Abstract

Anatomic and dosimetric changes occur in head and neck cancer during fractionated proton radiotherapy, and the actual dose received by patient is considerably different from original plan. Adaptive radiotherapy aims to modify treatment according to changes that occur during proton therapy. Intensity modulated proton therapy for head and neck cancer (HNC) patients benefitted by adaptation to correct the dose perturbations caused by weight loss, tumor volume changes, setup and range uncertainties. The following sections have elaborated the rationale of adaptation in HNC, proton physics in HNC, studies comparing non-adaptive and adaptive intensity modulated proton therapy (IMPT) plans, reasons for adaptation and how to mitigate these changes.

Highlights

  • Intensity Modulated Radiation Therapy (IMRT) with photons has become standard treatment for locally advanced head and neck cancer (HNC) because of its high conformality and better sparing of critical structures [1–3]

  • Proton therapy using spot scanning (Intensity Modulated Proton Therapy-intensity modulated proton therapy (IMPT)) has shown superior dose distribution compared to IMRT in head and neck cancer patients [4–8]

  • The unnecessary radiation to organ at risks (OARs) and nearby healthy tissues was significantly reduced with proton when compared with photons

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Summary

Introduction

Intensity Modulated Radiation Therapy (IMRT) with photons has become standard treatment for locally advanced head and neck cancer (HNC) because of its high conformality and better sparing of critical structures [1–3]. Plan adaptation is desirable to optimally treat these patients undergoing anatomical modifications and weight loss. These little alterations during proton therapy lead to huge dosimetric changes (like high dose to normal structures and low dose to target volume) because of sharp dose fall off between target volume (TV) and OAR, leading to increased complications and marginal failure. The influence of anatomical changes for proton therapy is more pronounced due to range uncertainties. Proton Therapy - Current Status and Future Directions possible strategy is Adaptive Radiotherapy (ART) of proton, i.e., repeat imaging and repeat planning to adapt to actual patient anatomy

Physics
Dosimetric studies
Practical considerations
Findings
Conclusion
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