Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice

Metin Figen; Didem Çolpan Öksüz; Evrim Duman; Robin Prestwich; Karen Dyker; Kate Cardale; Satiavani Ramasamy; Patrick Murray; Mehmet Şen

doi:10.3389/fonc.2020.579917

Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice

Front Oncol. 2020 Nov 12:10:579917. doi: 10.3389/fonc.2020.579917. eCollection 2020.

Authors

Metin Figen¹, Didem Çolpan Öksüz², Evrim Duman³, Robin Prestwich⁴, Karen Dyker⁴, Kate Cardale⁴, Satiavani Ramasamy⁴, Patrick Murray⁴, Mehmet Şen⁴

Affiliations

¹ Department of Radiation Oncology Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
² Department of Radiation Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
³ Department of Radiation Oncology Antalya Training and Research Hospital, Antalya, Turkey.
⁴ Department of Clinical Oncology, Leeds Cancer Center, St. James's Institute of Oncology, Leeds, United Kingdom.

Abstract

Purpose and objective: A proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require ad hoc treatment re-planning. The aim of this retrospective study is to analyze the patients who required ad hoc re-planning and to identify factors, which may predict need for re-planning.

Materials and methods: A single center evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January and December 2016 was undertaken. Patients who underwent ad hoc re-planning during the treatment were identified in electronic records. Reasons for re-planning were categorized as: weight loss, tumor shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumor site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated.

Results: 31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy required re-planning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for re-planning were tumor shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumor/treatment factors, nasopharyngeal primary site (p = 0.013) and use of concurrent chemotherapy with radiotherapy (p = 0.034) were found to be significantly correlated with the need for re-planning.

Conclusion: Effective on-treatment verification schedules and close follow up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualized triggered approach to ART rather than scheduled strategies as it is likely to be more feasible in terms of utilization of workload and resources.

Keywords: adaptive radiotherapy; chemoradiotherapy (CRT); head and neck cancer; replanning; volumetric modulated arc therapy (VMAT).