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Objectives: The objective of the paper was to assess real-life experience in the management of head and neck cancer (HNC) patients during the COVID-19 pandemic in radiotherapy departments and to evaluate the variability in terms of adherence to American Society of Radiation Oncology (ASTRO) and European Society for Radiotherapy and Oncology (ESTRO) recommendations. Materials and methods: In May 2020, an anonymous 30-question online survey, comparing acute phase of outbreak and pre-COVID-19 period, was conducted. Two sections exploited changes in general management of HNC patients and different HNC primary tumors, addressing specific statements from ASTRO ESTRO consensus statement as well. Results: Eighty-eight questionnaires were included in the demographic/clinical workflow analysis, and 64 were analyzed for treatment management. Forty-eight percent of radiotherapy departments became part of oncologic hubs. First consultations reduced, and patients were addressed to other centers in 33.8 and 18.3% of cases, respectively. Telematic consultations were used in 50% of follow-up visits and 73.9% of multidisciplinary tumor board discussions. There were no practical changes in the management of patients affected by different primitive HNCs. Hypofractionation was not favored over conventional schedules. Conclusions: Compared to pre-COVID era, the clinical workflow was highly re-organized, whereas there were no consistent changes in RT indications and schedules. [ABSTRACT FROM AUTHOR]

Backgrounds: Irradiation of the hippocampus plays a role in neurocognitive toxicity. Its delineation is complex and in practice different head position can vary hippocampus morphology on axial images; so atlas in a single standard position can result ineffective to describe different hippocampal morphologies in different head set-up. The purpose of our study was to develop a guide based on magnetic resonance imaging for hippocampus delineation in three different head set-ups. Materials and methods: Three patients were selected to elaborate our guide. Patients were submitted to a planning computed tomography of the brain district in different head positions: 1° patient in neutral, 2° patient in over-extended and 3° patient in head hypo-extended position; axial images of 2-mm thickness were obtained. Computed tomography images were fused with diagnostic brain magnetic resonance images; then hippocampus was delineated according to RTOG atlas. Contours were revised by two neuro-radiologists with >5-year expertise in neuroimaging. Results: A guide was developed for each of three head positions considered. RTOG atlas provided an easy and reliable guide for hippocampus delineation in neutral position of the head. Discrepancies were observed in cranial and caudal limit in case of head over/hypo-extension, as well as in hippocampal morphology near the encephalic trunk where hippocampus takes an oblong shape in over-extended set-up, and short and stocky in hypo-extension. Conclusion: Our guide can represent a useful tool for hippocampal delineation in clinical practice and for different anatomic variations due to different head positions. Certainly, it should be validated in practice. [ABSTRACT FROM AUTHOR]

Background and purpose: Sparing of the organs at risk is one of the primary end-points of radiotherapy. The effects of organ-at-risk delineation on the dosimetric parameters can be critical and can influence treatment planning and outcomes. The aim of our study was to provide anatomical boundaries for the identification and delineation of the following critical organs at risk in the head and neck district: brachial plexus, cochlea, pharyngeal constrictor muscles and optic chiasm. Patients and methods: One patient was initially selected to elaborate our atlas. This patient was subjected to a planning computed tomography of the brain and head and neck district; axial images of 3-mm thickness at 3-mm intervals were obtained. In the same set-up a magnetic resonance imaging study was also performed. The obtained images were fused based on anatomical landmarks and used by a radiation oncologist, supported by a neuroradiologist, to provide anatomo-radiological limits for the identification of the brachial plexus, cochlea, pharyngeal constrictor muscles and optic chiasm. These limits were further verified on three consecutive patients. Results: A computed tomography-based atlas was developed with definition of cranial, caudal, medial, lateral, anterior and posterior limits for each organ considered. Conclusions: This study allows improvement of definitions of anatomic boundaries for the brachial plexus, cochlea, pharyngeal constrictor muscles and optic chiasm. Our multidisciplinary experience led to the production of an institutional reference tool that could represent a useful aid for radiation oncologists in clinical practice. [ABSTRACT FROM AUTHOR]

Purpose: Whole-brain radiotherapy is performed as standard therapy in patients with multiple brain metastases and in patients with more favourable prognosis such as lymphoma and small-cell lung carcinoma in the prophylactic setting. Because of the prognosis and the total prescribed dose, the parotid glands are not usually regarded as an organ at risk in whole-brain radiotherapy. Long-term survival can be expected in some of these patients and late toxicity can be observed, becoming essential to evaluate organs at risk, particularly the parotid glands even in metastatic patients. We compared the 2D with 3D technique to evaluate parotid glands involvement and received dose, and coverage of the clinical target volume. Materials and methods: Seven patients were considered. The prescribed dose was 30 Gy in ten fractions. On the same day and with the same set-up, all the treatment planning were performed using a 2D and 3D technique. A treatment plan was performed following same technical characteristics as the 2D technique. The parotid glands and whole brain were delineated. Dose-volume statistics were analysed. Results: Dose-volume histograms of the parotid glands showed that 2/7 patients (28 %) received a mean dose >20 Gy. We found a lack of coverage of the clinical target volume in 6/7 patients. Conclusions: Planning whole-brain radiotherapy with only the 2D technique involves a risk of including parotid glands in the field and not covering the clinical target volume. The 3D technique should be systematically performed and the parotid glands should be regarded as an organ at risk in whole-brain radiotherapy. [ABSTRACT FROM AUTHOR]