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Original Article | Open Access

Assessment of dose gradient index variation during simultaneously integrated boost intensity-modulated radiation therapy for head and neck cancer patients

Salam Abdulrazzaq Ibrahim Al-Rawi1,2,3 ( ), Hassan Abouelenein4, Mohamad El-Sayed EL Nagdy3, Haidar Hamza Alabdei1,5, Awf Abdulrahman Sulaiman1,2, Dalya Saad Al-Nuaimi1,2, Magdy Mohammed Khalil3,6, Ahmed Salih Alshewered7 ( )
Baghdad Center for Radiotherapy and Nuclear Medicine, Medical City Complex, Ministry of Health, Baghdad, Iraq
Department of Radiation Oncology, Al-Andalus Specialist Hospital, Baghdad, Iraq
Faculty of Science, Department of Physics, Helwan University, Cairo, Egypt
Radiotherapy Department, Saudi German Hospital, Cairo, Egypt
College of Medicine, Baghdad University, Baghdad, Iraq
Department of Biotechnology, School of Biotechnology, Badr University in Cairo (BUC), Cairo, Egypt
Department of Radiotherapy, Misan Radiation Oncology Center, Misan Health Directorate, Ministry of Health and Environment, Misan, Iraq
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Abstract

Objective

Dose gradient index (DGI) is a tool used to evaluate radiation dose gradient outside the target. This study aimed to analyze the consistency of this tool through the long course of radiotherapy due to patient anatomical changes, such as body weight loss and tumor shrinkage.

Methods

A total of 30 patients diagnosed with different head and neck cancer were treated with the simultaneous integrated boost intensity-modulated radiation therapy technique; the patients underwent new computed tomography (CT) simulations after 10 and 20 treatment sessions. The gradient index was compared for the initial, reconstructed, and adaptive plans.

Results

All patients showed a significant decrease (p < 0.001) in weight at reconstructed CT1 (RCT1) and reconstructed CT2 compared with original CT. Also, primary gross tumor volume was significantly decreased (p < 0.001) at reconstructed CT1 and reconstructed CT2. In the dosimetric part, all organs showed a significant increase in dose delivery at reconstructed plans (Rplans) compared with the original plan (Oplan). Meanwhile, at adaptive plans (Aplans), all organs showed a significant decrease in dose delivery compared with Oplan. The DGI was significantly increased at Rplan1 and Rplan2 compared with Oplan, with a median value of 29 (15.5–41.3) and 30 (15.1–38) at Rplan1 and Rplan2, respectively, and 25.8 (14.9–37.6) at Oplan. Whereas DGI value decreased significantly at Aplan1 compared with Oplan, and then insignificantly increased at Aplan2 compared with Aplan1.

Conclusion

DGI must be evaluated during the intensity-modulated radiation therapy course in the treatment of head and neck cancers, which clearly varies significantly as a result of a patient's anatomical changes during the radiotherapy course, and it can be improved or maintained to its original value by using adaptive planning strategy.

Keywords

adaptive radiotherapydose gradient indexhead and neck cancerintensity-modulated radiation therapy

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Precision Radiation Oncology
Volume 6 Issue 3,
September 2022
Pages 216-224
DOI: 10.1002/pro6.1166
Cite this article:
Al-Rawi SAI, Abouelenein H, Nagdy ME-SE, et al. Assessment of dose gradient index variation during simultaneously integrated boost intensity-modulated radiation therapy for head and neck cancer patients. Precision Radiation Oncology, 2022, 6(3): 216-224. https://doi.org/10.1002/pro6.1166

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Received: 25 May 2022
Revised: 31 May 2022
Accepted: 21 June 2022
Published: 10 July 2022
© 2022 The Authors. Precision Radiation Oncology published by John Wiley & Sons Australia, Ltd on behalf of Shandong Cancer Hospital & Institute.

This is an open access article under the terms of the Creative Commons Attribution License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited.
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