2836 - Addressing the Need for 3D Tumor Margin Localization in Radiation Oncology
Presenter(s)
M. Schuweiler1,2, E. Turner1, I. Sharma1, S. Zhou1, A. Cheung1, M. Bundgaard Norlov1, A. Sideris1, Y. Yazdi1, and L. J. Mady3; 1Johns Hopkins University, Baltimore, MD, 2Johns Hopkins School of Medicine, Baltimore, MD, 3Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University, Baltimore, MD
Purpose/Objective(s): Head and neck cancers are the 6th most deadly cancer worldwide, with squamous cell carcinoma (HNSCC) accounting for 90% of cases. Many HNSCC cases require multidisciplinary treatment, involving head and neck surgeons, pathologists, and radiation oncologists. Accurate localization of surgical margins is crucial in radiation oncology for effective treatment planning. Current 2D imaging and manual delineation methods are often insufficient, leading to uncertainties in tumor targeting, radiation fall-off, and unnecessary morbidity. This study investigates unmet needs and seeks an innovation to address these challenges.
Materials/Methods: A total of 91 interviews with head and neck surgeons, radiation oncologists, pathologists, and medical oncologists were conducted to gather insights on the limitations of current surgical margin evaluation techniques. Additionally, 1,440 hours of head and neck surgeries, oncology clinics, and radiation treatments were observed. Key innovation targets were identified and categorized according to recurring themes, then filtered through an iterative scoring system and group discussions, assessing clinical, commercial, and technical feasibility. This ethnographic research was complemented by a comprehensive review of existing literature.
Results: Our investigation revealed that current imaging and delineation methods often fail to provide the necessary accuracy for surgical margin localization in radiation oncology, contributing to treatment uncertainty and increased risk of complications such as xerostomia and mucositis. Through thematic analysis of our findings, we identified that integrating 3D mapping techniques into post-operative radiation planning could significantly improve margin visualization. Specifically, the use of surgical markers placed within the resection bed emerged as a promising solution. These markers could serve as reference points on post-operative imaging, allowing for more precise tumor bed registration and reducing the risk of radiation fall-off into surrounding healthy tissues.
Conclusion: Accurate localization of surgical margins is essential for optimizing radiation treatment planning and minimizing unintended damage to surrounding structures. Our research suggests that there is an urgent need to implement 3D visualization techniques, particularly through the placement of surgical markers in the resection bed, to improve precision in radiation planning and treatment. This could minimize morbid side effects such as xerostomia, mucositis, and dysfunction of critical structures. Future work should also focus on developing and evaluating marker-based approaches to facilitate more precise margin localization and identification of tumor resection borders, ultimately improving patient outcomes in head and neck cancer care.