Lee Victor Shing-Cheung, SchettIno Giuseppe, Nisbet Andrew
Department of Medical Physics & Biomedical Engineering, University College London, London, UK.
BJR Open. 2020 Dec 11;2(1):20200051. doi: 10.1259/bjro.20200051. eCollection 2020.
To provide evidence on the extent and manner in which adaptive practices have been employed in the UK and identify the main barriers for the clinical implementation of adaptive radiotherapy (ART) in head and neck (HN) cancer cases.
In December 2019, a Supplementary Material 1, of 23 questions, was sent to all UK radiotherapy centres (67). This covered general information to current ART practices and perceived barriers to implementation.
31 centres responded (46%). 56% responding centres employed ART for between 10 and 20 patients/annum. 96% of respondents were using CBCT either alone or with other modalities for assessing "weight loss" and "shell gap," which were the main reasons for ART. Adaptation usually occurs at week three or four during the radiotherapy treatment. 25 responding centres used an online image-guided radiotherapy (IGRT) approach and 20 used an offline ART approach, either with or without protocol level. Nearly 70% of respondents required 2 to 3 days to create an adaptive plan and 95% used 3-5 mm adaptive planning target volume margins. All centres performed pre-treatment QA. "Limited staff resources" and "lack of clinical relevance" were identified as the two main barriers for ART implementation.
There is no consensus in adaptive practice for HN cancer patients across the UK. For those centres not employing ART, similar clinical implementation barriers were identified.
An insight into contemporary UK practices of ART for HN cancer patients indicating national guidance for ART implementation for HN cancer patients may be required.
提供关于英国采用适应性放疗实践的程度和方式的证据，并确定头颈部（HN）癌症病例中适应性放疗（ART）临床实施的主要障碍。
2019年12月，向英国所有放疗中心（共67个）发送了一份包含23个问题的补充材料1。内容涵盖当前ART实践的一般信息以及实施过程中存在的障碍。
31个中心做出了回应（回应率为46%）。56%做出回应的中心每年为10至20名患者采用ART。96%的受访者单独或与其他方式结合使用CBCT来评估“体重减轻”和“靶区外扩”，这是采用ART的主要原因。适应性调整通常在放疗治疗的第三周或第四周进行。25个做出回应的中心采用在线图像引导放疗（IGRT）方法，20个采用离线ART方法，无论是否有方案层面的规定。近70%的受访者需要2至3天来制定适应性计划，95%的受访者采用3至5毫米的适应性计划靶区边界。所有中心都进行了治疗前质量保证。“人员资源有限”和“缺乏临床相关性”被确定为ART实施的两个主要障碍。
英国HN癌症患者的适应性放疗实践尚无共识。对于那些未采用ART的中心，也发现了类似的临床实施障碍。
对英国当代HN癌症患者ART实践的洞察表明，可能需要针对HN癌症患者ART实施的国家指南。
