ABSTRACT
The definitive treatment of head and neck cancers requires a multidisciplinary approach in which radiotherapy plays a pivotal role. The standard radiation regimen for head and neck cancers typically involves administering 30-37 fractions of treatment. The impact of alterations in patient anatomy and tumor biology that may arise throughout the course of treatment on the ultimate end result is a subject of scientific interest. The technique known as “adaptive radiotherapy” involves the modification of the initial treatment plan in response to changes observed over the course of treatment, with the objective of creating an improved treatment plan. This technique involves tailoring the therapy to account for several factors, including potential changes in the tumor volume, alterations in tumor biology, weight loss, muscle atrophy, inflammation, and normal tissue changes that may arise throughout the course of treatment. The primary objective is to identify the most optimal definitive treatment strategy. This review aims to explore the utilization of positron emission tomography in adaptive radiotherapy approaches for head and neck cancers, drawing upon relevant literature references.
Keywords:
Head and neck cancer, adaptive radiotherapy, PET/CT
References
1
Argiris A, Karamouzis MV, Raben D, Ferris RL. Head and neck cancer. Lancet 2008;3719625:1695-1709.
2
Lacas B, Carmel A, Landais C, et al. Meta-analysis of chemotherapy in head and neck cancer (MACH-NC): An update on 107 randomized trials and 19,805 patients, on behalf of MACH-NC Group. Radiother Oncol 2021;156:281-293.
3
Network NCC. Head and Neck Cancers (Version 1.2023) [January 24, 2023]. Available from: https://www.nccn.org/professionals/physician_gls/pdf/head-and-neck.pdf.
4
Morgan HE, Sher DJ. Adaptive radiotherapy for head and neck cancer. Cancers Head Neck 2020;51:1
5
Lee C, Langen KM, Lu W, et al. Assessment of parotid gland dose changes during head and neck cancer radiotherapy using daily megavoltage computed tomography and deformable image registration. Int J Radiat Oncol Biol Phys 2008;715:1563-1571.
6
Castelli J, Simon A, Louvel G, et al. Impact of head and neck cancer adaptive radiotherapy to spare the parotid glands and decrease the risk of xerostomia. Radiat Oncol 2015;10:6.
7
Bussink J, van Herpen CM, Kaanders JH, Oyen WJ. PET-CT for response assessment and treatment adaptation in head and neck cancer. Lancet Oncol 2010;117:661-669.
8
Ljungkvist AS, Bussink J, Kaanders JH, Wiedenmann NE, Vlasman R, van der Kogel AJ. Dynamics of hypoxia, proliferation and apoptosis after irradiation in a murine tumor model. Radiat Res 2006;1653:326-336.
9
Langius JA, Twisk J, Kampman M, et al. Prediction model to predict critical weight loss in patients with head and neck cancer during (chemo)radiotherapy. Oral Oncol 2016;52:91-96.
10
Bhide SA, Davies M, Burke K, et al. Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer: a prospective observational study. Int J Radiat Oncol Biol Phys 2010;765:1360-1368.
11
Liu Q, Liang J, Zhou D, et al. Dosimetric Evaluation of Incorporating Patient Geometric Variations Into Adaptive Plan Optimization Through Probabilistic Treatment Planning in Head and Neck Cancers. Int J Radiat Oncol Biol Phys 2018;1014:985-997.
12
Beltran M, Ramos M, Rovira JJ, et al. Dose variations in tumor volumes and organs at risk during IMRT for head-and-neck cancer. J Appl Clin Med Phys 2012;136:3723.
13
Wang W, Yang H, Hu W, et al. Clinical study of the necessity of replanning before the 25th fraction during the course of intensity-modulated radiotherapy for patients with nasopharyngeal carcinoma. Int J Radiat Oncol Biol Phys 2010;772:617-621.
14
Chen AM, Daly ME, Cui J, Mathai M, Benedict S, Purdy JA. Clinical outcomes among patients with head and neck cancer treated by intensity-modulated radiotherapy with and without adaptive replanning. Head Neck 2014;3611:1541-1546.
15
Luo Y, Qin Y, Lang J. Effect of adaptive replanning in patients with locally advanced nasopharyngeal carcinoma treated by intensity-modulated radiotherapy: a propensity score matched analysis. Clin Transl Oncol 2017;194:470-476.
16
Daisne JF, Duprez T, Weynand B, et al. Tumor volume in pharyngolaryngeal squamous cell carcinoma: comparison at CT, MR imaging, and FDG PET and validation with surgical specimen. Radiology 2004;2331:93-100.
17
Geets X, Tomsej M, Lee JA, et al. Adaptive biological image-guided IMRT with anatomic and functional imaging in pharyngo-laryngeal tumors: impact on target volume delineation and dose distribution using helical tomotherapy. Radiother Oncol 2007;851:105-115.
18
Huang H, Lu H, Feng G, et al. Determining appropriate timing of adaptive radiation therapy for nasopharyngeal carcinoma during intensity-modulated radiation therapy. Radiat Oncol 2015;10:192.
19
Van den Bosch L, van der Schaaf A, van der Laan HP, et al. Comprehensive toxicity risk profiling in radiation therapy for head and neck cancer: A new concept for individually optimised treatment. Radiother Oncol 2021;157:147-154.
20
Bjordal K, Kaasa S. Psychological distress in head and neck cancer patients 7-11 years after curative treatment. Br J Cancer 1995;713:592-597.
