title: Assessment and topographic characterization of locoregional recurrences in head and neck tumours.
abstract: OBJECTIVE
  To evaluate the differences between three methods of classification of recurrences in patients with head and neck tumours treated with Radiation Therapy (RT).
  
  
  METHODS
  367 patients with head and neck tumours were included in the study. Tumour recurrences were delineated in the CT images taken during patient follow-up and deformable registration was used to transfer this volume into the planning CT. The methods used to classify recurrences were: method CTV quantified the intersection volume between the recurrence and the Clinical Target Volume (CTV); method TV quantified the intersection between the Treated Volume and the recurrence (for method CTV and TV, recurrences were classified in-field if more than 95% of their volume were inside the volume of interest, marginal if the intersection was between 20-95% and outfield otherwise); and method COM was based on the position of the Centre Of Mass of the recurrence. A dose assessment in the recurrence volume was also made.
  
  
  RESULTS
  The 2-year Kaplan-Meier locoregional recurrence incidence was 10%. Tumour recurrences occurred in 22 patients in a mean time of 16.5 ± 9.4 months resulting in 28 recurrence volumes. The percentage of in-field recurrences for methods CTV, TV and COM was 7%, 43% and 50%, respectively. Agreement between the three methods in characterizing individually in-field and marginal recurrences was found only in six cases. Methods CTV and COM agreed in 14. The percentage of outfield recurrences was 29% using all methods. For local recurrences (in-field or marginal to gross disease) the average difference between the prescribed dose and D 98% in the recurrence volume was -5.2 ± 3.5% (range: -10.1%-0.9%).
  
  
  CONCLUSIONS
  The classification of in-field and marginal recurrences is very dependent on the method used to characterize recurrences. Using methods TV and COM the largest percentage of tumour recurrences occurred in-field in tissues irradiated with high doses.
authors.affiliation: I3N Physics Department, Aveiro University, Aveiro, Portugal. brigida@ua.pt.|Serviço de Física Médica, Inst. Port. Oncology of Coimbra, Av. Bissaya Barreto 3000-075, Coimbra, Portugal. brigida@ua.pt.
authors.forename: Brigida Costa
authors.initials: BC
authors.lastname: Ferreira
authors.affiliation: Radiation Therapy Department, Portuguese Oncology Institute of Coimbra Francisco Gentil (IPOCFG), Coimbra, Portugal. ruivalemm@hotmail.com.
authors.forename: Rui Vale
authors.initials: RV
authors.lastname: Marques
authors.affiliation: Radiation Therapy Department, Portuguese Oncology Institute of Coimbra Francisco Gentil (IPOCFG), Coimbra, Portugal. leilakhouri@ipocoimbra.min-saude.pt.
authors.forename: Leila
authors.initials: L
authors.lastname: Khouri
authors.affiliation: Physics Department, Coimbra University, Coimbra, Portugal. tfilipa_santos@hotmail.com.
authors.forename: Tânia
authors.initials: T
authors.lastname: Santos
authors.affiliation: Center for Research and Development in Mathematics and Applications and Department of Mathematics, Aveiro University, Aveiro, Portugal. p.sa.couto@ua.pt.
authors.forename: Pedro
authors.initials: P
authors.lastname: Sá-Couto
authors.affiliation: Medical Physics Department, Portuguese Oncology Institute of Coimbra Francisco Gentil, Coimbra, Portugal. mclopes@ipocoimbra.min-saude.pt.
authors.forename: Maria
authors.initials: M
authors.lastname: do Carmo Lopes
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002294:Carcinoma, Squamous Cell / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006258:Head and Neck Neoplasms / Q000401:mortality / Q000473:pathology / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000145:classification* / Q000175:diagnosis* / Q000209:etiology; D009367:Neoplasm Staging; D011379:Prognosis; D011878:Radiotherapy / Q000009:adverse effects*; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods; D050397:Radiotherapy, Intensity-Modulated / Q000379:methods*; D012189:Retrospective Studies; D018570:Risk Assessment; D015996:Survival Rate; D014057:Tomography, X-Ray Computed / Q000379:methods; D055815:Young Adult