KEY TAKEAWAYS
- The study aimed to investigate the impact of IGRT on PoF following IMRT in HNSCC patients.
- Researchers noticed a severe impact of IGRT on PoF in HNSCC patients.
The standard treatment for head and neck squamous cell carcinoma (HNSCC) typically involves intensity-modulated radiation therapy (IMRT). Although IMRT offers improved precision and reduced margins, there are concerns about potential increases in marginal failures.
Previous studies have examined patterns of failure (PoF) following IMRT for HNSCC, but the significance of factors such as patient positioning quality and image-guided radiotherapy (IGRT) has yet to be thoroughly addressed, leaving their impact uncertain.
Paul-Henry Mackeprang and the team present work conducts a systematic review to explore the consideration of IGRT in PoF studies after IMRT for HNSCC.
Researchers performed an inclusive analysis, conducting a systematic literature search on PubMed for HNSCC, IMRT, and PoF terms according to PRISMA guidelines. Additionally, conference abstracts from ESTRO and ASTRO in 2020 and 2021 were screened for relevant studies.
Inclusion criteria included studies relating the PoF of HNSCC after IMRT to the treated volumes. The data were extracted, categorized, and analyzed, including patient and treatment characteristics, IGRT, treatment adaptation, PoF, and the correlation of PoF to IGRT.
About 110 studies were included in the analysis, with the majority (70) lacking any reported information on IGRT. Among the remaining studies, 18 reported daily IGRT, 7 reported daily on days 1-3 or 1-5, then weekly (7), 12 reported at least weekly, and 3 reported other schemes.
Immobilization techniques varied, with 78 studies employing masks, 4 using non-invasive frames, and 28 studies not reporting the method. The prevailing PoF classification among the studies was “in-field/marginal/out-of-field,” as reported by 76 studies. Notably, only 1 study correlated PoF in nasopharyngeal cancer patients to IGRT.
The study concluded that the IGRT on PoF in HNSCC is significantly underreported in the existing literature. With only one study correlating PoF to IGRT measures and setup uncertainty, a critical gap in understanding persists. Moreover, most studies’ reliance on outdated PoF terminology (“in/out-of-field”) hampers comprehensive evaluations.
The findings underscore the imperative for a clearly defined and up-to-date PoF terminology, emphasizing the need for systematic and preferably prospective data generation. PoF investigations to consistently and comprehensively consider and report on the role of IGRT in HNSCC treatment. The study received no funds
Source: https://pubmed.ncbi.nlm.nih.gov/38444011/
Mackeprang PH, Bryjova K, Heusel AE, et al. (2024); EORTC Head & Neck Young Investigators Group. Consideration of image guidance in patterns of failure analyses of intensity-modulated radiotherapy for head and neck cancer: a systematic review. Radiat Oncol. 2024 Mar 5;19(1):30. doi: 10.1186/s13014-024-02421-w. PMID: 38444011; PMCID: PMC10916111.
