Adaptive radiotherapy of head and neck cancer

Intensity-modulated radiation therapy (IMRT) in head and neck (H&N) cancer has the capability to generate steep dose gradients, leading to an improved therapeutic index. IMRT plans are typically based on a pretreatment computed tomography scan that provides a snapshot of the patient's anatomy. Nevertheless, interfractional patient variations may occur because of setup error and anatomical modifications. Therefore, the accuracy of IMRT delivery for H&N cancer may be compromised during the treatment course, potentially affecting the therapeutic index. In this framework, adaptive radiotherapy is a potential solution, which consists of "the explicit inclusion of the temporal changes in anatomy during the imaging, planning, and delivery of radiotherapy." Adaptive radiotherapy has brought an additional dimension to the management of patients with H&N cancer and has the potential to counteract the effects of positioning errors and anatomical changes. This article reviews the causes and discusses potential solutions to circumvent the discrepancies between the planned dose and the actual dose received by patients treated for H&N malignancies.