21
van Dijk LV, Noordzij W, Brouwer CL, et al. (18)F-FDG PET image biomarkers improve prediction of late radiation-induced xerostomia. Radiother Oncol 2018;1261:89-95.
22
Li Y, Sijtsema NM, de Vette SPM, et al. Validation of the (18)F-FDG PET image biomarker model predicting late xerostomia after head and neck cancer radiotherapy. Radiother Oncol 2023;180:109458.
23
Hermens AF, Barendsen GW. Changes of cell proliferation characteristics in a rat rhabdomyosarcoma before and after X-irradiation. Eur J Cancer (1965) 1969;52:173-189.
24
Withers HR, Taylor JMG, Maciejewski B. The hazard of accelerated tumor clonogen repopulation during radiotherapy. Acta Oncol 1988;272:131-146.
25
Bourhis J, Overgaard J, Audry H, et al. Hyperfractionated or accelerated radiotherapy in head and neck cancer: a meta-analysis. Lancet 2006;3689538:843-854.
26
Nordsmark M, Bentzen SM, Rudat V, et al. Prognostic value of tumor oxygenation in 397 head and neck tumors after primary radiation therapy. An international multi-center study. Radiother Oncol 2005;771:18-24.
27
Nordsmark M, Overgaard J. A confirmatory prognostic study on oxygenation status and loco-regional control in advanced head and neck squamous cell carcinoma treated by radiation therapy. Radiother Oncol 2000;571:39-43.
28
Bentzen SM. Theragnostic imaging for radiation oncology: dose-painting by numbers. Lancet Oncol 2005;62:112-117.
29
Madani I, Duthoy W, Derie C, et al. Positron emission tomography-guided, focal-dose escalation using intensity-modulated radiotherapy for head and neck cancer. Int J Radiat Oncol Biol Phys 2007;681:126-135.
30
Grosu AL, Souvatzoglou M, Röper B, et al. Hypoxia imaging with FAZA-PET and theoretical considerations with regard to dose painting for individualization of radiotherapy in patients with head and neck cancer. Int J Radiat Oncol Biol Phys 2007;692:541-551.
31
Welz S, Paulsen F, Pfannenberg C, et al. Dose escalation to hypoxic subvolumes in head and neck cancer: A randomized phase II study using dynamic [18F]FMISO PET/CT. Radiother Oncol 2022;171:30-36.
32
Bentzen SM. Repopulation in radiation oncology: perspectives of clinical research. Int J Radiat Biol 2003;797:581-585.
33
Menda Y, Boles Ponto LL, Dornfeld KJ, et al. Kinetic analysis of 3'-deoxy-3'-(18)F-fluorothymidine ((18)F-FLT) in head and neck cancer patients before and early after initiation of chemoradiation therapy. J Nucl Med 2009;507:1028-1035.
34
Troost EG, Bussink J, Hoffmann AL, Boerman OC, Oyen WJ, Kaanders JH. 18F-FLT PET/CT for early response monitoring and dose escalation in oropharyngeal tumors. J Nucl Med 2010;516:866-874.
35
Min M, Lin P, Lee MT, et al. Prognostic role of metabolic parameters of (18)F-FDG PET-CT scan performed during radiation therapy in locally advanced head and neck squamous cell carcinoma. Eur J Nucl Med Mol Imaging 2015;4213:1984-1994.
36
Lin P, Min M, Lee M, et al. Prognostic utility of (18)F-FDG PET-CT performed prior to and during primary radiotherapy for nasopharyngeal carcinoma: Index node is a useful prognostic imaging biomarker site. Radiother Oncol 2016;1201:87-91.
37
Min M, Lin P, Lee M, et al. 18F-FDG PET-CT performed before and during radiation therapy of head and neck squamous cell carcinoma: Are they independent or complementary to each other? J Med Imaging Radiat Oncol 2016;603:433-440.
38
Yom SS, Torres-Saavedra P, Caudell JJ, et al. Reduced-Dose Radiation Therapy for HPV-Associated Oropharyngeal Carcinoma (NRG Oncology HN002). J Clin Oncol 2021;399:956-965.
39
Ferris RL, Flamand Y, Weinstein GS, et al. Phase II Randomized Trial of Transoral Surgery and Low-Dose Intensity Modulated Radiation Therapy in Resectable p16+ Locally Advanced Oropharynx Cancer: An ECOG-ACRIN Cancer Research Group Trial (E3311). J Clin Oncol 2022;402:138-149.
40
Moule RN, Kayani I, Prior T, et al. Adaptive 18fluoro-2-deoxyglucose positron emission tomography/computed tomography-based target volume delineation in radiotherapy planning of head and neck cancer. Clin Oncol (R Coll Radiol) 2011;235:364-371.
41
Hentschel M, Appold S, Schreiber A, et al. Serial FDG-PET on patients with head and neck cancer: implications for radiation therapy. Int J Radiat Biol 2009;859:796-804.
42
Duprez F, De Neve W, De Gersem W, Coghe M, Madani I. Adaptive dose painting by numbers for head-and-neck cancer. Int J Radiat Oncol Biol Phys 2011;804:1045-1055.
43
Trada Y, Keall P, Jameson M, et al. Changes in serial multiparametric MRI and FDG-PET/CT functional imaging during radiation therapy can predict treatment response in patients with head and neck cancer. Eur Radiol 2023;33:8788-8799.
44
Oderinde OM, Shirvani SM, Olcott PD, Kuduvalli G, Mazin S, Larkin D. The technical design and concept of a PET/CT linac for biology-guided radiotherapy. Clin Transl Radiat Oncol 2021;29:106-112.