Optimizing Treatment Quality in Head and Neck Cancer Therapy: Impact of Adaptive Intensity-Modulated Radiotherapy on Plan Quality and Tumor Volume Changes
DOI:
https://doi.org/10.22317/jcms.v10i2.1522Keywords:
Adaptive IMRT, PTV shifting, volumetric reduction , Conformity Index (CI), Homogeneity Index (HI).Abstract
Objective: This research analyses whether volumetric changes and PTV shifting affect adaptive intensity-modulated radiotherapy (IMRT) plan quality and head and neck cancer therapy.
Methods: The research was carried out at the Sohag Cancer Centre in Egypt, including a sample of 36 individuals diagnosed with head and neck squamous cell carcinoma (HNSCC). Patients were chosen on the basis of the following criteria: locally progressed and node-positive malignancy, oropharyngeal cancer, oral cavity cancer, and unknown primary. The research used dynamic intensity-modulated radiation therapy (D-IMRT) to establish treatment plans and Siemens SOMATOM DEFINITION CT scanners to acquire 3D anatomical images. A range of 1.64 to 2.12 Gy was observed for the median dosage per fraction. Using the conformance index (CI) and the homogeneity index, the quality of the plan was assessed (HI). The threshold for statistical significance was set at 0.05.
Results: The study analysed patients with unilateral and bilateral HNSCC tumors, with a majority having bilateral tumors. The findings demonstrated that the tumor PTV was significantly reduced as a consequence of the suggested adaptive radiation techniques. Both the homogeneity index and the conformity index were used to evaluate the plan's quality (HI). The maximal homogeneity index (HI) was reached after 7 and 14 fractions, respectively. The positive correlation between PTV reduction and CI after 7 fractions, while a negative correlation found after fractions 14 and 21. It was also shown that HI is positively correlated with PTV changes after 7 and 14.
Conclusion: The use of adaptive radiotherapy in intensity-modulated radiation therapy (IMRT) treatment planning improves plan quality and decreases error rates due to tumor margin movement. Following radiation fractions, PTV shifting affects the homogeneity index (HI).
References
Jubbier ON, Abdullah SS, Alabedi HH, Alazawy NM, Al-Musawi MJ. The Effect of Modulation Complexity Score (MCS) on the IMRT Treatment Planning Delivery Accuracy. J Phys Conf Ser. 2021 Apr 7;1829(1):12017.
Hameed DD, Abdulhakeem VH, Madlool SA, Ali NM, Salih DA, Mohammed FJ. The efficiency of Intensity Modulated Radiation Therapy (IMRT) and Volumetric Modulated Arc Therapy (VMAT) in bone marrow of lumber spinal cord tumor radiotherapy. Onkologia i Radioterapia. 2023;17(9):290–7.
Chen AM, Farwell DG, Luu Q, Donald PJ, Perks J, Purdy JA. Evaluation of the planning target volume in the treatment of head and neck cancer with intensity-modulated radiotherapy: What is the appropriate expansion margin in the setting of daily image guidance? Int J Radiat Oncol Biol Phys. 2011;81(4).
Hong TS, Ritter MA, Tomé WA, Harari PM. Intensity-modulated radiation therapy: Emerging cancer treatment technology. Vol. 92, British Journal of Cancer. 2005.
Jubbier ON, Abdullah SS, Alabedi HH, Alazawy NM, Al-Musawi MJ. The Effect of Modulation Complexity Score (MCS) on the IMRT Treatment Planning Delivery Accuracy. J Phys Conf Ser [Internet]. 2021;1829(1):12017. Available from: https://dx.doi.org/10.1088/1742-6596/1829/1/012017
Grégoire V, Guckenberger M, Haustermans K, Lagendijk JJW, Ménard C, Pötter R, et al. Image guidance in radiation therapy for better cure of cancer. Vol. 14, Molecular Oncology. 2020.
Rehman J ur, Zahra, Ahmad N, Khalid M, Noor ul Huda Khan Asghar HM, Gilani ZA, et al. Intensity modulated radiation therapy: A review of current practice and future outlooks. J Radiat Res Appl Sci. 2018;11(4):361–7.
van Timmeren JE, Chamberlain M, Bogowicz M, Ehrbar S, Dal Bello R, Schüler HG, et al. MR-guided adaptive radiotherapy for head and neck cancer: Prospective evaluation of migration and anatomical changes of the major salivary glands. Cancers (Basel). 2021;13(21).
Figen M, Çolpan Öksüz D, Duman E, Prestwich R, Dyker K, Cardale K, et al. Radiotherapy for Head and Neck Cancer: Evaluation of Triggered Adaptive Replanning in Routine Practice. Front Oncol. 2020;10.
Burnet NG, Thomas SJ, Burton KE, Jefferies SJ. Defining the tumour and target volumes for radiotherapy. Cancer Imaging. 2004;4(2).
Noble DJ, Yeap PL, Seah SYK, Harrison K, Shelley LEA, Romanchikova M, et al. Anatomical change during radiotherapy for head and neck cancer, and its effect on delivered dose to the spinal cord. Radiotherapy and Oncology. 2019;130.
Alves N, Dias JM, Rocha H, Ventura T, Mateus J, Capela M, et al. Assessing the need for adaptive radiotherapy in head and neck ancer patients using an automatic planning tool. Reports of Practical Oncology and Radiotherapy. 2021;26(3).
Alabedi H. Assessing setup errors and shifting margins for planning target volume in head , neck , and breast cancer. J Med Life. 2023;16(3):394–8.
Kanakavelu N, Samuel JJ. Determination of patient set-up error and optimal treatment margin for intensity modulated radiotherapy using image guidance system. Journal of BUON. 2016;21(2).
Madlool SA, Abdullah SS, Alabedi HH, Alazawy N, Al-Musawi MJ, Saad D, et al. Optimum Treatment Planning Technique Evaluation For Synchronous Bilateral Breast Cancer With Left Side Supraclavicular Lymph Nodes. Iranian Journal of Medical Physics [Internet]. 2020 Nov 9 [cited 2021 May 29];0. Available from: https://ijmp.mums.ac.ir/article_16970.html
Vol I. Prescribing, Recording, and Reporting Photon-Beam Intensity-Modulated Radiation Therapy (IMRT): J ICRU. 2010;10(1):NP.3-NP.
Gugić J, Strojan P. Squamous cell carcinoma of the head and neck in the elderly. Vol. 18, Reports of Practical Oncology and Radiotherapy. 2013.
Huang S, Goldstein D, Weinreb I, Perez-Ordonez B, Fung S, Irish J, et al. Positive Postradiotherapy Planned Neck Dissection is Strongly Associated with Increased Distant Metastasis Rather Than Regional Relapse. International Journal of Radiation Oncology*Biology*Physics. 2010;78(3).
De Lamarliere MG, Lusque A, Khalifa JA, Esteyrie V, Chevreau C, Valentin T, et al. Management of tumor volume changes during preoperative radiotherapy for extremity soft tissue sarcoma: a new strategy of adaptive radiotherapy. Radiol Oncol. 2023 Dec;57(4):507–15.
Patel G, Mandal A, Choudhary S, Mishra R, Shende R. Plan evaluation indices: A journey of evolution. Vol. 25, Reports of Practical Oncology and Radiotherapy. Urban and Partner; 2020. p. 336–44.
Huang H, Lu H, Feng G, Jiang H, Chen J, Cheng J, et al. Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy. Radiation Oncology. 2015;10(1).
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