Top Line: Does daily adaptive radiation reduce xerostomia for head and neck cancer patients?
The Study: Revised treatment plans are common for HNSCC due to decreased tumor volume, weight loss, or both. This would seem like an ideal opportunity to use adaptive RT. A few years ago, though, the randomized ARTIX trial found no significant reduction in salivary toxicity with weekly (off-line) adaptive replanning. DARTBOARD was a randomized phase 2 trial in which 50 patients receiving definitive RT for oropharynx (76%), larynx, or hypopharynx were randomized to daily adaptive RT (DART) or standard IGRT. Of note, the DART arm used much smaller PTV margins (1mm radial, 2mm craniocaudal) than the IGRT arm (5mm). The primary endpoint of patient-reported xerostomia was not significantly different at 1 year. However, DART did significantly reduce grade 2 dermatitis (8% v 31%) while also significantly decreasing ipsilateral parotid dose and bilateral submandibular dose. The challenge seems to be translating the improved dosimetry of adaptive RT into meaningful improvements in clinical endpoints.
TBL: In the DARTBOARD trial, daily adaptive RT did not significantly reduce patient-reported xerostomia at 1 year compared to standard IGRT. | Sher, J Natl Cancer Inst 2025
The Study: Revised treatment plans are common for HNSCC due to decreased tumor volume, weight loss, or both. This would seem like an ideal opportunity to use adaptive RT. A few years ago, though, the randomized ARTIX trial found no significant reduction in salivary toxicity with weekly (off-line) adaptive replanning. DARTBOARD was a randomized phase 2 trial in which 50 patients receiving definitive RT for oropharynx (76%), larynx, or hypopharynx were randomized to daily adaptive RT (DART) or standard IGRT. Of note, the DART arm used much smaller PTV margins (1mm radial, 2mm craniocaudal) than the IGRT arm (5mm). The primary endpoint of patient-reported xerostomia was not significantly different at 1 year. However, DART did significantly reduce grade 2 dermatitis (8% v 31%) while also significantly decreasing ipsilateral parotid dose and bilateral submandibular dose. The challenge seems to be translating the improved dosimetry of adaptive RT into meaningful improvements in clinical endpoints.
TBL: In the DARTBOARD trial, daily adaptive RT did not significantly reduce patient-reported xerostomia at 1 year compared to standard IGRT. | Sher, J Natl Cancer Inst 2025