Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning

Background The purpose of this study was to determine the effect of adaptive replanning on clinical outcome among patients treated by intensity‐modulated radiotherapy (IMRT) for head and neck cancer. Methods Three hundred seventeen patients underwent IMRT with daily image‐guidance for newly diagnose...

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Bibliographic Details
Published in:Head & neck 2014-11, Vol.36 (11), p.1541-1546
Main Authors: Chen, Allen M., Daly, Megan E., Cui, Jing, Mathai, Mathew, Benedict, Stanley, Purdy, James A.
Format: Article
Language:English
Subjects:
adaptive radiotherapy
Aged
Carcinoma, Squamous Cell - diagnosis
Carcinoma, Squamous Cell - mortality
Carcinoma, Squamous Cell - radiotherapy
Cohort Studies
Disease-Free Survival
Dose-Response Relationship, Radiation
Female
head and neck cancer
Head and Neck Neoplasms - diagnosis
Head and Neck Neoplasms - mortality
Head and Neck Neoplasms - radiotherapy
Humans
image-guidance
intensity-modulated radiotherapy (IMRT)
Kaplan-Meier Estimate
Male
Middle Aged
outcomes
Prognosis
Radiotherapy Dosage
Radiotherapy Planning, Computer-Assisted
Radiotherapy, Intensity-Modulated - adverse effects
Radiotherapy, Intensity-Modulated - methods
Retrospective Studies
Risk Assessment
Squamous Cell Carcinoma of Head and Neck
Survival Analysis
Treatment Outcome
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Summary:Background The purpose of this study was to determine the effect of adaptive replanning on clinical outcome among patients treated by intensity‐modulated radiotherapy (IMRT) for head and neck cancer. Methods Three hundred seventeen patients underwent IMRT with daily image‐guidance for newly diagnosed squamous cell carcinoma of the head and neck to a median dose of 66 Gy (range, 60–74 Gy). Of these 317 patients, 51 (16%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment. Results The 2‐year local‐regional control was 88% for patients treated with adaptive replanning compared with 79% for patients treated without (p = .01). The median time to local‐regional recurrence for the 4 patients treated by adaptive radiotherapy was 7 months (range, 3–15 months) with all failures occurring within the high‐dose planning target volume (PTV). Conclusion Although the use of routine replanning is probably not necessary, our findings do suggest a significant benefit in appropriately selected patients. © 2014 Wiley Periodicals, Inc. Head Neck 36: 1541–1546, 2014
ISSN:1043-3074
1097-0347
DOI:10.1002/hed.23477