title: Clinical outcomes of adaptive radiotherapy in head and neck cancers.
abstract: OBJECTIVE
  The present study evaluated the efficacy and toxicity of adaptive radiotherapy (RT) among patients with head and neck cancer.
  
  
  METHODS
  36 patients eligible for radical RT underwent RT planning scans and were planned for 54-Gy dose to both high-risk and low-risk target volumes in Phase I. All patients underwent a second (adaptive) scan during the fifth week of RT. Phase II plans for 16 Gy to high-risk planning target volume were developed on these mid-treatment scans. The primary end point was local response. Disease-free survival (DFS), overall survival (OS) and treatment-related morbidity were secondary end points.
  
  
  RESULTS
  Median reductions in gross primary and nodal disease volumes on mid-treatment scans were 34% and 43.2%, respectively. 16 patients experienced grade 3 acute mucositis. No patient had grade 3 or above haematologic toxicity. Four patients developed local recurrences, all within the RT field. Median DFS and OS were 17.5 and 23.5 months, respectively.
  
  
  CONCLUSIONS
  Adaptation to changes in the anatomic and tumour volume or shape may help tilt the balance towards more efficient dose delivery as well as better normal tissue sparing.
  
  
  CONCLUSIONS
  This study supports the need for adaptive replanning for minimizing normal tissue toxicity without compromising local control and adds to the existing body of literature.
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Tejinder
authors.initials: T
authors.lastname: Kataria
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Deepak
authors.initials: D
authors.lastname: Gupta
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Shikha
authors.initials: S
authors.lastname: Goyal
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Shyam S
authors.initials: SS
authors.lastname: Bisht
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Trinanjan
authors.initials: T
authors.lastname: Basu
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Ashu
authors.initials: A
authors.lastname: Abhishek
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Kushal
authors.initials: K
authors.lastname: Narang
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Susovan
authors.initials: S
authors.lastname: Banerjee
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Shahida
authors.initials: S
authors.lastname: Nasreen
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Sasikumar
authors.initials: S
authors.lastname: Sambasivam
authors.affiliation: Division of Radiation Oncology, Medanta-The Medicity, Gurgaon, Haryana, India.
authors.forename: Aruj
authors.initials: A
authors.lastname: Dhyani
mesh_terms: D000328:Adult; D000368:Aged; D019583:Dose Fractionation, Radiation; D005260:Female; D006258:Head and Neck Neoplasms / Q000175:diagnosis / Q000532:radiotherapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011832:Radiation Injuries / Q000209:etiology* / Q000517:prevention & control; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D020266:Radiotherapy, Conformal / Q000009:adverse effects*; D016896:Treatment Outcome