Adaptive Radiation Therapy for Head & Neck Cancer Patients

The investigators' secondary objectives for this study are to assess the possibility of
using kV cone beam for treatment replanning as compared to standard the treatment planning,
to determine the need and feasibility of adaptive radiation therapy, to develop concept of
establishing cumulative DVH (C-DVH) with daily updates and compare it to planned DVH
(P-DVH), to identify tolerance margins, to evaluate local control, locoregional control,
distant metastasis, and overall survival, to assess patient quality of life,and to develop
predictors of patients which may benefit from ART.

Inclusion Criteria:

- Patients should have an ECOG (Eastern Clinical Oncology Group) performance status of
0-2

- Patients should meet at least one of the following criteria:

1. Locally advanced cancer (T3-T4 and/or N2-N3)

2. Tumors wrapping around critical structures such as the optic nerves, optic
chiasm, or brainstem

3. Significant expected weight loss.

Exclusion Criteria:

- Previous surgical procedure more significant than a biopsy to the primary tumor or
regional lymph nodes.

- Poor renal function (inability to undergo a CT with IV contrast)

- Previous radiation therapy to the head and neck.

- Inability to tolerate prolonged immobilization.

- Children and women who are pregnant or decline to use contraception.