
  • Dosimetry
  • Head-and-neck tumor
  • Positional change
  • Radiotherapy

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Adaptive planning in intensity-modulated radiation therapy for head and neck cancers : Single-institution experience and clinical implications. / Ahn, Peter H.; Chen, Chin Cheng; Ahn, Andrew I.; Hong, Linda; Scripes, Paola G.; Shen, Jin; Lee, Chen Chiao; Miller, Ekeni; Kalnicki, Shalom; Garg, Madhur K.

In: International Journal of Radiation Oncology Biology Physics, Vol. 80, No. 3, 01.07.2011, p. 677-685.

Research output: Contribution to journalArticle

Ahn, Peter H. ; Chen, Chin Cheng ; Ahn, Andrew I. ; Hong, Linda ; Scripes, Paola G. ; Shen, Jin ; Lee, Chen Chiao ; Miller, Ekeni ; Kalnicki, Shalom ; Garg, Madhur K. / Adaptive planning in intensity-modulated radiation therapy for head and neck cancers : Single-institution experience and clinical implications. In: International Journal of Radiation Oncology Biology Physics. 2011 ; Vol. 80, No. 3. pp. 677-685.
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AU - Shen, Jin

AU - Lee, Chen Chiao

AU - Miller, Ekeni

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AB - Purpose: Anatomic changes and positional variability during intensity-modulated radiation therapy (IMRT) for head and neck cancer can lead to clinically significant dosimetric changes. We report our single-institution experience using an adaptive protocol and correlate these changes with anatomic and positional changes during treatment. Methods and Materials: Twenty-three sequential head and neck IMRT patients underwent serial computed tomography (CT) scans during their radiation course. After undergoing the planning CT scan, patients underwent planned rescans at 11, 22, and 33 fractions; a total of 89 scans with 129 unique CT plan combinations were thus analyzed. Positional variability and anatomic changes during treatment were correlated with changes in dosimetric parameters to target and avoidance structures between planning CT and subsequent scans. Results: A total of 15/23 patients (65%) benefited from adaptive planning, either due to inadequate dose to gross disease or to increased dose to organs at risk. Significant differences in primary and nodal targets (planning target volume, gross tumor volume, and clinical tumor volume), parotid, and spinal cord dosimetric parameters were noted throughout the treatment. Correlations were established between these dosimetric changes and weight loss, fraction number, multiple skin separations, and change in position of the skull, mandible, and cervical spine. Conclusions: Variations in patient positioning and anatomy changes during IMRT for head and neck cancer can affect dosimetric parameters and have wide-ranging clinical implications. The interplay between random positional variability and gradual anatomic changes requires careful clinical monitoring and frequent use of CT- based image-guided radiation therapy, which should determine variations necessitating new plans.

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