A systematic review on clinical adaptive radiotherapy for head and neck cancer

Figures & data

Figure 1. PubMed Search results: ‘Adaptive radiotherapy head neck cancer’. English language filter was applied. Each column represents the number of published articles per year. Picture is captured from: https://pubmed.ncbi.nlm.nih.gov/. Modified using the windows office package.

Figure 2. PRISMA diagram of study selection. Diagram made in https://lucidchart.com.

Table 1. Characteristics of studies included in the review.

Author/year	Tumor site	Reference	No. of patients		Time of rescan	No. of replans (patients)	Endpoints		Median follow up time
			ART	Non-ART			Dosimetric	Clinical
Wang 2010	NPC	Hybrid plan	28		CT before 25′th fraction	1 (28)	Dmean parotis right, left Dmax spinal cord
Ahn 2011	HNC†	Hybrid plan	15	8	CT at fraction 11, 22 and 33	1 (10) 2 (5)	Dmean parotis right, left Dmax spinal cord
Capelle 2012	HNC‡	Hybrid plan	20		CT after 15′th fraction.	1 (20)	Dmean parotis combined Dmax spinal cord		18 months
Schwartz 2012	OPSCC	Hybrid plan	24♠		Weekly recalculation or as indicated by IGRT. Replanning decided by treating physician	1 (14) 2 (8)	Dmean parotis ipisi., contra.	LC, RC, Acute and chronic toxicity (CTCAE v.3 MDADI)	31 months
Schwartz 2013	OPSCC		22			1 (14) 2 (8)	Dmean parotis ipisi., contra.
Yang 2013	NPC	Comparative non-ART group	86	43	CT before 15′th and/or 25′th fraction	1 (63) 2 (23)		OS, LRC, (EORTC QLQ-C30, EORTC QLQ-H&N35)	ART: 30 months Non ART: 29 months
Wang 2014	NPC	Hybrid plan, original plan	20		CT after 40 Gy	1 (20)	Dmean parotis right, left Dmax spinal cord
Bhandari 2014	HNC	Hybrid plan	15		CT after 3′rd fraction or when clinical indicated	1 (15)	Dmean parotis right, left Dmean spinal cord
Chitapanarux 2015	NPC	Hybrid plan, original plan	17		CT at 17′th fraction	1 (17)	Dmean parotis ipsi., contra. Dmax spinal cord
Hvid 2018	HNC§	Hybrid plan	33	120		1 (29) 2 (4)	Dmean parotis
Bahl 2019	NPC	Hybrid plan	20		CT at 17′th fraction	1 (20)	Dmean parotis right, left Dmax spinal cord	Acute toxicity (CTCAE v.3)
Maheshwari 2020*	HNC	Comparative non-ART group	30	30	CT after 3′rd week of treatment	1 (30)	Dmean parotis ipsi., contra. Dmax spinal cord	CR, PR, Acute and late toxicity (RTOG/EORTC and CTCAE v.4)
McDonald 2021	HNC¶	Hybrid plan	4	6	Daily setup CT. Replan if: All shifts <5 mm + failure of any dosimetric constraints on 3 consecutive fractions or Any shift >5 mm even after repositioning	1 (4)	Dose difference (%) between reference plan and summation plan
Chatterjee 2022	HNC#	Comparative non-ART group	45	42	CT or CBCT after 14′th fraction. If no adaption needed repeated at 19′th fraction	1 (45)		Quality of Life (QualiXeQLS, EORTC QLQ-C30, HN35)
Gul 2023	HNC	Hybrid plan	15		CT at fraction 14 and 24	2 (15)	Dmean parotis ipsi., contra. Dmax spinal cord

* Significant results could not be reconstructed from raw data. ^†1 unknown primary, 4 receiving postoperative RT. ^‡ 7 receiving postoperative RT. § 8 unknown primary, 6 recurrent disease, 22 non-HNC. ^¶ 1 recurrent disease. ^# 46 receiving postoperative RT. ♠ 22 was analyzed.

‘Hybridplan’ refers to a simulated non-ART setting where the original plan was applied to the rescan for dose accumulation.

Abbreviations: HNC, head and neck cancer; OPSCC, oropharyngeal squamous cell carcinoma; NPC, nasopharyngeal carcinoma; CT, computed tomography; IGRT, image guided radiotherapy; CBCT, cone-beam CT; CR, complete response; PR, partial response; LC, local control; RC, regional control; OS, overall survival; LRC, locoregional control.

Figure 3. The 392 patients treated with adaptive radiotherapy by year of publication. Each column represents the number of patients treated with ART in each study. Sections marked pink, blue and green represent the share of patients not analyzed, treated off protocol or treated with palliative intend respectively. Mean number of patients treated per study was 26, and the median was 20 (interquartile range: 15-30).

Figure 4. Reduction in mean dose to parotid glands by publication year. Circles represent significant results and triangles represent non-significant results of the reduction in mean dose with ART vs. non-ART. The squares represent the reduction in mean dose found in the PARSPORT trial with parotid sparring IMRT vs. 3D-RT.

Data availability statement

Data derived from public domain resources.