ArticleJournal of applied clinical medical physics2023
Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols.
Article in Journal of applied clinical medical physics, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 9 papers.
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Who cites it
9 citing papers in PubMed, 7 citations in OpenAlex.
- Inverse treatment planning using deep learning-based organs at risk in radiotherapy for head and neck cancer: a prospective planning study.Strahlentherapie und Onkologie : Organ der Deutschen Rontgengesellschaft ... [et al] · 2026Article
- Quantitative stability of CT numbers in novel cone-beam CT: An intra-institution cross-scanner and longitudinal analysis.Journal of applied clinical medical physics · 2026Article
- Development of CBCT-Guided Online Adaptive Radiotherapy.Cancers · 2026Review
- Evaluating synthetic CT from deformable registration in directed adaptive radiotherapy for head and neck cancer.Journal of applied clinical medical physics · 2026Article
- Daily adaptive radiotherapy in head and neck squamous cell carcinoma can negatively impact organ at risk dosimetry.Clinical and translational radiation oncology · 2026Article
- Assessment of the optimal timing for projected dose evaluation in head and neck cancer patients treated with helical tomotherapy.Reports of practical oncology and radiotherapy : journal of Greatpoland Cancer Center in Poznan and Polish Society of Radiation Oncology · 2026Article
- Deep learning-based synthetic CT for dosimetric monitoring of combined conventional radiotherapy and lattice boost in large lung tumors.Radiation oncology (London, England) · 2025Article
- Adaptive radiotherapy for head and neck cancer: Pitfalls and possibilities from the radiation oncologist's point of view.Cancer medicine · 2024Review
- Dosimetrically triggered adaptive radiotherapy for head and neck cancer: Considerations for the implementation of clinical protocols.Journal of applied clinical medical physics · 2023Article
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6 authors at 2 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeDefining dosimetric rules to automatically detect patients requiring adaptive radiotherapy (ART) is not straightforward, and most centres perform ad-hoc ART with no specific protocol. This study aims to propose and analyse different steps to design a protocol for dosimetrically triggered ART of head and neck (H&N) cancer. As a proof-of-concept, the designed protocol was applied to patients treated in TomoTherapy units, using their available software for daily MVCT image and dose accumulation.
methodsAn initial protocol was designed by a multidisciplinary team, with a set of flagging criteria based only on dose-volume metrics, including two action levels: (1) surveillance (orange flag), and (2) immediate verification (red flag). This protocol was adapted to the clinical needs following an iterative process. First, the protocol was applied to 38 H&N patients with daily imaging. Automatic software generated the daily contours, recomputed the daily dose and flagged the dosimetric differences with respect to the planning dose. Second, these results were compared, by a sensitivity/specificity test, to the answers of a physician. Third, the physician, supported by the multidisciplinary team, performed a self-analysis of the provided answers and translated them into mathematical rules in order to upgrade the protocol. The upgraded protocol was applied to different definitions of the target volume (i.e. deformed CTV + 0, 2 and 4 mm), in order to quantify how the number of flags decreases when reducing the CTV-to-PTV margin.
resultsThe sensitivity of the initial protocol was very low, specifically for the orange flags. The best values were 0.84 for red and 0.15 for orange flags. After the review and upgrade process, the sensitivity of the upgraded protocol increased to 0.96 for red and 0.84 for orange flags. The number of patients flagged per week with the final (upgraded) protocol decreased in median by 26% and 18% for red and orange flags, respectively, when reducing the CTV-to-PTV margin from 4 to 2 mm. This resulted in only one patient flagged at the last fraction for both red and orange flags.
conclusionOur results demonstrate the value of iterative protocol design with retrospective data, and shows the feasibility of automatically-triggered ART using simple dosimetric rules to mimic the physician's decisions. Using a proper target volume definition is important and influences the flagging rate, particularly when decreasing the CTV-to-PTV margin.
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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.