DOSIMETRIC ANALYSIS OF ADAPTIVE RADIOTHERAPY(ART) IN LOCALLY ADVANCED HEAD AND NECK CANCER

Abstract

PURPOSE/OBJECTIVE: The objective of this study is to evaluate the dosimetric parameters in adaptive radiotherapy for locally advanced head and neck cancers METHODS AND MATERIALS: This is a Hospital-based Prospective study conducted in the period from Dec 2020 to March 2021. Histologically proven Head and Neck Carcinoma patients with Stage III to IV (locally advanced) were selected for the study. A total of 10 patients receiving denitive, conformal radiation therapy to the head and neck region were evaluated for the study. After the acquisition of CT images, target volumes, OARs were contoured in the planning CT. Images were again acquired midway during the planned course of radiation therapy. Body contours, target volumes, and organs at risk were redrawn on the new set of images. Two sets of additional treatment plans were generated: 1) a non-optimized plan (plan 2), which is an overlay of the original plan (plan 1) on the new set of contours, and 2) an optimized plan(plan 3) with the new set of contours. These 3 sets of plans were then compared for dosimetric differences. RESULTS: Four patients had locally advanced nasopharyngeal cancers, 4 patients had locally advanced oropharyngeal cancers, 2 patients had locally advanced hypopharyngeal cancer. The average reduction in gross tumour volume was 37.1 ml. The average changes in right and left parotid volume were 5.94 and 5.49 ml, respectively. With the non-optimized plan, the average increase in the maximum dose to the spinal cord was 9.8% (58.96-68.76; p= 0.156). With reoptimization, the maximum dose to the spinal cord decreased from 68.76% to 54.97% (mean difference, -13.79%, p=0.03). The average D99 for the planning target volume( dose received by 99% of the target volume) was 98.68% and 98.65% with the original and reoptimized plans, respectively. Most of the patients during radiation had Grade 2 skin toxicity and Grade 2 mucositis which was managed conservatively. CONCLUSIONS: This study demonstrates that during radiation there is gross changes of volumes in locally advanced head and neck cancers and thus adaptive radiation therapy plays a pivotal role in locally advanced head and neck cancer