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Cancers
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Adaptive Radiotherapy for Head and Neck Cancer
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Adaptive Radiotherapy for Head and Neck Cancer

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (30 September 2021) | Viewed by 16221

Special Issue Editor

Prof. Dr. Johannes H.A.M. Kaanders

E-Mail Website
Guest Editor
Department of Radiation Oncology, Radboud University Medical Center, 6500 HB Nijmegen, The Netherlands
Interests: head and neck oncology; image guided adaptive radiotherapy; functional imaging; tumor oxygenation; radiation dose/volume de-escalation

Special Issue Information

Dear Colleagues,

Adaptive radiotherapy has been introduced to correct the radiotherapy dose plan for changes in the target volume and organs at risk during treatment. Initially, focus was placed on physics-associated aspects of geometry and anatomy. Today, it is much more than that; it involves tailoring radiotherapy to changing biological tumor characteristics based on functional MRI and PET scanning as well as early response adaptations to concomitant systemic therapies.

Much of the pioneering work in adaptive radiotherapy is done in head and neck cancer. The anatomy of the head and neck area is complex, with close proximity of the tumor and vulnerable organs and tissues essential to swallowing and speech. Important biological aspects of head and neck cancer include hypoxia, tumor cell repopulation, and responsiveness to chemotherapy and targeted therapies.

This Special Issue aims to provide a comprehensive overview of the state-of-the-art in, and future perspectives of, “Adaptive Radiotherapy for Head and Neck Cancer”.

Prof. Dr. Johannes H.A.M. Kaanders
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • adaptive radiotherapy
  • head and neck cancer
  • radiotherapy target volume
  • functional imaging
  • PET scan
  • dynamic MRI
  • targeted therapies.

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Published Papers (5 papers)

