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Title: Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques

Abstract

Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a matching anterior beam. Because IMRT can treat the entire volume or whole field (WF), the primary aim of the study was to test the ability to plan cases using WF-IMRT while obtaining an optimal plan and acceptable dose distribution and also respecting normal critical structures. Methods and Materials: Thirteen patients with early-stage oropharynx cancers had treatment plans created with HB-IMRT and WF-IMRT techniques. Plans were deemed acceptable if they met the planning guidelines (as defined or with minor violations) of the Radiation Therapy Oncology Group protocol H0022. Comparisons included coverage to the planning target volume (PTV) of the primary (PTV66) and subclinical disease (PTV54). We also compared the ability of both techniques to respect the tolerance of critical structures. Results: The volume of PTV66 treated to >110% was less in 9 of the 13 patients in the WF-IMRT plan as compared to the HB-IMRT plan. The calculated mean volume receiving >110% for all patients planned with WF-IMRT was 9.3% (0.8%-25%) compared to 13.7%more » (2.7%-23.7%) with HB-IMRT (p = 0.09). The PTV54 volume receiving >110% of dose was less in 10 of the 13 patients planned with WF-IMRT compared to HB-IMRT. The mean doses to all critical structures except the larynx were comparable with each plan. The mean dose to the larynx was significantly less (p = 0.001), 18.7 Gy, with HB-IMRT compared to 47 Gy with WF-IMRT. Conclusions: Regarding target volumes, acceptable plans can be generated with either WF-IMRT or HB-IMRT. WF-IMRT has an advantage if uncertainty at the match line is a concern, whereas HB-IMRT, particularly in cases not involving the base of tongue, can achieve much lower doses to the larynx.« less

Authors:
 [1];  [1];  [1];  [1];  [1];  [1];  [2]
  1. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States)
  2. Department of Radiation Oncology, University of Texas M.D. Anderson Cancer Center, Houston, TX (United States). E-mail: agarden@mdanderson.org
Publication Date:
OSTI Identifier:
20706240
Resource Type:
Journal Article
Resource Relation:
Journal Name: International Journal of Radiation Oncology, Biology and Physics; Journal Volume: 63; Journal Issue: 4; Other Information: DOI: 10.1016/j.ijrobp.2005.03.069; PII: S0360-3016(05)00708-X; Copyright (c) 2005 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA)
Country of Publication:
United States
Language:
English
Subject:
62 RADIOLOGY AND NUCLEAR MEDICINE; CARCINOMAS; HEAD; LARYNX; LETHAL DOSES; NECK; PATIENTS; PLANNING; RADIATION DOSE DISTRIBUTIONS; RADIATION DOSES; RADIOTHERAPY; RECOMMENDATIONS; TOLERANCE; TONGUE

Citation Formats

Dabaja, Bouthaina, Salehpour, Mohammad R., Rosen, Isaac, Tung, Sam, Morrison, William H., Ang, K. Kian, and Garden, Adam S.. Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques. United States: N. p., 2005. Web. doi:10.1016/j.ijrobp.2005.03.069.
Dabaja, Bouthaina, Salehpour, Mohammad R., Rosen, Isaac, Tung, Sam, Morrison, William H., Ang, K. Kian, & Garden, Adam S.. Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques. United States. doi:10.1016/j.ijrobp.2005.03.069.
Dabaja, Bouthaina, Salehpour, Mohammad R., Rosen, Isaac, Tung, Sam, Morrison, William H., Ang, K. Kian, and Garden, Adam S.. Tue . "Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques". United States. doi:10.1016/j.ijrobp.2005.03.069.
@article{osti_20706240,
title = {Intensity-modulated radiation therapy (IMRT) of cancers of the head and neck: Comparison of split-field and whole-field techniques},
author = {Dabaja, Bouthaina and Salehpour, Mohammad R. and Rosen, Isaac and Tung, Sam and Morrison, William H. and Ang, K. Kian and Garden, Adam S.},
abstractNote = {Background: Oropharynx cancers treated with intensity-modulated radiation (IMRT) are often treated with a monoisocentric or half-beam technique (HB). IMRT is delivered to the primary tumor and upper neck alone, while the lower neck is treated with a matching anterior beam. Because IMRT can treat the entire volume or whole field (WF), the primary aim of the study was to test the ability to plan cases using WF-IMRT while obtaining an optimal plan and acceptable dose distribution and also respecting normal critical structures. Methods and Materials: Thirteen patients with early-stage oropharynx cancers had treatment plans created with HB-IMRT and WF-IMRT techniques. Plans were deemed acceptable if they met the planning guidelines (as defined or with minor violations) of the Radiation Therapy Oncology Group protocol H0022. Comparisons included coverage to the planning target volume (PTV) of the primary (PTV66) and subclinical disease (PTV54). We also compared the ability of both techniques to respect the tolerance of critical structures. Results: The volume of PTV66 treated to >110% was less in 9 of the 13 patients in the WF-IMRT plan as compared to the HB-IMRT plan. The calculated mean volume receiving >110% for all patients planned with WF-IMRT was 9.3% (0.8%-25%) compared to 13.7% (2.7%-23.7%) with HB-IMRT (p = 0.09). The PTV54 volume receiving >110% of dose was less in 10 of the 13 patients planned with WF-IMRT compared to HB-IMRT. The mean doses to all critical structures except the larynx were comparable with each plan. The mean dose to the larynx was significantly less (p = 0.001), 18.7 Gy, with HB-IMRT compared to 47 Gy with WF-IMRT. Conclusions: Regarding target volumes, acceptable plans can be generated with either WF-IMRT or HB-IMRT. WF-IMRT has an advantage if uncertainty at the match line is a concern, whereas HB-IMRT, particularly in cases not involving the base of tongue, can achieve much lower doses to the larynx.},
doi = {10.1016/j.ijrobp.2005.03.069},
journal = {International Journal of Radiation Oncology, Biology and Physics},
number = 4,
volume = 63,
place = {United States},
year = {Tue Nov 15 00:00:00 EST 2005},
month = {Tue Nov 15 00:00:00 EST 2005}
}