Clinical practice guidance for radiotherapy planning after induction chemotherapy in locoregionally advanced head-and-neck cancer.
OBJECTIVE
The use of induction chemotherapy (IC) for locoregionally advanced head-and-neck cancer is increasing. The response to IC often causes significant alterations in tumor volume and location and shifts in normal anatomy. Proper determination of the radiotherapy (RT) targets after IC becomes challenging, especially with the use of conformal and precision RT techniques. Therefore, a consensus conference was convened to discuss issues related to RT planning and coordination of care for patients receiving IC.


METHODS
Ten participants with special expertise in the various aspects of integration of IC and RT for the treatment of locoregionally advanced head-and-neck cancer, including radiation oncologists, medical oncologists, and a medical physicist, participated. The individual members were assigned topics for focused, didactic presentations. Discussion was encouraged after each presentation, and recommendations were formulated.


RESULTS
Recommendations and guidelines emerged that emphasize up-front evaluation by all members of the head-and-neck management team, high-quality baseline and postinduction planning scans with the patient in the treatment position, the use of preinduction target volumes, and the use of full-dose RT, even in the face of a complete response.


CONCLUSIONS
A multidisciplinary approach is strongly encouraged. Although these recommendations were provided primarily for patients treated with IC, many of these same principles apply to concurrent chemoradiotherapy without IC. A rapid response during RT is quite common, requiring the development of two or more plans in a sizeable fraction of patients, and suggesting the need for similar guidance in the rapidly evolving area of adaptive RT.
Salama
Joseph K
JK
Department of Radiationand Cellular Oncology, University of Chicago, 5758 S. Maryland Ave., Chicago, IL 60637, USA. jsalama@radonc.uchicago.edu
Haddad
Robert I
RI
Kies
Merril S
MS
Busse
Paul M
PM
Dong
Lei
L
Brizel
David M
DM
Eisbruch
Avraham
A
Tishler
Roy B
RB
Trotti
Andy M
AM
Garden
Adam S
AS
D003131:Combined Modality Therapy / Q000379:methods / Q000592:standards; D019788:Fluorodeoxyglucose F18; D006258:Head and Neck Neoplasms / Q000000981:diagnostic imaging / Q000188:drug therapy* / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D015596:Nutrition Assessment; D010808:Physical Examination / Q000592:standards; D049268:Positron-Emission Tomography / Q000379:methods; D019275:Radiopharmaceuticals; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods / Q000592:standards*; D012074:Remission Induction; D014057:Tomography, X-Ray Computed / Q000379:methods; D047368:Tumor Burden
D019275:Radiopharmaceuticals; D019788:Fluorodeoxyglucose F18