Selection of head and neck cancer patients for adaptive radiotherapy to decrease xerostomia

• Published in: Radiotherapy and oncology 2016-07, Vol.120 (1), p.36-40
• Main Authors: Brouwer, Charlotte L, Steenbakkers, Roel J.H.M, van der Schaaf, Arjen, Sopacua, Chantal T.C, van Dijk, Lisanne V, Kierkels, Roel G.J, Bijl, Hendrik P, Burgerhof, Johannes G.M, Langendijk, Johannes A, Sijtsema, Nanna M
• Format: Article
• Language: English
• Subjects: Adaptive radiotherapy; Aged; Dosimetric changes; Female; Head and neck; Head and Neck Neoplasms - radiotherapy; Hematology, Oncology and Palliative Medicine; Humans; Linear Models; Male; Middle Aged; Parotid Gland - radiation effects; Parotid glands; Patient selection; Radiation Injuries - prevention & control; Xerostomia; Xerostomia - prevention & control
• ISSN: 0167-8140; 1879-0887
• DOI: 10.1016/j.radonc.2016.05.025

Abstract Background and purpose The aim of this study was to develop and validate a method to select head and neck cancer patients for adaptive radiotherapy (ART) pre-treatment. Potential pre-treatment selection criteria presented in recent literature were included in the analysis. Materials and methods Deviations from the planned parotid gland mean dose (PG ΔDmean) were estimated for 113 head and neck cancer patients by re-calculating plans on repeat CT scans. Uni- and multivariable linear regression analyses were performed to select pre-treatment parameters, and ROC curve analysis was used to determine cut off values, for selecting patients with a PG dose deviation larger than 3 Gy. The patient selection method was validated in a second patient cohort of 43 patients. Results After multivariable analysis, the planned PG Dmean remained the only significant parameter for PG ΔDmean. A sensitivity of 91% and 80% could be obtained using a threshold of PG Dmean of 22.2 Gy, for the development and validation cohorts, respectively. This would spare 38% (development cohort) and 24% (validation cohort) of patients from the labour-intensive ART procedure. Conclusions The presented method to select patients for ART pre-treatment reduces the labour of ART, contributing to a more effective allocation of the department resources.