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Volumetric and dosimetric comparison in adaptive radiotherapy for patients with head and neck cancer:a systematic review and Meta-analysis
Zhang Biao,Jia Pengfei,Tang Lemin
Medical School of Nantong University,Nantong 226001,China (Zhang B,Tang LM);Department of Radiation Oncology,Affiliated Hospital of Nantong University,Nantong 226001,China (Jia PF)
Objective To perform a systematic review and Meta-analysis on volumetric and dosimetric changes in target volumes and organs at risk (OARs) in adaptive radiotherapy (ART) for patientswith head and neck cancer (HNC), and to investigate the role of ART in the treatment of HNC. Methods Literature retrieval was performed to include related studies, and the parameters of primary tumor, GTV-T and GTV-N, parotid volume, D95 and Dmean of target volumes, Dmean of ipsilateral and contralateral parotid volume (I-PG and C-PG), and Dmax of the spinal cord and brainstem. Results A total of 17 studies involving 336 patients were included in the meta-analysis. Primary tumor and parotid volume changed significantly. The volumes of GTV-T, GTV-N, and I-PG were significantly reduced during the 15-20th radiotherapy and after the 20th radiotherapy (P<0.05), and the C-PG was significantly reduced after the 20th radiotherapy (P=0.004). The analysis of actual dose showed that the D95 and Dmean of primary tumor showed no significant differences, and during the 15-20th radiotherapy, the Dmax of the spinal cord was increased by 2.26 Gy (P=0.000), while the Dmax of the brainstem showed no significant changes before the 20th radiotherapy and was increased by 1.78 Gy after the 25th radiotherapy (P=0.020). In addition, the Dmean of I-PG was increased by 2 Gy during the 20-25th radiotherapy (P=0.0001), and the Dmean of C-PG was increased before the 20th radiotherapy and showed no significant changes after the 25th radiotherapy (P=0.110). The dosimetric analysis of ART showed that the Dmax of the spinal cord and brainstem was reduced significantly (spinal cord:MD=-2.15, 95% CI-3.12 to -1.18,P=0.000;brainstem:MD=-2.20, 95% CI-3.32 to -1.09, P=0.000). The Dmean of I-PG was reduced by about 3.5 Gy, and the sensitivity analysis revealed that the results of Dmean of C-PG were unstable. Conclusions The volumes of primary tumors and parotid glands change significantly, and the actual doses of OARs (Dmax of the spinal cord and brainstem and Dmean of the parotid glands) significantly increase, while the doses of GTV-T and GTV-N show no significant changes. ART can effectively protect the OARs, and patients with locally advanced HNC who receive concurrent chemoradiotherapy can obtain good dose gains from ART plan performed during the 15-20th radiotherapy and at about the 25th radiotherapy.
Zhang Biao,Jia Pengfei,Tang Lemin. Volumetric and dosimetric comparison in adaptive radiotherapy for patients with head and neck cancer:a systematic review and Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 557-564.
Zhang Biao,Jia Pengfei,Tang Lemin. Volumetric and dosimetric comparison in adaptive radiotherapy for patients with head and neck cancer:a systematic review and Meta-analysis[J]. Chinese Journal of Radiation Oncology, 2016, 25(6): 557-564.
