Detailed analysis of failure patterns using deformable image registration in hypopharyngeal cancer patients treated with sequential boost intensity‐modulated radiotherapy

  • Manami Otsuka
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan
  • Koichi Yasuda
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan
  • Yusuke Uchinami
    Department of Radiation Oncology, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Nayuta Tsushima
    Department of Otolaryngology‐Head and Neck Surgery, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Takayoshi Suzuki
    Department of Otolaryngology‐Head and Neck Surgery, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Satoshi Kano
    Department of Otolaryngology‐Head and Neck Surgery, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Ryusuke Suzuki
    Department of Medical Physics Hokkaido University Hospital Sapporo Japan
  • Naoki Miyamoto
    Department of Medical Physics Hokkaido University Hospital Sapporo Japan
  • Hideki Minatogawa
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan
  • Yasuhiro Dekura
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan
  • Takashi Mori
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan
  • Kentaro Nishioka
    Department of Radiation Medical Science and Engineering, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Jun Taguchi
    Department of Medical Oncology, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Yasushi Shimizu
    Department of Medical Oncology, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Norio Katoh
    Department of Radiation Oncology, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Akihiro Homma
    Department of Otolaryngology‐Head and Neck Surgery, Faculty and Graduate School of Medicine Hokkaido University Sapporo Japan
  • Hidefumi Aoyama
    Department of Radiation Oncology Hokkaido University Hospital Sapporo Japan

Abstract

<jats:title>Abstract</jats:title><jats:sec><jats:title>Introduction</jats:title><jats:p>Sequential boost intensity‐modulated radiotherapy (SQB‐IMRT) uses two different planning CTs (pCTs) and treatment plans. SQB‐IMRT is a form of adaptive radiotherapy that allows for responses to changes in the shape of the tumour and organs at risk (OAR). On the other hand, dose accumulation with the two plans can be difficult to evaluate. The purpose of this study was to analyse patterns of loco‐regional failure using deformable image registration (DIR) in hypopharyngeal cancer patients treated with SQB‐IMRT.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>Between 2013 and 2019, 102 patients with hypopharyngeal cancer were treated with definitive SQB‐IMRT at our institution. Dose accumulation with the 1st and 2nd plans was performed, and the dose to the loco‐regional recurrent tumour volume was calculated using the DIR workflow. Failure was classified as follows: (i) in‐field (≥95% of the recurrent tumour volume received 95% of the prescribed dose); (ii) marginal (20–95%); or (iii) out‐of‐field (<20%).</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>After a median follow‐up period of 25 months, loco‐regional failure occurred in 34 patients. Dose–volume histogram analysis showed that all loco‐regional failures occurred in the field within 95% of the prescribed dose, with no marginal or out‐of‐field recurrences observed.</jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p>The dosimetric analysis using DIR showed that all loco‐regional failures were within the high‐dose region. More aggressive treatment may be required for gross tumours.</jats:p></jats:sec>

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