Adaptive radiotherapy for head and neck cancer

Figures & data

Figure 1. PRISMA flow diagram of the literature search.

Table 1. Dosimetric benefits of ART in patients with head and neck cancer.

Author (Year)	Nb pts	Replanning strategies		Dosimetric analysis			Dosimetric benefit
		Nb	Timing	Time point to cumulate the dose	Method to cumulate the dose	Total dose for the comparison (Gy)	Parotid Gland (Dmean)	Spinal cord (Dmax)	Target Volume (PTV)
Capelle (2012) [11]	20	1	3rd week	2	Average DVH	66	–0.6 Gy*	–0.6 Gy*	+0.5 Gy (D1%)*
Castelli (2015) [12]	15	6	Weekly	7	DIR	70	–3.8 Gy*	–	–
Dewan (2016) [13]	30	1	40 Gy	2	DVH	30	IL -6 Gy*	–6 Gy*	More uniform coverage
							CL -2.2 Gy		Decrease V110% by 2*
Duma (2012) [3]	11	1	16th (9th–21st) Fr	1	DVH	2	No variation	–0.14 Gy	–
Jensen (2012) [14]	15	2 to 4	–	3 to 5	DIR	70	CL: –11.5%^a	–	Improvement of coverage by 8%
			IL: –3.8%^a
Olteanu (2014) [15]	10	2	8th and 18th Fr	3	DIR	70	–6%^a*	–	Higher minimum and lower maximum doses
Schwartz (2013) [16]	22	1 or 2	16th and 22nd Fr	2 or 3	DIR	70	–0.7 Gy*	–	Increase coverage and dose homogeneity
Zhao (2011) [17]	33	1	15th (+/−5) Fr	2	DVH	37.5 Gy (20–50 Gy)	Decrease mean dose*	–	–

* = p-value < .05; a = Median dose; – = Not assessed; Nb pts = Number of patients; HNC: head and neck cancer; LAHNC: locally advanced head and neck cancer; NPC: nasopharyngeal carcinoma; Fr: Fraction; RT: radiotherapy; RTCT: chemoradiotherapy; DVH: dose volume histogram; DIR: deformable image registration; Dmean: mean dose; Dmax: maximum dose; D1: dose received by 1% of the volume; V110%: Percentage of target volume receiving 110% of the dose prescribed (hot spot); IL: Ipsilateral; CL: contralateral; PTV: planning target volume.

Table 2. Clinical benefits of ART in patients with head and neck cancer.

Author (Year)	Nb pts		Tumor site	Total dose(Gy)	Replanning strategies		Follow-up (months)	Clinical endpoint
	ART	No ART			Nb	Timing		Loco-regional control and survival	Acute Toxicity	Late toxicity
Schwartz (2012) [16]^a	22	0	OPC	66–70	1 or 2	16th and 22nd Fr	31	2-year LRC = 95%	– G III mucosal = 100%	Full preservation or functional recovery of speech and eating at 20 months
									– G II xerostomia = 55%
									– G III xerostomia = 5%
Kataria (2016) [18]	36	0	LAHNC	70	1	54 Gy		− 2-year DFS = 72%	G II-III mucosal = 100%	– G II xerostomia = 8%
								− 2-year OS = 75%		– G II mucosal = 11%
										– No G III
Yang (2013) [19]^a	86	43	NPC	70–76	1 or 2	15th and/or 25th Fr	29	2-year LRC	–	Improvements in quality of life with ART
								− 97.2% (ART)
								− 82.2% (No-ART) p = .04
								2-year OS
								− 89.8% (ART)
								− 82.2% (No-ART) p = .47
Chen (2014) [20]	51	266	LAHNC	60^b	1	40 Gy (10–58 Gy)	30	2-year LRC	G III:	G III:
								− 88% (ART)
								− 79% (No-ART) p = .01	− 39% (ART)	− 14% (ART)
				70^µ				2-year OS	− 30% (No-ART)	− 19% (No-ART)
								− 73% (ART)	p = .45	p = 0.71
								− 79% (No-ART) p = .55
Zhao (2011) [17]	33	66	NPC	70	1	15th (+/−5) Fr	38	3-year LRFS	–	No difference except less xerostomia and mucosal with ART for N2 and N3 patients
								− 72.7% (ART)
								− 68.1% (No-ART) p = .3

^a = Prospective studies (non-randomized);

^b = Adjuvant RT; µ = Definitive RT.

Nb pts: number of patients; LAHNC: locally advanced head and neck cancer; OPC: oropharynx cancer; NPC: nasopharyngeal carcinoma; Nb: number; ART: adaptive radiotherapy; Fr: fraction; LRC: loco-regional control; LRFS: loco-regional free survival; DFS: disease-free survival; OS: overall survival.

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