Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Clinical Trial
. 2012 Jul 1;83(3):986-93.
doi: 10.1016/j.ijrobp.2011.08.017. Epub 2011 Dec 2.

Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial

David L Schwartz  1 , Adam S Garden, Jimmy Thomas, Yipei Chen, Yongbin Zhang, Jan Lewin, Mark S Chambers, Lei Dong
Affiliations
Clinical Trial

Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial

David L Schwartz et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma.

Methods and materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy.

Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated.

Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Deformable Registration for ART
Our ART process starts with rigid alignment between the reference planning CT and the daily in-room CT (left and middle). The planning contours are overlaid to the daily CT to verify setup accuracy and to evaluate changes in anatomy relative to baseline. If changes are significant, as illustrated in the middle picture, a deformable image registration can be performed to propagate original planning contours onto current anatomy. Final deformed contours are shown on the right.
Figure 2
Figure 2. ART Replanning
An example of serial ART dose recalculation using a daily CT image acquired at the 25th treatment fraction. On the left, the original plan is calculated on current anatomy. The original plan provides inappropriate treatment margins and dose heterogeneity within the high dose CTV. In the middle figure, an earlier ART replan (ART1, designed at the 15th treatment fraction) is calculated onto current anatomy. On the right, a 2nd ART replan (ART2) is designed and calculated for the current daily image set. The ART2 plan provides improved contralateral parotid sparing and a lower total body dose than the ART1 plan.
Figure 3
Figure 3. Timing of ART Replanning
Distribution of the triggering fraction for replanning is plotted for both 1st and 2nd ART events.
Figure 4
Figure 4. PSS-HN Outcomes
Serial mean scores plotted for diet, eating, and speech.
Figure 5
Figure 5. Sialometry Outcomes
Serial mean stimulated and unstimulated measurements relative to the baseline.
See this image and copyright information in PMC

References

    1. de Arruda FF, Puri DR, Zhung J, Narayana A, Wolden S, Hunt M, et al. Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 2006 Feb 1;64(2):363–73. - PubMed
    1. Garden AS, Morrison WH, Wong PF, Tung SS, Rosenthal DI, Dong L, et al. Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2007 Feb 1;67(2):438–44. - PMC - PubMed
    1. Feng FY, Kim HM, Lyden TH, Haxer MJ, Feng M, Worden FP, et al. Intensity-modulated radiotherapy of head and neck cancer aiming to reduce dysphagia: early dose-effect relationships for the swallowing structures. Int J Radiat Oncol Biol Phys. 2007 Aug 1;68(5):1289–98. - PubMed
    1. Eisbruch A, Levendag PC, Feng FY, Teguh D, Lyden T, Schmitz PI, et al. Can IMRT or brachytherapy reduce dysphagia associated with chemoradiotherapy of head and neck cancer? The Michigan and Rotterdam experiences. Int J Radiat Oncol Biol Phys. 2007;69(2 Suppl):S40–2. - PMC - PubMed
    1. Yao M, Karnell LH, Funk GF, Lu H, Dornfeld K, Buatti JM. Health-related quality-of-life outcomes following IMRT versus conventional radiotherapy for oropharyngeal squamous cell carcinoma. Int J Radiat Oncol Biol Phys. 2007 Dec 1;69(5):1354–60. - PubMed

Publication types

MeSH terms