Figen Metin, Çolpan Öksüz Didem, Duman Evrim, Prestwich Robin, Dyker Karen, Cardale Kate, Ramasamy Satiavani, Murray Patrick, Şen Mehmet
Department of Radiation Oncology Şişli Hamidiye Etfal Training and Research Hospital, Istanbul, Turkey.
Department of Radiation Oncology, Cerrahpaşa Faculty of Medicine, Istanbul University-Cerrahpaşa, Istanbul, Turkey.
Front Oncol. 2020 Nov 12;10:579917. doi: 10.3389/fonc.2020.579917. eCollection 2020.
A proportion of patients receiving radiotherapy for head and neck squamous cell carcinoma (HNSCC) require treatment re-planning. The aim of this retrospective study is to analyze the patients who required re-planning and to identify factors, which may predict need for re-planning.
A single center evaluation of all patients receiving radical or adjuvant (chemo)radiotherapy (CRT) for HNSCC between January and December 2016 was undertaken. Patients who underwent re-planning during the treatment were identified in electronic records. Reasons for re-planning were categorized as: weight loss, tumor shrinkage, changes in patient position and immobilization-related factors. Potential trigger factors for adaptive radiotherapy such as patient characteristics, primary tumor site, stage, concomitant chemotherapy, weight loss ratios, radical/adjuvant treatment, and nutritional interventions were investigated.
31/290 (10.6%) HNSCC patients who underwent radical/adjuvant radiotherapy required re-planning. The adaptive radiotherapy (ART) was performed at a mean fraction of 15. The most common documented reasons for re-planning were tumor shrinkage (35.5%) and weight loss (35.5%). Among the patient/tumor/treatment factors, nasopharyngeal primary site (p = 0.013) and use of concurrent chemotherapy with radiotherapy (p = 0.034) were found to be significantly correlated with the need for re-planning.
Effective on-treatment verification schedules and close follow up of patients especially with NPC primary and/or treated with concurrent chemoradiotherapy are crucial to identify patients requiring ART. We suggest an individualized triggered approach to ART rather than scheduled strategies as it is likely to be more feasible in terms of utilization of workload and resources.
一部分接受头颈部鳞状细胞癌（HNSCC）放射治疗的患者需要重新规划治疗方案。这项回顾性研究的目的是分析需要重新规划治疗方案的患者，并确定可能预测重新规划需求的因素。
对2016年1月至12月期间在单一中心接受HNSCC根治性或辅助性（化疗）放疗（CRT）的所有患者进行评估。在电子记录中识别出治疗期间进行重新规划的患者。重新规划的原因分为：体重减轻、肿瘤缩小、患者体位变化和固定相关因素。研究了适应性放疗的潜在触发因素，如患者特征、原发肿瘤部位、分期、同步化疗、体重减轻比例、根治性/辅助性治疗以及营养干预措施。
290例接受根治性/辅助性放疗的HNSCC患者中有31例（10.6%）需要重新规划治疗方案。适应性放疗（ART）平均在第第15分次时进行。重新规划最常见的记录原因是肿瘤缩小（35.5%）和体重减轻（35.5%）。在患者/肿瘤/治疗因素中，发现鼻咽原发部位（p = 0.013）和放疗同步化疗的使用（p = 0.034）与重新规划的需求显著相关。
有效的治疗期间验证计划以及对患者，尤其是鼻咽癌原发患者和/或接受同步放化疗患者的密切随访，对于识别需要适应性放疗的患者至关重要。我们建议采用个体化触发式适应性放疗方法，而非预定策略，因为就工作量和资源利用而言，前者可能更可行
