Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins
Background and Purpose: Adaptive radiotherapy (ART) involves treatment re-planning based on anatomical changes, which may improve target coverage and sparing of organs-at-risk (OARs). This study retrospectively assessed the technical feasibility and potential benefits of daily ART in combination wit...
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| Format: | Article |
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Elsevier
2025-01-01
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| Series: | Physics and Imaging in Radiation Oncology |
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| Online Access: | http://www.sciencedirect.com/science/article/pii/S2405631625000016 |
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| author | Hedda Enocson André Haraldsson Per Engström Sofie Ceberg Maria Gebre-Medhin Gabriel Adrian Per Munck af Rosenschöld |
| author_facet | Hedda Enocson André Haraldsson Per Engström Sofie Ceberg Maria Gebre-Medhin Gabriel Adrian Per Munck af Rosenschöld |
| author_sort | Hedda Enocson |
| collection | DOAJ |
| description | Background and Purpose: Adaptive radiotherapy (ART) involves treatment re-planning based on anatomical changes, which may improve target coverage and sparing of organs-at-risk (OARs). This study retrospectively assessed the technical feasibility and potential benefits of daily ART in combination with reduced planning target volume (PTV) margins for head and neck squamous cell carcinoma (HNSCC). Materials and Methods: Thirty-one patients, encompassing 902 treatment fractions, treated with radiotherapy to 60.0–68.0 Gy in 2 Gy/fraction were studied. Synthetic CTs (sCT) from daily kVCT images were created and contours propagated using deformable image registration (DIR). Target contours were reviewed and corrected. On the sCT, non-adapted delivered doses and ART-plans with 5 mm (clinical standard) and 2 mm PTV-margin were evaluated. All daily dose distributions were then accumulated. Results: Target contours required correction in 48 % of the fractions. Daily non-adapted D98%,CTV was > 95 % in 890 (5 mm) and 825 (2 mm) out of 902 fractions. All adapted plans achieved D98%,CTV > 95 %. Significant reductions in mean doses to OARs were observed for PTV = 2 mm ART-plans: 4.1 Gy for parotid, 2.6 Gy for submandibular, 3.3 Gy for oral cavity, 4.0 Gy for esophagus, and 3.8 Gy for larynx. Conclusion: ART-planning on sCT and DIR propagated contours was feasible and promising for further clinical testing. To obtain a potential clinical benefit of ART, a synchronous reduction of the PTV-margin was warranted. Daily ART can be used to maintain adequate target dosimetry for every fraction, though for the accumulated treatment, insufficient target coverage without ART is unlikely to occur. |
| format | Article |
| id | doaj-art-8b591fc72b2b4128824ccaf7a35d082d |
| institution | Kabale University |
| issn | 2405-6316 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Physics and Imaging in Radiation Oncology |
| spelling | doaj-art-8b591fc72b2b4128824ccaf7a35d082d2025-01-21T04:13:14ZengElsevierPhysics and Imaging in Radiation Oncology2405-63162025-01-0133100696Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced marginsHedda Enocson0André Haraldsson1Per Engström2Sofie Ceberg3Maria Gebre-Medhin4Gabriel Adrian5Per Munck af Rosenschöld6Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, Sweden; Corresponding author at: Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Barngatan 4, Skånes Universitetssjukhus, 221 85 Lund, Sweden.Medical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, SwedenRadiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, SwedenMedical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, SwedenOncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Oncology, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, SwedenOncology, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Oncology, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, SwedenMedical Radiation Physics, Department of Clinical Sciences Lund, Lund University, Lund, Sweden; Radiation Physics, Department of Hematology, Oncology, and Radiation Physics, Skåne University Hospital, SwedenBackground and Purpose: Adaptive radiotherapy (ART) involves treatment re-planning based on anatomical changes, which may improve target coverage and sparing of organs-at-risk (OARs). This study retrospectively assessed the technical feasibility and potential benefits of daily ART in combination with reduced planning target volume (PTV) margins for head and neck squamous cell carcinoma (HNSCC). Materials and Methods: Thirty-one patients, encompassing 902 treatment fractions, treated with radiotherapy to 60.0–68.0 Gy in 2 Gy/fraction were studied. Synthetic CTs (sCT) from daily kVCT images were created and contours propagated using deformable image registration (DIR). Target contours were reviewed and corrected. On the sCT, non-adapted delivered doses and ART-plans with 5 mm (clinical standard) and 2 mm PTV-margin were evaluated. All daily dose distributions were then accumulated. Results: Target contours required correction in 48 % of the fractions. Daily non-adapted D98%,CTV was > 95 % in 890 (5 mm) and 825 (2 mm) out of 902 fractions. All adapted plans achieved D98%,CTV > 95 %. Significant reductions in mean doses to OARs were observed for PTV = 2 mm ART-plans: 4.1 Gy for parotid, 2.6 Gy for submandibular, 3.3 Gy for oral cavity, 4.0 Gy for esophagus, and 3.8 Gy for larynx. Conclusion: ART-planning on sCT and DIR propagated contours was feasible and promising for further clinical testing. To obtain a potential clinical benefit of ART, a synchronous reduction of the PTV-margin was warranted. Daily ART can be used to maintain adequate target dosimetry for every fraction, though for the accumulated treatment, insufficient target coverage without ART is unlikely to occur.http://www.sciencedirect.com/science/article/pii/S2405631625000016Adaptive radiotherapyHead-and-neck cancerRe-planningRadiotherapyTomotherapyVMAT |
| spellingShingle | Hedda Enocson André Haraldsson Per Engström Sofie Ceberg Maria Gebre-Medhin Gabriel Adrian Per Munck af Rosenschöld Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins Physics and Imaging in Radiation Oncology Adaptive radiotherapy Head-and-neck cancer Re-planning Radiotherapy Tomotherapy VMAT |
| title | Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins |
| title_full | Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins |
| title_fullStr | Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins |
| title_full_unstemmed | Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins |
| title_short | Adaptive radiotherapy in locally advanced head and neck cancer: The importance of reduced margins |
| title_sort | adaptive radiotherapy in locally advanced head and neck cancer the importance of reduced margins |
| topic | Adaptive radiotherapy Head-and-neck cancer Re-planning Radiotherapy Tomotherapy VMAT |
| url | http://www.sciencedirect.com/science/article/pii/S2405631625000016 |
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