[1] Rades D,Fehlauer F,Wroblesky J,et al. Prognostic factors in head-and-neck cancer patients treated with surgery followed by intensity-modulated radiotherapy (IMRT),3D-conformal radiotherapy,or conventional radiotherapy[J].Oral Oncol,2007,43(6):535-543.DOI:10.1016/j.oraloncology.2006.05.006. [2] Nutting C,A’Hern R,Rogers MS,et al. First results of a phase Ⅲ multicenter randomized controlled trial of intensity modulated (IMRT) versus conventional radiotherapy (RT) in head and neck cancer (PARSPORT:ISRCTN48243537;CRUK/03/005)[J].J Clin Oncol,2009,27(18S):LBA6006. [3] Rusthoven KE,Raben D,Ballonoff A,et al. Effect of radiation techniques in treatment of oropharynx cancer[J].Laryngoscope,2008,118(4):635-639.DOI:10.1097/MLG.0b013e31815fdf0e. [4] Kam KM,Leung SF,Zee B,et al. Prospective randomized study of intensity-modulated radiotherapy on salivary gland function in early-stage nasopharyngeal carcinoma patients[J].J Clin Oncol,2007,25(31):4873-4879.DOI:10.1200/JCO.2007.11.5501. [5] Han CH,Chen YJ,Liu A,et al. Actual dose variation of parotid glands and spinal cord for nasopharyngeal cancer patients during radiotherapy[J].Int J Radiat Oncol Biol Phys,2008,70(4):1256-1262.DOI:10.1016/j.ijrobp.2007.10.067. [6] Hansen EK,Larson DA,Aubin M,et al. Image-guided radiotherapy using megavoltage cone-beam computed tomography for treatment of paraspinous tumors in the presence of orthopedic hardware[J].Int J Radiat Oncol Biol Phys,2006,66(2):323-326.DOI:10.1016/j.ijrobp.2006.05.038. [7] Ding GX,Duggan DM,Coffey CW,et al. A study on adaptive IMRT treatment planning using KV cone-beam CT[J].Radiother Oncol,2007,85(1):116-125.DOI:10.1016/j.radonc.2007.06.015. [8] Hansen EK,Bucci MK,Quivey JM,et al. Repeat CT imaging and replanning during the course of IMRT for head-and-neck cancer[J].Int J Radiat Oncol Biol Phys,2006,64(2):355-362.DOI:10.1016/j.ijrobp.2005.07.957. [9] Wells GA,Shea B,O’Connell D,et al. The Newcastle-Ottawa Scale (NOS) for assessing the quality of nonrandomised studies in Metaanalyses[EB/OL].[2015-01-04].http://www.ohri.ca/programs/clinical-epidemiology/oxford.asp. [10] Wang W,Yang HH,Hu W,et al. Clinical study of the necessity of replanning before the 25th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma[J].Int J Radiat Oncol Biol Phys,2010,77(2):617-621.DOI:10.1016/j.ijrobp.2009.08.036. [11] Bhide SA,Davies M,Burke K,et al. Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer:a prospective observational study[J].Int J Radiat Oncol Biol Phys,2010,76(5):1360-1368.DOI:10.1016/j.ijrobp.2009.04.005. [12] Ahn PH,Chen CC,Ahn AI,et al. Adaptive planning in intensity-modulated radiation therapy for head and neck cancers:single-institution experience and clinical implications[J].Int J Radiat Oncol Biol Phys,2011,80(3):677-685.DOI:10.1016/j.ijrobp.2010.03.014. [13] Zhao L,Wan QY,Zhou YQ,et al. The role of replanning in fractionated intensity modulated radiotherapy for nasopharyngeal carcinoma[J].Radiother Oncol,2011,98(1):23-27.DOI:10.1016/j.radonc.2010.10.009. [14] Capelle L,Mackenzie M,Field C,et al. Adaptive radiotherapy using helical tomotherapy for head and neck cancer in definitive and postoperative settings:initial results[J].Clinical Oncology,2012,24(3):208-215.DOI:10.1016/j.clon.2011.11.005. [15] Cheng HCY,Wu VWC,Ngan RKC,et al. A prospective study on volumetric and dosimetric changes during intensity-modulated radiotherapy for nasopharyngeal carcinoma patients[J].Radiother Oncol,2012,104(3):317-323.DOI:10.1016/j.radonc.2012.03.013. [16] Fung WWK,Wu VWC,Teo PML.Dosimetric evaluation of a three-phase adaptive radiotherapy for nasopharyngeal carcinoma using helical tomotherapy[J].Med Dosim,2012,37(1):92-97.DOI:10.1016/j.meddos.2011.01.006. [17] Zhang X,Li M,Cao J,et al. Dosimetric variations of target volumes and organs at risk in nasopharyngeal carcinoma intensity-modulated radiotherapy[J].Br J Radiol,2012,85(1016):e506-e513.DOI:10.1259/bjr/20695672. [18] Nishi T,Nishimura Y,Shibata T,et al. Volume and dosimetric changes and initial clinical experience of a two-step adaptive intensity modulated radiation therapy (IMRT) scheme for head and neck cancer[J].Radiother Oncol,2013,106(1):85-89.DOI:10.1016/j.radonc.2012.11.005. [19] Chen CB,Lin X,Pan JJ,et al. Is it necessary to repeat CT imaging and replanning during the course of intensity-modulated radiation therapy for locoregionally advanced nasopharyngeal carcinoma?