Abstract
Objective:To provide evidence on the extent and manner in which adaptive practices have been employed in the UK and identify the main barriers for the clinical implementation of adaptive radiotherapy (ART) in head and neck (HN) cancer cases.Methods:In December 2019, a Supplementary Material 1, of 23 questions, was sent to all UK radiotherapy centres (67). This covered general information to current ART practices and perceived barriers to implementation.Results:31 centres responded (46%). 56% responding centres employed ART for between 10 and 20 patients/annum. 96% of respondents were using CBCT either alone or with other modalities for assessing “weight loss” and “shell gap,” which were the main reasons for ART. Adaptation usually occurs at week three or four during the radiotherapy treatment. 25 responding centres used an online image-guided radiotherapy (IGRT) approach and 20 used an offline ad hoc ART approach, either with or without protocol level. Nearly 70% of respondents required 2 to 3 days to create an adaptive plan and 95% used 3–5 mm adaptive planning target volume margins. All centres performed pre-treatment QA. “Limited staff resources” and “lack of clinical relevance” were identified as the two main barriers for ART implementation.Conclusion:There is no consensus in adaptive practice for HN cancer patients across the UK. For those centres not employing ART, similar clinical implementation barriers were identified.Advances in knowledge:An insight into contemporary UK practices of ART for HN cancer patients indicating national guidance for ART implementation for HN cancer patients may be required
Highlights
Head and neck (HN) cancer is the eighth most common cancer in the UK and there are around 12 200 new cases every year.[1]
Increase the precision of treatment, so that the radiation dose to the target volumes and organs at risk (OAR) are closely matched with the original treatment plan
The results show that CBCT plays a dominant role for assessing whether HN patients require adaptive radiotherapy (ART)
Summary
Head and neck (HN) cancer is the eighth most common cancer in the UK and there are around 12 200 new cases every year.[1]. An adaptive plan may be created by acquiring a new set of images at some point over the treatment course and applying new parameters, for example, new volumes or different prescription dose levels, for the remainder of the treatment. This process is called ART which varies across different radiotherapy centres, but the main goals are the same. Increase the precision of treatment, so that the radiation dose to the target volumes and organs at risk (OAR) are closely matched with the original treatment plan This first stage can be achieved with IGRT facilities for eliminating random and systematic setup errors if daily online imaging is applied. Alter prescription dose levels in order to increase the tumour control or ensure the OARs are still within dose tolerance.[6]
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