An efficient strategy to select head and neck cancer patients for adaptive radiotherapy.

BACKGROUND AND PURPOSE

Adaptive radiotherapy (ART) is workload intensive but only benefits a subgroup of patients. We aimed to develop an efficient strategy to select candidates for ART in the first two weeks of head and neck cancer (HNC) radiotherapy.

MATERIALS AND METHODS

This study retrospectively enrolled 110 HNC patients who underwent modern photon radiotherapy with at least 5 weekly in-treatment re-scan CTs. A semi auto-segmentation method was applied to obtain the weekly mean dose (D) to OARs. A comprehensive NTCP-profile was applied to obtain NTCP's. The difference between planning and actual values of D (ΔD) and dichotomized difference of clinical relevance (BIOΔNTCP) were used for modelling to determine the cut-off maximum ΔD of OARs in week 1 and 2 (maxΔD and maxΔD). Four strategies to select candidates for ART, using cut-off maxΔD were compared.

RESULTS

The Spearman's rank correlation test showed significant positive correlation between maxΔD and BIOΔNTCP (p-value <0.001). For major BIOΔNTCP (>5%) of acute and late toxicity, 10.9% and 4.5% of the patients were true candidates for ART. Strategy C using both cut-off maxΔD (3.01 and 5.14 Gy) and cut-off maxΔD (3.41 and 5.30 Gy) showed the best sensitivity, specificity, positive and negative predictive values (0.92, 0.82, 0.38, 0.99 for acute toxicity and 1.00, 0.92, 0.38, 1.00 for late toxicity, respectively).

CONCLUSIONS

We propose an efficient selection strategy for ART that is able to classify the subgroup of patients with >5% BIOΔNTCP for late toxicity using imaging in the first two treatment weeks.