Deterioration of intended target volume radiation dose due to anatomical changes in patients with head-and-neck cancer

Olga Hamming-Vrieze, Simon van Kranen, Iris Walraven, Arash Navran, Abrahim Al-Mamgani, Margot Tesselaar, Michiel van den Brekel, Jan-Jakob Sonke

Research output: Contribution to journalArticleAcademicpeer-review


Delivered radiation dose can differ from intended dose. This study quantifies dose deterioration in targets, identifies predictive factors, and compares dosimetric to clinical patient selection for adaptive radiotherapy in head-and-neck cancer patients. One hundred and eighty-eight consecutive head-and-neck cancer patients treated up to 70 Gy were analyzed. Daily delivered dose was calculated, accumulated, and compared to the planned dose. Cutoff values (1 Gy/2 Gy) were used to assess plan deterioration in the highest/lowest dose percentile (D1/D99). Differences in clinical factors between patients with/without dosimetric deterioration were statistically tested. Dosimetric deterioration was evaluated in clinically selected patients for adaptive radiotherapy with CBCT. Respectively, 16% and 4% of patients had deterioration over 1 Gy in D99 and D1 in any of the targets, this was 5% (D99) and 2% (D1) over 2 Gy. Factors associated with deterioration of D99 were higher baseline weight/BMI, weight gain early in treatment, and smaller PTV margins. The sensitivity of visual patient selection with CBCT was 22% for detection of dosimetric changes over 1 Gy. Large dose deteriorations in targets occur in a minority of patients. Clinical prediction based on patient characteristics or CBCT is challenging and dosimetric selection tools seem warranted to identify patients in need for ART, especially in treatment with small PTV margins.
Original languageEnglish
Article number4253
Issue number17
Publication statusPublished - 1 Sep 2021


  • Adaptive radiotherapy
  • Cone beam CT
  • Dose accumulation
  • Head-and-neck cancer

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