Image-guided adaptive radiotherapy improves acute toxicity during intensity-modulated radiation therapy for head and neck cancer

The purpose of this study was to evaluate the impact of an image-guided adaptive re-planning strategy on patients treated by intensity-modulated radiotherapy (IMRT) for head and neck cancer. Among 198 patients with head and neck cancer comprising the primary study population, 79 (40%) underwent adaptive radiotherapy with modification of the original IMRT midway during treatment. The incidence of grade 3+ acute skin toxicity was 15 and 35% among patients treated with and without adaptive radiotherapy, respectively (p = 0.01). The incidence of grade 3+ oral mucositis was 15 and 29%, respectively (p = 0.03). There was no significant difference in the 2-year rates of local-regional control or overall survival between the two cohorts (p > 0.05, for both). The use of an image-guided adaptive radiotherapy strategy reduced the incidence of high-grade skin toxicity and oral mucositis in the acute setting. Further studies are needed to better define which subset of patients may benefit the most.