Weekly volume and dosimetric changes during chemoradiotherapy with intensity-modulated radiation therapy for head and neck cancer: a prospective observational study.

ABSTRACT

PURPOSE: The aim of this study was to investigate prospectively the weekly volume changes in the target volumes and organs at risk and the resulting dosimetric changes during induction chemotherapy followed by chemoradiotherapy with intensity-modulated radiation therapy (C-IMRT) for head-and-neck cancer patients. METHODS AND MATERIALS Patients receiving C-IMRT for head-and-neck cancer had repeat CT scans at weeks 2, 3, 4, and 5 during radiotherapy. The volume changes of clinical target volume 1 (CTV1) and CTV2 and the resulting dosimetric changes to planning target volume 1 (PTV1) and PTV2 and the organs at risk were measured. RESULTS: The most significant volume differences were seen at week 2 for CTV1 and CTV2. The reductions in the volumes of CTV1 and CTV2 at week 2 were 3.2% and 10%, respectively (p = 0.003 and p < 0.001). The volume changes resulted in a significant reduction in the minimum dose to PTV1 and PTV2 (2 Gy, p = 0.002, and 3.9 Gy, p = 0.03, respectively) and an increased dose range across PTV1 and PTV2 (2.5 Gy, p < 0.001, and 5.1 Gy, p = 0.008, respectively). There was a 15% reduction in the parotid volumes by week 2 (p < 0.001) and 31% by week 4 (p < 0.001). There was a statistically significant increase in the mean dose to the ipsilateral parotid only at week 4 (2.7 Gy, p = 0.006). The parotid glands shifted medially by an average of 2.3 mm (p < 0.001) by week 4. CONCLUSION: The most significant volumetric changes and dosimetric alterations in the tumor volumes and organs at risk during a course of C-IMRT occur by week 2 of radiotherapy. Further adaptive radiotherapy with replanning, if appropriate, is recommended.