Dosimetric impact of adaptive proton therapy in head and neck cancer – A review

Merle Huiskes*, Eleftheria Astreinidou, Wens Kong, Sebastiaan Breedveld, Ben Heijmen, Coen Rasch

*Corresponding author for this work

Research output: Contribution to journalReview articleAcademicpeer-review

3 Citations (Scopus)
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Background: Intensity Modulated Proton Therapy (IMPT) in head and neck cancer (HNC) is susceptible to anatomical changes and patient set-up inaccuracies during the radiotherapy course, which can cause discrepancies between planned and delivered dose. The discrepancies can be counteracted by adaptive replanning strategies. This article reviews the observed dosimetric impact of adaptive proton therapy (APT) and the timing to perform a plan adaptation in IMPT in HNC. Methods: A literature search of articles published in PubMed/MEDLINE, EMBASE and Web of Science from January 2010 to March 2022 was performed. Among a total of 59 records assessed for possible eligibility, ten articles were included in this review. Results: Included studies reported on target coverage deterioration in IMPT plans during the RT course, which was recovered with the application of an APT approach. All APT plans showed an average improved target coverage for the high- and low-dose targets as compared to the accumulated dose on the planned plans. Dose improvements up to 2.5 Gy (3.5 %) and up to 4.0 Gy (7.1 %) in the D98 of the high- and low dose targets were observed with APT. Doses to the organs at risk (OARs) remained equal or decreased slightly after APT was applied. In the included studies, APT was largely performed once, which resulted in the largest target coverage improvement, but eventual additional APT improved the target coverage further. There is no data showing what is the most appropriate timing for APT. Conclusion: APT during IMPT for HNC patients improves target coverage. The largest improvement in target coverage was found with a single adaptive intervention, and an eventual second or more frequent APT application improved the target coverage further. Doses to the OARs remained equal or decreased slightly after applying APT. The most optimal timing for APT is yet to be determined.

Original languageEnglish
Article number100598
JournalClinical and Translational Radiation Oncology
Publication statusPublished - Mar 2023

Bibliographical note

Funding Information:
The research for this work was funded by Varian, a Siemens Healthineers Company (HollandPTC-Varian Consortium grant ID 2019021), and partly financed by the Surcharge for Top Consortia for Knowledge and Innovation (TKIs) from the Dutch Ministry of Economic Affairs and Climate.

Publisher Copyright: © 2023 The Author(s)


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