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What lies beneath the image? Using functional imaging to guide radiation therapy for head and neck cancer.

Researchers from the Applied Radiation Therapy Research group, Discipline of Radiation Therapy, based at the Trinity Centre for Health Sciences, St. James’s Hospital Campus, have published a systematic review entitled “Exploring the impact of metabolic imaging in head and neck cancer treatment”. We spoke to the study’s authors, Ms. Diana Raquel Dias Domingues and Dr Michelle Leech, about their work, which has been published in Head & Neck – Journal of the Sciences and Specialities of the Head and Neck.

The study, conducted as part of Diana’s MSc research within the Applied Radiation Therapy Trinity (ARTT) research group in the School of Medicine was funded by the Cambridge University Hospitals. We first asked Diana about the background to the study;

Head and neck radiation therapy is an effective method of treating cancer in this region. However, as there are many critical structures in the head and neck (e.g. spinal cord, brain stem, salivary glands), it is important to research ways to try and minimise the volume of tissue that is irradiated, thereby keeping the toxicity to the patient as low as possible. This is important for patient quality of life as head and neck treatments are very difficult for patients.

Summarising the study’s approach, findings and conclusion, Diana stated;

In this paper, we have collated all of the literature to date on functional imaging, (images that tell us about the underlying biology of tissues), to see if their use can help clinicians in determining smaller volumes to be treated in the head and neck region for cancer. We found out that currently it is not possible to make definitive recommendations on which type of functional imaging to use as the literature shows conflicting results. These conflicting results are largely due to heterogeneity in metrics used to measure the difference in the volumes being treated using functional imaging compared to regular anatomic imaging.

We concluded that more homogenous reporting needs to be performed to reach a definitive conclusion. We have also determined that future research should focus on alternate functional imaging methods to comprehensively answer this research question and guide clinical decision making.

Dr Michelle Leech, Associate Professor of Radiation Therapy, and corresponding author on the study, commented that;

This paper has really made us consider how we report metrics in imaging in radiation therapy and the importance of common ontologies. This has been achieved in some areas of radiation therapy to date (e.g. in treatment planning) but now needs to be extended to functional imaging too. This will help us to maximise the information that we get from routine images in the clinic, which is an important consideration for all service providers, regardless of location.

Research on minimising side effects in radiation therapy is a focus of my research group within the Discipline of Radiation Therapy. Other research now under way, led by Dr. Amara Naseer, Research Fellow, is assessing factors to minimise osteoradionecrosis in head and neck cancer, a serious consequence for patients where the jawbone can become necrotic and impact negatively on patient quality of life.”

The study paper is open access and can be freely downloaded here: