Long‐term experience with reduced planning target volume margins and intensity‐modulated radiotherapy with daily image‐guidance for head and neck cancer

Chen, Allen M.; Yu, Yao; Daly, Megan E.; Farwell, D. Gregory; Benedict, Stanley H; Purdy, James A.

doi:10.1002/hed.23532

Cited by 48 publications

(41 citation statements)

References 21 publications

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“…It may be argued that the extra effort to define a GTV_L and CTV_L would be trivial, since CTV to PTV margins of at least 3 mm are used. Today, less than 3-5 mm expansion margins are not recommended to generate PTV from CTV in SCCHN [13, 14], and this may blur and rule out any delineation uncertainties occurring at the air-tissue border, even though these suggested PTV margins do not take the CTV_Δ into account. In a practical sense, an increased PTV expansion based on the HDs arising from CTV_Δ would overcome this problem without increasing the L-based delineation workload.…”

Section: Discussionmentioning

confidence: 99%

Primary tumor volume delineation in head and neck cancer: missing the tip of the iceberg?

et al. 2017

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BackgroundThe aim was to evaluate the geometric and corresponding dosimetric differences between two delineation strategies for head and neck tumors neighboring air cavities.MethodsPrimary gross and clinical tumor volumes (GTV and CTV) of 14 patients with oropharynx or larynx tumors were contoured using a soft tissue window (S). In a second strategy, the same volumes were contoured with an extension to include the parts which became visible on lung window (L). For the calculation of Hausdorff-distances (HD) between contoured volumes of the two strategies, triangular meshes were exported. Two radiotherapy plans with identical goals and optimization parameters were generated for each case. Plan_S were optimized on CTV_S, and Plan_L on CTV_L. The dose coverages of CTV_L and CTV_Δ (CTV_L minus CTV_S) were evaluated in Plan_S. OAR doses were compared among Plan_S and Plan_L.ResultsMedian three-dimensional HD for GTVs and CTVs were 5.7 (±2.6) and 9.3 (±2.8) mm, respectively. The median volume differences between structures contoured using L and S windows were 9% (±5%) and 9% (±4%) for GTV and CTV, respectively. In 13 out of 14 cases, Plan_S met the plan acceptance criteria for CTV_L. In 8 cases CTV_Δ was covered insufficiently in Plan_S. Mean and median differences in OAR dose-volume histogram parameters between Plan_S and Plan_L were within 3%.ConclusionFor the current practice in radiotherapy planning for head and neck cancer, the delineation of L-based volumes seems unnecessary. However, in special settings, where smaller or no PTV margins are used, this approach may play an important role for local control.Electronic supplementary materialThe online version of this article (doi:10.1186/s13014-017-0838-4) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Primary tumor volume delineation in head and neck cancer: missing the tip of the iceberg?

et al. 2017

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“…Combining this high degree of conformality with IGRT offers the potential for further reducing toxicity while maintaining local-regional control [ 64 ]. One group successfully reduced PTV margins for patients with head and neck cancer from 5 to 3 mm, reducing the incidence of gastrostomy tube dependence and esophageal stricture but without affecting local-regional control [ 19 ]. Image-guided IMRT may also offer the possibility of dose escalation, which can improve control of some tumors [ 117 ].…”

Section: Higher Conformality/margin Reductionmentioning

confidence: 98%

Principles of IMRT

Court

Balter

Mohan

2015

Intensity-Modulated Radiation Therapy

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Keywords IMRT • VMAT • IMRT treatment planning • IMRT treatment delivery IntroductionThis chapter describes the basic principles of intensity-modulated radiation therapy (IMRT), providing the necessary background for subsequent clinical chapters. We start by describing the IMRT treatment planning and delivery process, introducing the wide range of different approaches and technologies currently in clinical use. Then, other topics important in the implementation of IMRT are discussed, including quality assurance (QA), facility design, and respiratory motion management. The chapter closes by reviewing some potential advantages and challenges of IMRT. Treatment PlanningIMRT relies on many of the same tools for imaging, dose calculations, plan evaluation, QA, and delivery as conventional treatments do. However, some signifi cant differences exist, particularly in the planning and treatment delivery processes. The following sections describe the workfl ow for the entire IMRT process, from the viewpoint of patients and clinic staff.

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“…Although radiotherapy could potentially cure NPC, it can also result in significant long-term morbidity. 10 Notably, despite these advances and the consequential improvements in the safety profile of radiotherapy, the toxicity of this treatment modality is still substantial and reducing it further remains an important goal. [3][4][5] These advances include improved radiotherapy treatment design (intensity-modulated radiation therapy [IMRT]) and improved planning and implementation (image-guided radiation therapy [IGRT]).…”

Section: Introductionmentioning

confidence: 99%

Long‐term outcomes in patients with nasopharyngeal carcinoma treated with reduced‐volume conformal radiotherapy: A retrospective cohort study

et al. 2018

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Long‐term experience with reduced planning target volume margins and intensity‐modulated radiotherapy with daily image‐guidance for head and neck cancer

Abstract: The use of reduced (3 mm) CTV-to-PTV margins was associated with reduced late toxicity while maintaining locoregional control.

Cited by 48 publications

References 21 publications

Primary tumor volume delineation in head and neck cancer: missing the tip of the iceberg?

Primary tumor volume delineation in head and neck cancer: missing the tip of the iceberg?

Principles of IMRT

Long‐term outcomes in patients with nasopharyngeal carcinoma treated with reduced‐volume conformal radiotherapy: A retrospective cohort study

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