The role of advanced imaging techniques in radiotherapy for head and neck cancer

Abstract

This thesis explores the potential role of advanced imaging in radiotherapy for head and neck cancer (HNC).
The first part looks at the role of ¹⁸F-FDG-PET-CT, now a widely available functional imaging diagnostic modality, in guiding radiotherapy dose escalation. It is based on the results of the FiGaRO study (¹⁸F-FDG-PET in Guiding Dose-Painting with Intensity Modulated Radiotherapy in Oropharyngeal Tumours). This was a multi-centre phase I Feasibility Study aiming to test the safety of ¹⁸F-FDG-PET-CT dose-painted intensity modulated radiotherapy (IMRT) in locally advanced oropharyngeal squamous cell carcinoma (SCC).
The second part looks at the role of hybrid PET-MR – a new imaging tool in the clinical arena with a lot of potential in sites that depend on good soft tissue delineation (like head and neck) but with relatively little data to define its use. This was based on the PET-MR in HNC Radiotherapy Pilot Study. This was a single institution study that looks at the feasibility of obtaining a hybrid ¹⁸F-FDG-PET-MR in the radiotherapy immobilization position, at baseline and 2 weeks into radiotherapy treatment. Image quality, registration with radiotherapy scans, workflow and patient tolerability were assessed. The aim was to establish imaging and radiotherapy protocols that can potentially be used in a randomized study of dose escalation based on a combined intra-treatment ¹⁸F-FDG-PET and MRI.
The aim of this thesis was to explore the potential use of advanced imaging techniques in HNC patients undergoing radical radiotherapy treatment, with a particular focus on dose escalation and potential adaptive radiotherapy techniques. Ultimately the purpose is to assess how information from advanced imaging can be best used to adapt treatment for patient benefit.

Date of Award	1 Feb 2020
Original language	English
Awarding Institution	King's College London
Supervisor	Sally Barrington (Supervisor)