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
- Department of Radiation Oncology, University of California, Davis, Cancer Center, Sacramento, CA (United States)
- Department of Radiation Oncology, Memorial Sloan-Kettering Cancer Center, New York, NY (United States)
- 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, Vol. 72, Issue 5; Other Information: DOI: 10.1016/j.ijrobp.2008.03.004; PII: S0360-3016(08)00416-1; Copyright (c) 2008 Elsevier Science B.V., Amsterdam, The Netherlands, All rights reserved; Country of input: International Atomic Energy Agency (IAEA); ISSN 0360-3016
- Country of Publication:
- United States
- Language:
- English
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