Virtual Patient-Specific 3-Dimensional Specimen Maps for Adjuvant Radiation Therapy Planning in Mucosal Head and Neck Squamous Cell Carcinoma

Purpose Adjuvant radiation therapy planning for mucosal head and neck squamous cell carcinoma is challenging due to postoperative anatomic changes, contributing to variability in clinical target volume (CTV) delineation and risk of geographic miss or unnecessary dose expansion. Patient-specific 3-dimensional (3D) specimen maps may offer a novel approach to improve the localization of high-risk margins and facilitate multidisciplinary communication. Methods and Materials In this prospective, noninterventional feasibility study, 3D scanning and virtual pathologic mapping of surgical specimens were performed as part of routine pathologic processing. Annotated 3D maps were integrated into the radiation therapy planning workflow and reviewed by the multidisciplinary team. Two adjuvant radiation therapy plans were prepared: 1 per standard of care and 1 with a 3D specimen map added. Changes in CTV primary or CTV boost delineation, dosimetric parameters for organs at risk, and clinician-reported confidence were assessed. Results Thirteen patients were treated by 5 radiation oncologists. Changes in CTV primary and CTV boost delineation occurred in 3 cases each. 3D specimen mapping enabled focal expansion or reduction of boost volumes, reflecting improved localization of high-risk surgical margins. Small dosimetric changes were observed for organs at risk, but none exceeded clinically significant thresholds. Radiation oncologists reported increased confidence in treatment volumes (mean score increased from 64.5 to 84.9; P = .02) and improved ability to localize positive margins (mean score increased from 51.6 to 75.4; P = .02). Conclusions Integration of patient-specific 3D specimen maps into adjuvant radiation therapy planning for head and neck squamous cell carcinoma is feasible and can meaningfully influence target delineation, particularly for boost volumes. This strategy improves margin localization, multidisciplinary communication, and clinician confidence, with the potential to optimize oncologic coverage.