Development and Validation of a Standardized Method for Contouring the Brachial Plexus: Preliminary Dosimetric Analysis Among Patients Treated With IMRT for Head-and-Neck Cancer

Journal Article · Mon Dec 01 04:00:00 EST 2008 · International Journal of Radiation Oncology, Biology and Physics

DOI:https://doi.org/10.1016/j.ijrobp.2008.03.004· OSTI ID:21172494

Hall, William H; Guiou, Michael ^[1]; Lee, Nancy Y ^[2]; Dublin, Arthur ^[3]; Narayan, Samir; Vijayakumar, Srinivasan; Purdy, James A ^[1]

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1. Department of Radiation Oncology, University of California, Davis, Cancer Center, Sacramento, CA (United States)
2. Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
3. Department of Diagnostic Radiology, University of California, Davis, Cancer Center, Sacramento, CA (United States)

Purpose: Although Radiation Therapy Oncology Group protocols have proposed a limiting dose to the brachial plexus for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, essentially no recommendations exist for the delineation of this structure for treatment planning. Methods and Materials: Using anatomic texts, radiologic data, and magnetic resonance imaging, a standardized method for delineating the brachial plexus on 3-mm axial computed tomography images was devised. A neuroradiologist assisted with identification of the brachial plexus and adjacent structures. This organ at risk was then contoured on 10 consecutive patients undergoing intensity-modulated radiotherapy for head-and-neck cancer. Dose-volume histogram curves were generated by applying the proposed brachial plexus contour to the initial treatment plan. Results: The total dose to the planning target volume ranged from 60 to 70 Gy (median, 70). The mean brachial plexus volume was 33 {+-} 4 cm{sup 3} (range, 25.1-39.4). The mean irradiated volumes of the brachial plexus were 50 Gy (17 {+-} 3 cm{sup 3}), 60 Gy (6 {+-} 3 cm{sup 3}), 66 Gy (2 {+-} 1 cm{sup 3}), 70 Gy (0 {+-} 1 cm{sup 3}). The maximal dose to the brachial plexus was 69.9 Gy (range, 62.3-76.9) and was {>=}60 Gy, {>=}66 Gy, and {>=}70 Gy in 100%, 70%, and 30% of patients, respectively. Conclusions: This technique provides a precise and accurate method for delineating the brachial plexus organ at risk on treatment planning computed tomography scans. Our dosimetric analysis suggest that for patients undergoing intensity-modulated radiotherapy for head-and-neck cancer, brachial plexus routinely receives doses in excess of historic and Radiation Therapy Oncology Group limits.

• OSTI ID: 21172494
• Journal Information: International Journal of Radiation Oncology, Biology and Physics, Journal Name: International Journal of Radiation Oncology, Biology and Physics Journal Issue: 5 Vol. 72; ISSN IOBPD3; ISSN 0360-3016
• Country of Publication: United States
• Language: English

Related Subjects

62 RADIOLOGY AND NUCLEAR MEDICINE
CARCINOMAS
COMPUTERIZED TOMOGRAPHY
HEAD
IMAGES
IRRADIATION
NECK
NMR IMAGING
PATIENTS
RADIATION DOSES
RADIATION HAZARDS
RADIOTHERAPY
RECOMMENDATIONS
VALIDATION