Limits...
Technical advances and pitfalls in head and neck radiotherapy.

Parvathaneni U, Laramore GE, Liao JJ - J Oncol (2012)

Bottom Line: However, these benefits come with a serious and sobering price.Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose".The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.

ABSTRACT
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

No MeSH data available.


Related in: MedlinePlus

(a): Patient with locally advanced nasopharyngeal cancer showing CT simulation planning CT and a corresponding daily CBCT localization scan acquired during week 4 of treatment. Primary tumor is outlined in red. Note the interval tumor regression evident on CBCT. (b): Superimposed planning CT and CBCT demonstrating obvious anterior-posterior misalignment before then after image-guided correction.
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fig3: (a): Patient with locally advanced nasopharyngeal cancer showing CT simulation planning CT and a corresponding daily CBCT localization scan acquired during week 4 of treatment. Primary tumor is outlined in red. Note the interval tumor regression evident on CBCT. (b): Superimposed planning CT and CBCT demonstrating obvious anterior-posterior misalignment before then after image-guided correction.

Mentions: Treatment planning target volumes, organs at risk, and/or any user-defined regions of interest (ROI) or structures may be visualized. Bony misalignments are readily identified, rectified, and the offsets are automatically recorded. In addition, soft tissue deformations of tumor (e.g., due to regression), as well as normal structures (e.g., due to weight loss) may be identified, and it raises the possibility of “adaptive radiotherapy” (ART) in response to these changes (Figure 3).


Technical advances and pitfalls in head and neck radiotherapy.

Parvathaneni U, Laramore GE, Liao JJ - J Oncol (2012)

(a): Patient with locally advanced nasopharyngeal cancer showing CT simulation planning CT and a corresponding daily CBCT localization scan acquired during week 4 of treatment. Primary tumor is outlined in red. Note the interval tumor regression evident on CBCT. (b): Superimposed planning CT and CBCT demonstrating obvious anterior-posterior misalignment before then after image-guided correction.
© Copyright Policy - open-access
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC3369487&req=5

fig3: (a): Patient with locally advanced nasopharyngeal cancer showing CT simulation planning CT and a corresponding daily CBCT localization scan acquired during week 4 of treatment. Primary tumor is outlined in red. Note the interval tumor regression evident on CBCT. (b): Superimposed planning CT and CBCT demonstrating obvious anterior-posterior misalignment before then after image-guided correction.
Mentions: Treatment planning target volumes, organs at risk, and/or any user-defined regions of interest (ROI) or structures may be visualized. Bony misalignments are readily identified, rectified, and the offsets are automatically recorded. In addition, soft tissue deformations of tumor (e.g., due to regression), as well as normal structures (e.g., due to weight loss) may be identified, and it raises the possibility of “adaptive radiotherapy” (ART) in response to these changes (Figure 3).

Bottom Line: However, these benefits come with a serious and sobering price.Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose".The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

View Article: PubMed Central - PubMed

Affiliation: Department of Radiation Oncology, University of Washington, Seattle, WA 98195, USA.

ABSTRACT
Intensity Modulated Radiotherapy (IMRT) is the standard of care in the treatment of head and neck squamous cell carcinomas (HNSCC) based on level 1 evidence. Technical advances in radiotherapy have revolutionized the treatment of HNSCC, with the most tangible gain being a reduction in long term morbidity. However, these benefits come with a serious and sobering price. Today, there is a greater chance of missing the target/tumor due to uncertainties in target volume definition by the clinician that is demanded by the highly conformal planning process involved with IMRT. Unless this is urgently addressed, our patients would be better served with the historically practiced non conformal radiotherapy, than IMRT which promises lesser morbidity. Image guided radiotherapy (IGRT) ensures the level of set up accuracy warranted to deliver a highly conformal treatment plan and should be utilized with IMRT, where feasible. Proton therapy has a theoretical physical advantage over photon therapy due to a lack of "exit dose". However, clinical data supporting the routine use of this technology for HNSCC are currently sparse. The purpose of this article is to review the literature, discuss the salient issues and make recommendations that address the gaps in knowledge.

No MeSH data available.


Related in: MedlinePlus