[J].Japan J Radiol,2013,31(9):593-599.DOI:10.1007/s11604-013-0225-5. [20] Berwouts D,Olteanu LAM,Duprez F,et al. Three-phase adaptive dose-painting-by-numbers for head-and-neck cancer:initial results of the phase I clinical trial[J].Radiother Oncol,2013,107(3):310-316.DOI:10.1016/j.radonc.2013.04.002. [21] Lu J,Ma YD,Chen JH,et al. Assessment of anatomical and dosimetric changes by a deformable registration method during the course of intensity-modulated radiotherapy for nasopharyngeal carcinoma[J].J Radiat Res,2014,55(1):97-104.DOI:10.1093/jrr/rrt076. [22] Bhandari V,Patel P,Gurjar OP,et al. Impact of repeat computerized tomography replans in the radiation therapy of head and neck cancers[J].J Med Phys,2014,39(3):164-168.DOI:10.4103/0971-6203.139005. [23] Wang RH,Zhang SX, Zhou LH,et al. Volume and dosimetric variations during two-phase adaptive intensity-modulated radiotherapy for locally advanced nasopharyngeal carcinoma[J].Biomed Mater Eng,2014,24(1):1217-1225.DOI:10.3233/BME-130923. [24] Castelli J,Simon A,Louvel G,et al. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia[J].Radiat Oncol,2015,10:6.DOI:10.1186/s13014-014-0318-z. [25] Wang W,Yang HH,Mi YC,et al. Rules of parotid gland dose variations and shift during intensity modulated radiation therapy for nasopharyngeal carcinoma[J].Radiat Oncol,2015,10:3.DOI:10.1186/s13014-014-0307-2. [26] Jin XC,Hu WG,Shang HJ,et al. CBCT-based volumetric and dosimetric variation evaluation of volumetric modulated arc radiotherapy in the treatment of nasopharyngeal cancer patients[J].Radiat Oncol,2013,8:279.DOI:10.1186/1748-717X-8-279. [27] Tan WY,Li YP,Han G,et al. Target volume and position variations during intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma[J].Onco Targets Ther,2013,6:1719-1728.DOI:10.2147/OTT.S53639. [28] Schwartz DL,Garden AS,Shah SJ,et al. Adaptive radiotherapy for head and neck cancer-Dosimetric results from a prospective clinical trial[J].Radiother Oncol,2013,106(1):80-84.DOI:10.1016/j.radonc.2012.10.010. [29] McMillan AS,Pow EHN,Leung WK,et al. Oral health-related quality of life in disease-free survivors following radiotherapy for nasopharyngeal carcinoma[J].J Oral Rehabil,2004,31(6):600-608.DOI:10.1111/j.1365-2842.2004.01383.x. [30] Roesink JM,Schipper M,Busschers W,et al. A comparison of mean parotid gland dose with measures of parotid gland function after radiotherapy for head-and-neck cancer:implications for future trials[J].Int J Radiat Oncol Biol Phys,2005,63(4):1006-1009.DOI:10.1016/j.ijrobp.2005.04.023. [31] Vergeer MR,Doornaert PAH,Rietveld DHF,et al. Intensity-modulated radiotherapy reduces radiation-induced morbidity and improves health-related quality of life:results of a nonrandomized prospective study using a standardized follow-up program[J].Int J Radiat Oncol Biol Phys,2009,74(1):1-8.DOI:10.1016/j.ijrobp.2008.07.059. [32] Jabbari S,Kim HM,Feng M,et al. Matched case-control study of quality of life and xerostomia after intensity-modulated radiotherapy or standard radiotherapy for head-and-neck cancer:initial report[J].Int J Radiat Oncol Biol Phys,2005,63(3):725-731.DOI:10.1016/j.ijrobp.2005.02.045. [33] Lee C,Langen KM,Lu WG,et al. Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration[J].Int J Radiat Oncol Biol Phys,2008,71(5):1563-1571.DOI:10.1016/j.ijrobp.2008.04.013. [34] Elstrm UV,Wysocka BA,Muren LP,et al. Daily kV cone-beam CT and deformable image registration as a method for studying dosimetric consequences of anatomic changes in adaptive IMRT of head and neck cancer[J].Acta Oncol,2010,49(7):1101-1108.DOI:10.3109/0284186X.2010.500304. [35] Kierkels RG,Pickup LC,Gooding MJ,et al. Rigid dose transformation as a surrogate for dose recalculation when assessing the need for adaptive re-planning in head and neck cancer patients[J].Int J Radiat Oncol Biol Phys,2014,90(1):S107.DOI:10.1016/j.ijrobp.2014.05.522.
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