Top Line: Does weekly adaptive treatment planning during head and neck radiation reduce salivary toxicity?
The Study: ARTIX was a randomized, multicenter French trial that enrolled 131 patients with stage III-IVB (AJCC 7) oropharyngeal SCC who were receiving concurrent chemoradiation. They were randomized to standard treatment with up to one repeat CT simulation and plan or adaptive treatment with a weekly CT simulation and plan. Everyone was treated using IMRT and a 3-volume approach with doses of 70 Gy, 63 Gy, and 56 Gy to primary and nodal disease, high risk subclinical disease, and low risk sites, respectively. Treatment planning goals for the parotid glands were mean dose <30 Gy and median dose <26 Gy. In the adaptive arm, everyone had a CT once per week and the new treatment plan was started within the next 5 days. In the standard arm, 10.8% of patients had a revised plan. The primary endpoint was xerostomia, which was objectively measured at baseline and every 6 months after treatment. A saliva flow rate <500mg/min was considered xerostomia. For the baseline treatment plans, there was no difference in mean ipsilateral or contralateral parotid dose between arms. Surprisingly, mean parotid dose in the adaptive arm didn’t get lower with each adaptive plan. There was no difference between the baseline mean parotid dose and mean parotid dose in any of the subsequent adaptive plans. As a result, adaptive replanning did not significantly improve saliva flow rate after treatment nor reduce the rate of xerostomia (47.5% v 47.9%). There were also no differences in patient or physician reported toxicity.
TBL: In the ARTIX trial, adaptive weekly replanning during chemoradiation for oropharyngeal cancer did not reduce parotid dose nor did it reduce salivary toxicity. | Castelli, JAMA Oncol 2023
The Study: ARTIX was a randomized, multicenter French trial that enrolled 131 patients with stage III-IVB (AJCC 7) oropharyngeal SCC who were receiving concurrent chemoradiation. They were randomized to standard treatment with up to one repeat CT simulation and plan or adaptive treatment with a weekly CT simulation and plan. Everyone was treated using IMRT and a 3-volume approach with doses of 70 Gy, 63 Gy, and 56 Gy to primary and nodal disease, high risk subclinical disease, and low risk sites, respectively. Treatment planning goals for the parotid glands were mean dose <30 Gy and median dose <26 Gy. In the adaptive arm, everyone had a CT once per week and the new treatment plan was started within the next 5 days. In the standard arm, 10.8% of patients had a revised plan. The primary endpoint was xerostomia, which was objectively measured at baseline and every 6 months after treatment. A saliva flow rate <500mg/min was considered xerostomia. For the baseline treatment plans, there was no difference in mean ipsilateral or contralateral parotid dose between arms. Surprisingly, mean parotid dose in the adaptive arm didn’t get lower with each adaptive plan. There was no difference between the baseline mean parotid dose and mean parotid dose in any of the subsequent adaptive plans. As a result, adaptive replanning did not significantly improve saliva flow rate after treatment nor reduce the rate of xerostomia (47.5% v 47.9%). There were also no differences in patient or physician reported toxicity.
TBL: In the ARTIX trial, adaptive weekly replanning during chemoradiation for oropharyngeal cancer did not reduce parotid dose nor did it reduce salivary toxicity. | Castelli, JAMA Oncol 2023