title: Adaptive radiation therapy in head and neck cancer for clinical practice: state of the art and practical challenges.
abstract: Modern radiation therapy techniques are characterized by high conformality to tumor volumes and steep dose gradients to spare normal organs. These techniques require accurate clinical target volume definitions and rigorous assessment of set up uncertainties using image guidance, a concept called image-guided radiation therapy. Due to alteration of patient anatomy, changes in tissue density/volumes and tumor shrinkage over the course of treatment, treatment accuracy may be challenged. This may result in excessive irradiation of organs at risk/healthy tissues and undercoverage of target volumes with a significant risk of locoregional failure. Adaptive radiation therapy (ART) is a concept allowing the clinician to reconsider the planned dose based on potential changes to accurately delivering the remaining radiation dose to the tumor while optimally minimizing irradiation of healthy tissues. There is little consensus on how to apply this concept in clinical practice. The current review investigates the current ART issues, including patient selection, clinical/dosimetric criteria and timing for re-planning, and practical technical issues. A practical algorithm is proposed for patient management in cases where ART is required.
authors.affiliation: Oncology Radiotherapy, Centre Henri Becquerel, Rouen, France.
authors.forename: Ovidiu
authors.initials: O
authors.lastname: Veresezan
authors.affiliation: Oncology Radiotherapy Pitié Salepêtrière, 47-83 boulevard de l'Hôpital, 75013, Paris, France.
authors.forename: Idriss
authors.initials: I
authors.lastname: Troussier
authors.affiliation: Centre d'imagerie Médicale, 47, Boulevard du Pont Rouge, 15000, Aurillac, France. lacout.alexis@wanadoo.fr.
authors.forename: Alexis
authors.initials: A
authors.lastname: Lacout
authors.affiliation: Medical Oncology Radiotherapy, Georges Pompidou European Hospital, Paris Descartes University, Paris, France.
authors.forename: Sarah
authors.initials: S
authors.lastname: Kreps
authors.affiliation: Department Head and Neck, Centre Oscar Lambret, 3 rue Frédéric Combemale, BP 307-59020, Lille Cedex, France.
authors.forename: Sophie
authors.initials: S
authors.lastname: Maillard
authors.affiliation: Saint Michel Centre, Rue du Dr Schweitzer, 17000, La Rochelle, France.
authors.forename: Aude
authors.initials: A
authors.lastname: Toulemonde
authors.affiliation: Department of Radiology, Centre Lacassagne, 33 Av de la Lanterne, 06189, Nice, France.
authors.forename: Pierre-Yves
authors.initials: PY
authors.lastname: Marcy
authors.affiliation: , CHU Tenon, 75020, Paris, France.
authors.forename: Florence
authors.initials: F
authors.lastname: Huguet
authors.affiliation: Department of Radiation Oncology/Institut Universitaire de la Face et du Cou-Cancer Centre Antoine-Lacassagne, University Nice Sophia-Antipolis, 33 Av. Valombrose, 06189, Nice Cedex 2, France.
authors.forename: Juliette
authors.initials: J
authors.lastname: Thariat
mesh_terms: D006258:Head and Neck Neoplasms / Q000532:radiotherapy*; D006801:Humans; D011879:Radiotherapy Dosage; D011880:Radiotherapy Planning, Computer-Assisted / Q000379:methods*; D011881:Radiotherapy, Computer-Assisted / Q000379:methods*
keywords: Adaptive radiation therapy; Anatomy; Dose; Head and neck squamous cell cancer; Image guided radiotherapy (IGRT); Replanning