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Research

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16 pages, 2090 KiB  
Article
MR-Guided Adaptive Radiotherapy for Head and Neck Cancer: Prospective Evaluation of Migration and Anatomical Changes of the Major Salivary Glands
by Janita E. van Timmeren, Madalyne Chamberlain, Marta Bogowicz, Stefanie Ehrbar, Riccardo Dal Bello, Helena Garcia Schüler, Jérôme Krayenbuehl, Lotte Wilke, Nicolaus Andratschke, Matthias Guckenberger, Stephanie Tanadini-Lang and Panagiotis Balermpas
Cancers 2021, 13(21), 5404; https://doi.org/10.3390/cancers13215404 - 28 Oct 2021
Cited by 14 | Viewed by 2664
Abstract
The aim of this study was to quantify anatomical changes of parotids and submandibular glands and evaluate potential dosimetric advantages during weekly adaptive MR-guided radiotherapy (MRgRT) for the definitive treatment of head and neck cancer (HNC). The data and plans of 12 patients [...] Read more.
The aim of this study was to quantify anatomical changes of parotids and submandibular glands and evaluate potential dosimetric advantages during weekly adaptive MR-guided radiotherapy (MRgRT) for the definitive treatment of head and neck cancer (HNC). The data and plans of 12 patients treated with bilateral intensity-modulated radiotherapy for HNC using MR-linac, with weekly offline adaptations, were prospectively evaluated. The positional and volumetric changes of the salivary glands were analyzed by manual segmentation in weekly MRI images and the dosimetric impact of these anatomical changes on the adapted treatment plans was assessed. The mean volume change in parotid and submandibular gland volume was −31.9% (p < 0.0001) and −29.7% (p < 0.0001) after five weeks, respectively. The volume change was significantly correlated with the cumulative dose for the respective gland at the time of volume measurement. Inter-parotid distance changed by −5.4% (6.5 mm) on average after five weeks (p = 0.0005). The distance became significantly smaller only in the left-right direction. The inter-submandibular gland distance changed by 0.7 mm (p = 0.38). This study demonstrated significant changes in salivary gland volumes and position following daily MR guidance and weekly plan adaptation. Ongoing clinical trials will provide data on the clinical impact of these changes and novel MR-based adaptation strategies. Full article
(This article belongs to the Special Issue Adaptive Radiotherapy for Head and Neck Cancer)
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12 pages, 1273 KiB  
Article
Deterioration of Intended Target Volume Radiation Dose Due to Anatomical Changes in Patients with Head-and-Neck Cancer
by Olga Hamming-Vrieze, Simon van Kranen, Iris Walraven, Arash Navran, Abrahim Al-Mamgani, Margot Tesselaar, Michiel van den Brekel and Jan-Jakob Sonke
Cancers 2021, 13(17), 4253; https://doi.org/10.3390/cancers13174253 - 24 Aug 2021
Cited by 2 | Viewed by 1695
Abstract
Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to [...] Read more.
Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to 70 Gy were analyzed. Daily delivered dose was calculated, accumulated, and compared to the planned dose. Cutoff values (1 Gy/2 Gy) were used to assess plan deterioration in the highest/lowest dose percentile (D1/D99). Differences in clinical factors between patients with/without dosimetric deterioration were statistically tested. Dosimetric deterioration was evaluated in clinically selected patients for adaptive radiotherapy with CBCT. Respectively, 16% and 4% of patients had deterioration over 1 Gy in D99 and D1 in any of the targets, this was 5% (D99) and 2% (D1) over 2 Gy. Factors associated with deterioration of D99 were higher baseline weight/BMI, weight gain early in treatment, and smaller PTV margins. The sensitivity of visual patient selection with CBCT was 22% for detection of dosimetric changes over 1 Gy. Large dose deteriorations in targets occur in a minority of patients. Clinical prediction based on patient characteristics or CBCT is challenging and dosimetric selection tools seem warranted to identify patients in need for ART, especially in treatment with small PTV margins. Full article
(This article belongs to the Special Issue Adaptive Radiotherapy for Head and Neck Cancer)
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19 pages, 2077 KiB  
Article
Feasibility of Continual Deep Learning-Based Segmentation for Personalized Adaptive Radiation Therapy in Head and Neck Area
by Nalee Kim, Jaehee Chun, Jee Suk Chang, Chang Geol Lee, Ki Chang Keum and Jin Sung Kim
Cancers 2021, 13(4), 702; https://doi.org/10.3390/cancers13040702 - 9 Feb 2021
Cited by 24 | Viewed by 4027
Abstract
This study investigated the feasibility of deep learning-based segmentation (DLS) and continual training for adaptive radiotherapy (RT) of head and neck (H&N) cancer. One-hundred patients treated with definitive RT were included. Based on 23 organs-at-risk (OARs) manually segmented in initial planning computed tomography [...] Read more.
This study investigated the feasibility of deep learning-based segmentation (DLS) and continual training for adaptive radiotherapy (RT) of head and neck (H&N) cancer. One-hundred patients treated with definitive RT were included. Based on 23 organs-at-risk (OARs) manually segmented in initial planning computed tomography (CT), modified FC-DenseNet was trained for DLS: (i) using data obtained from 60 patients, with 20 matched patients in the test set (DLSm); (ii) using data obtained from 60 identical patients with 20 unmatched patients in the test set (DLSu). Manually contoured OARs in adaptive planning CT for independent 20 patients were provided as test sets. Deformable image registration (DIR) was also performed. All 23 OARs were compared using quantitative measurements, and nine OARs were also evaluated via subjective assessment from 26 observers using the Turing test. DLSm achieved better performance than both DLSu and DIR (mean Dice similarity coefficient; 0.83 vs. 0.80 vs. 0.70), mainly for glandular structures, whose volume significantly reduced during RT. Based on subjective measurements, DLS is often perceived as a human (49.2%). Furthermore, DLSm is preferred over DLSu (67.2%) and DIR (96.7%), with a similar rate of required revision to that of manual segmentation (28.0% vs. 29.7%). In conclusion, DLS was effective and preferred over DIR. Additionally, continual DLS training is required for an effective optimization and robustness in personalized adaptive RT. Full article
(This article belongs to the Special Issue Adaptive Radiotherapy for Head and Neck Cancer)
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Review

