Three discipline collaborative radiation therapy special debate: All head and neck cancer patients with intact tumors/nodes should have scheduled adaptive replanning performed at least once during the course of radiotherapy

Abstract

Radiation Oncology is a highly multidisciplinary medical specialty, drawing significantly from three scientific disciplines medicine, physics, and biology. As a result, discussion of or changes in practice within radiation oncology involves input from all three disciplines. For this reason, significant effort has been expended recently to foster collaborative multidisciplinary research in radiation oncology, with substantial demonstrated benefit. In light of these results, we endeavor here to adopt this “team‐science” approach to the traditional debates featured in this journal. This article represents the third in a series of special debates entitled “Three Discipline Collaborative Radiation Therapy (3DCRT)” in which each debate team will include a radiation oncologist, medical physicist, and radiobiologist. We hope that this format will not only be engaging for the readership but will also foster further collaboration in the science and clinical practice of radiation oncology. The advent of Intensity Modulated Radiation Therapy (IMRT) has significantly improved our ability to shape the dose distribution around tumors to spare adjacent normal tissue structures. The treatment of tumors in the head and neck has benefited substantially from this capability since there are typically many adjacent normal tissue structures and both tumors and organs at risk (OARs) tend to be complex in shape. However, creating more conformal treatment plans requires more accurate knowledge of the location and shape of patient anatomy. Anatomical changes throughout the course of treatment can result in significant changes in the delivered dose distribution, thus prompting the creation of new plans during the course of treatment to adapt to these anatomical changes. However, this necessitates a significant increase in workload for radiotherapy staff, increases the cost of care, and provides no guarantee that the anatomy will be the same when the adapted plan is ready to be delivered. Given the potential theoretical improvement in the delivered dose distribution, one may question whether all head and neck cancer patients should receive adaptive replanning. This is the subject of this month s three discipline collaborative radiation therapy debate. Arguing for the proposition will be Drs. Emilie Soisson, Patrizia Guerrieri, and Sundaravadivel Balasubramanian. Emilie Soisson, PhD, is a medical physicist at the University of Vermont Medical Center. She holds faculty appointments at the University of Vermont and McGill University. She earned a PhD in Medical Physics at the University of Wisconsin where she was heavily involved in the clinical implementation of TomoTherapy, one of the first radiotherapy delivery systems specifically designed for adaptive radiotherapy (ART). Patrizia Guerrieri, MD, is board certified in Radiation Oncology in Italy and the USA and has an MS in Radiation Sciences. She currently practices at Allegheny Health Network in Pittsburgh and has special expertise in HDR brachytherapy, IMRT, and SBRT, for Head/ Neck, Breast, and Gynecological cancers. She has authored publications, abstracts, and book chapters on gynecological brachytherapy, altered fractionation, and brachytherapy in the elderly and was a contributor to the Radiation Oncology Encyclopedia as well as “Principles and Practice of Radiation Oncology” by Perez and Brady. Sundaravadivel Balasubramanian, PhD, is a cell biology researcher whose primary research focuses on cell signaling pathways altered during radiation treatment in the presence of cigarette smoke and e‐ cigarettes, and regulated breathing practices for symptom management in cancer and other conditions. He is also active in teaching radiation biology at the Medical University of South Carolina. Arguing against the proposition will be Drs. Anesa Ahamad, Jean Moran, and Michael Joiner. Anesa Ahamad, MD, FRCR is an Associate Professor (pending, University of Miami) who trained in Manchester, UK and Houston. She balances patient care with research. With interests in spatial targeting of tumors, combined‐modality tumor‐ablation, and global‐health, she has 138 publications, 27 professional honors and awards, and 115 oral presentations. Jean M. Moran, PhD, FAAPM is Professor and Co‐Director of the Physics Division in Radiation Oncology at the University of Michigan. Her research areas include patient safety and integration of technology advancements for appropriate patients. She is a Co‐ Director of the Michigan Radiation Oncology Quality Consortium, a statewide registry to improve quality. She serves AAPM and ASTRO through committee work. Michael C. Joiner, MA, PhD, Professor in the Division of Radiation Oncology (Department of Oncology) at Wayne State University, leads WSU s radiobiology research. He focuses on how clinical