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Review
. 2019 Jul;29(3):258-273.
doi: 10.1016/j.semradonc.2019.02.008.

Head and Neck Cancer Adaptive Radiation Therapy (ART): Conceptual Considerations for the Informed Clinician

Jolien Heukelom  1 , Clifton David Fuller  2
Affiliations
Review

Head and Neck Cancer Adaptive Radiation Therapy (ART): Conceptual Considerations for the Informed Clinician

Jolien Heukelom et al. Semin Radiat Oncol. 2019 Jul.

Abstract

For nearly 2 decades, adaptive radiation therapy (ART) has been proposed as a method to account for changes in head and neck tumor and normal tissue to enhance therapeutic ratios. While technical advances in imaging, planning and delivery have allowed greater capacity for ART delivery, and a series of dosimetric explorations have consistently shown capacity for improvement, there remains a paucity of clinical trials demonstrating the utility of ART. Furthermore, while ad hoc implementation of head and neck ART is reported, systematic full-scale head and neck ART remains an as yet unreached reality. To some degree, this lack of scalability may be related to not only the complexity of ART, but also variability in the nomenclature and descriptions of what is encompassed by ART. Consequently, we present an overview of the history, current status, and recommendations for the future of ART, with an eye toward improving the clarity and description of head and neck ART for interested clinicians, noting practical considerations for implementation of an ART program or clinical trial. Process level considerations for ART are noted, reminding the reader that, paraphrasing the writer Elbert Hubbard, "Art is not a thing, it is a way."

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Figures

Figure 1.
Figure 1.. Possible typologies of ART implementation.
1A:fixed interval approach; 1B: ‘triggered’ ART; 1C: serial ART,1D cascade ART.
Figure 2.
Figure 2.. The importance of the reference frame in ART
Figure 2A: forward calculation with dose accumulation, and back-projection; 2B: Dose-volume histogram (DVF/dose accumulation); 2C: dose-volume histogram (deformation back-projection).
Figure 2.
Figure 2.. The importance of the reference frame in ART
Figure 2A: forward calculation with dose accumulation, and back-projection; 2B: Dose-volume histogram (DVF/dose accumulation); 2C: dose-volume histogram (deformation back-projection).
Figure 3.
Figure 3.. Volume loss and dose accumulation.
V: volume; M: mass; φ: deformable registration algorithm; EDEL: energy delivered;T0: start of treatment.
See this image and copyright information in PMC

References

    1. LeWitt S Paragraphs on Conceptual Art. Artforum. 1967;10(Summer).
    1. Ackerstaff AH, Rasch CR, Balm AJ, de Boer JP, Wiggenraad R, Rietveld DH, et al. Five-year quality of life results of the randomized clinical phase III (RADPLAT) trial, comparing concomitant intra-arterial versus intravenous chemoradiotherapy in locally advanced head and neck cancer. Head Neck. 2012;34(7):974–80. - PubMed
    1. Langendijk JA, Doornaert P, Verdonck-de Leeuw IM, Leemans CR, Aaronson NK, Slotman BJ. Impact of late treatment-related toxicity on quality of life among patients with head and neck cancer treated with radiotherapy. J Clin Oncol. 2008;26(22):3770–6. - PubMed
    1. Jensen AD, Nill S, Huber PE, Bendl R, Debus J, Munter MW. A clinical concept for interfractional adaptive radiation therapy in the treatment of head and neck cancer. Int J Radiat Oncol Biol Phys. 2012;82(2):590–6. - PubMed
    1. Bhandari V, Patel P, Gurjar OP, Gupta KL. Impact of repeat computerized tomography replans in the radiation therapy of head and neck cancers. J Med Phys. 2014;39(3):164–8. - PMC - PubMed

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