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18 pages, 1793 KiB  
Review
Target Definition in MR-Guided Adaptive Radiotherapy for Head and Neck Cancer
by Mischa de Ridder, Cornelis P. J. Raaijmakers, Frank A. Pameijer, Remco de Bree, Floris C. J. Reinders, Patricia A. H. Doornaert, Chris H. J. Terhaard and Marielle E. P. Philippens
Cancers 2022, 14(12), 3027; https://doi.org/10.3390/cancers14123027 - 20 Jun 2022
Cited by 10 | Viewed by 3490
Abstract
In recent years, MRI-guided radiotherapy (MRgRT) has taken an increasingly important position in image-guided radiotherapy (IGRT). Magnetic resonance imaging (MRI) offers superior soft tissue contrast in anatomical imaging compared to computed tomography (CT), but also provides functional and dynamic information with selected sequences. [...] Read more.
In recent years, MRI-guided radiotherapy (MRgRT) has taken an increasingly important position in image-guided radiotherapy (IGRT). Magnetic resonance imaging (MRI) offers superior soft tissue contrast in anatomical imaging compared to computed tomography (CT), but also provides functional and dynamic information with selected sequences. Due to these benefits, in current clinical practice, MRI is already used for target delineation and response assessment in patients with head and neck squamous cell carcinoma (HNSCC). Because of the close proximity of target areas and radiosensitive organs at risk (OARs) during HNSCC treatment, MRgRT could provide a more accurate treatment in which OARs receive less radiation dose. With the introduction of several new radiotherapy techniques (i.e., adaptive MRgRT, proton therapy, adaptive cone beam computed tomography (CBCT) RT, (daily) adaptive radiotherapy ensures radiation dose is accurately delivered to the target areas. With the integration of a daily adaptive workflow, interfraction changes have become visible, which allows regular and fast adaptation of target areas. In proton therapy, adaptation is even more important in order to obtain high quality dosimetry, due to its susceptibility for density differences in relation to the range uncertainty of the protons. The question is which adaptations during radiotherapy treatment are oncology safe and at the same time provide better sparing of OARs. For an optimal use of all these new tools there is an urgent need for an update of the target definitions in case of adaptive treatment for HNSCC. This review will provide current state of evidence regarding adaptive target definition using MR during radiotherapy for HNSCC. Additionally, future perspectives for adaptive MR-guided radiotherapy will be discussed. Full article
(This article belongs to the Special Issue Adaptive Radiotherapy for Head and Neck Cancer)
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14 pages, 791 KiB  
Review
MR-Guided Adaptive Radiotherapy for OAR Sparing in Head and Neck Cancers
by Samuel L. Mulder, Jolien Heukelom, Brigid A. McDonald, Lisanne Van Dijk, Kareem A. Wahid, Keith Sanders, Travis C. Salzillo, Mehdi Hemmati, Andrew Schaefer and Clifton D. Fuller
Cancers 2022, 14(8), 1909; https://doi.org/10.3390/cancers14081909 - 10 Apr 2022
Cited by 12 | Viewed by 3307
Abstract
MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) [...] Read more.
MR-linac devices offer the potential for advancements in radiotherapy (RT) treatment of head and neck cancer (HNC) by using daily MR imaging performed at the time and setup of treatment delivery. This article aims to present a review of current adaptive RT (ART) methods on MR-Linac devices directed towards the sparing of organs at risk (OAR) and a view of future adaptive techniques seeking to improve the therapeutic ratio. This ratio expresses the relationship between the probability of tumor control and the probability of normal tissue damage and is thus an important conceptual metric of success in the sparing of OARs. Increasing spatial conformity of dose distributions to target volume and OARs is an initial step in achieving therapeutic improvements, followed by the use of imaging and clinical biomarkers to inform the clinical decision-making process in an ART paradigm. Pre-clinical and clinical findings support the incorporation of biomarkers into ART protocols and investment into further research to explore imaging biomarkers by taking advantage of the daily MR imaging workflow. A coherent understanding of this road map for RT in HNC is critical for directing future research efforts related to sparing OARs using image-guided radiotherapy (IGRT). Full article
(This article belongs to the Special Issue Adaptive Radiotherapy for Head and Neck Cancer)
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