Adaptive radiotherapy for head-and-neck cancer: initial clinical outcomes from a prospective trial

Int J Radiat Oncol Biol Phys. 2012 Jul 1;83(3):986-93. doi: 10.1016/j.ijrobp.2011.08.017. Epub 2011 Dec 2.


Purpose: To present pilot toxicity and survival outcomes for a prospective trial investigating adaptive radiotherapy (ART) for oropharyngeal squamous cell carcinoma.

Methods and materials: A total of 24 patients were enrolled in an institutional review board-approved clinical trial; data for 22 of these patients were analyzed. Daily CT-guided setup and deformable image registration permitted serial mapping of clinical target volumes and avoidance structures for ART planning. Primary site was base of tongue in 15 patients, tonsil in 6 patient, and glossopharyngeal sulcus in 1 patient. Twenty patients (91%) had American Joint Committee on Cancer (AJCC) Stage IV disease. T stage distribution was 2 T1, 12 T2, 3 T3, 5 T4. N stage distribution was 1 N0, 2 N1, 5 N2a, 12 N2b, and 2 N2c. Of the patients, 21 (95%) received systemic therapy.

Results: With a 31-month median follow-up (range, 13-45 months), there has been no primary site failure and 1 nodal relapse, yielding 100% local and 95% regional disease control at 2 years. Baseline tumor size correlated with absolute volumetric treatment response (p = 0.018). Parotid volumetric change correlated with duration of feeding tube placement (p = 0.025). Acute toxicity was comparable to that observed with conventional intensity-modulated radiotherapy (IMRT). Chronic toxicity and functional outcomes beyond 1 year were tabulated.

Conclusion: This is the first prospective evaluation of morbidity and survival outcomes in patients with locally advanced head-and-neck cancer treated with automated adaptive replanning. ART can provide dosimetric benefit with only one or two mid-treatment replanning events. Our preliminary clinical outcomes document functional recovery and preservation of disease control at 1-year follow-up and beyond.

Publication types

  • Clinical Trial
  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Carcinoma, Squamous Cell / diagnostic imaging
  • Carcinoma, Squamous Cell / pathology
  • Carcinoma, Squamous Cell / radiotherapy*
  • Female
  • Humans
  • Male
  • Middle Aged
  • Neoplasm Staging / methods
  • Organs at Risk / diagnostic imaging
  • Oropharyngeal Neoplasms / diagnostic imaging
  • Oropharyngeal Neoplasms / pathology
  • Oropharyngeal Neoplasms / radiotherapy*
  • Prospective Studies
  • Radiotherapy Planning, Computer-Assisted / methods*
  • Radiotherapy Setup Errors / prevention & control
  • Radiotherapy, Image-Guided / adverse effects
  • Radiotherapy, Image-Guided / methods*
  • Radiotherapy, Intensity-Modulated / adverse effects
  • Radiotherapy, Intensity-Modulated / methods*
  • Tomography, X-Ray Computed / methods
  • Tongue Neoplasms / diagnostic imaging
  • Tongue Neoplasms / pathology
  • Tongue Neoplasms / radiotherapy
  • Tonsillar Neoplasms / diagnostic imaging
  • Tonsillar Neoplasms / pathology
  • Tonsillar Neoplasms / radiotherapy
  • Tumor Burden