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Routine Adaptive Replanning of p16-Positive Stage N2b Oropharyngeal Cancer

Quality Improvement or Waste of Time?

Zhu, James H., MD, PhD; Amdur, Robert J., MD; Lu, Bo, PhD; Liu, Chihray, PhD; Hitchcock, Kathryn E., MD, PhD; Mendenhall, William M., MD

American Journal of Clinical Oncology: December 2018 - Volume 41 - Issue 12 - p 1211–1215
doi: 10.1097/COC.0000000000000453
Original Articles: Head and Neck

Purpose/Objective(s): To determine if routinely replanning patients treated for oropharyngeal cancer that is p16-positive and clinical neck stage N2b (AJCC 7th edition) is likely to result in dose changes that will improve patient outcomes to a meaningful degree.

Methods: In 10 consecutive patients treated with primary radiotherapy (RT) and concurrent weekly chemotherapy for p16-positive N2b oropharyngeal carcinoma, we prospectively evaluated dose changes from replanning for the final 4 or 2 weeks of RT of a 7-week RT program.

Results: Replanning for the final 4 or 2 weeks improved planning target volume coverage by an average of 4 and 2 percentage points, respectively. For all normal structures, the dose change was small (<1 Gy) with replanning.

Conclusions: In patients with p16-positive N2b oropharynx cancer, the value of replanning RT is a small improvement in target coverage with minimal improvement in normal tissue sparing. In response to our study, some of the physicians in our group replan most node-positive oropharyngeal cancer cases while others think routine replanning is not valuable.

Department of Radiation Oncology, University of Florida College of Medicine, Gainesville, FL

The authors declare no conflicts of interest.

Reprints: Robert J. Amdur, MD, 2000 SW Archer Road, P.O. Box 100385, Gainesville, FL 32610-0385. E-mail:

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