Evaluation of Larynx-Sparing Techniques With IMRT When Treating the Head and Neck

Webster, G.; Rowbottom, C.; Ho, Kean F; Slevin, Nicholas J; Mackay, Ranald I

doi:10.1016/j.ijrobp.2008.06.1495

Cited by 22 publications

(12 citation statements)

References 12 publications

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“…The averaged mean laryngeal dose was 18 Gy using WF-IMRT, identical with the averaged mean laryngeal dose achieved with J-IMRT. Furthermore, the current study results suggest that laryngeal doses obtained by using WF-IMRT may be further reduced to values below 25 Gy previously reported in the literature [11]. Webster et al demonstrated that the dose to the larynx was decreased significantly from a reported mean dose of approximately 45-50 Gy, usually described when larynx sparing is not attempted with WF-IMRT, to a mean dose of 25-40 Gy if the larynx is considered an organ at risk and is incorporated into the WF-IMRT optimization process [9][10][11].…”

Section: Discussionsupporting

confidence: 58%

Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

Lin

Hwang

et al. 2012

Medical Dosimetry

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Section: Discussionsupporting

confidence: 58%

Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

Lin

Hwang

et al. 2012

Medical Dosimetry

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“…On the other hand, sparing of the glottic larynx in cases of oropharyngeal cancer is usually easier than sparing the supraglottic larynx, especially where the vallecula is included in the targets. Substantial sparing of the glottis can be equally achieved by split-field technique or, as done in the current study, by whole-neck IMRT, if the glottic larynx is assigned a high priority in the optimization cost function, and slight under-dosage of the lymphatic CTVs in the low neck is accepted (32). …”

Section: Discussionmentioning

confidence: 90%

Chemo-IMRT of Oropharyngeal Cancer Aiming to Reduce Dysphagia: Swallowing Organs Late Complication Probabilities and Dosimetric Correlates

Eisbruch

Kim

Feng

et al. 2011

International Journal of Radiation Oncology*Biology*Physics

225

188

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Purpose Assess dosimetric correlates of long-term dysphagia after chemo-IMRT of oropharyngeal cancer (OPC) sparing parts of the swallowing organs. Patients and Methods Prospective longitudinal study: weekly chemotherapy concurrent with IMRT for stages III/IV OPC, aiming to reduce dysphagia by sparing non-involved parts of swallowing-related organs: pharyngeal constrictors (PC), glottic and supraglottic larynx (GSL), and esophagus, as well as oral cavity and major salivary glands. Dysphagia outcomes included patient-reported Swallowing and Eating Domain scores, Observer-based (CTCAEv.2) dysphagia, and videofluoroscopy (VF), before and periodically after therapy through 2 years. Relationships between dosimetric factors and worsening (from baseline) of dysphagia through 2 years were assessed by linear mixed-effects model. Results 73 patients participated. Observer-based dysphagia was not modeled because at >6 months there were only four grade ≥2 cases (one of whom feeding-tube dependent). PC, GSL, and esophagus mean doses, as well as their partial volume doses (VDs), were each significantly correlated with all dysphagia outcomes. However, the VDs for each organ inter-correlated and also highly correlated with the mean doses, leaving only mean doses significant. Mean doses to each of the parts of the PCs (superior, middle and inferior) were also significantly correlated with all dysphagia measures, with superior PCs demonstrating highest correlations. For VF-based strictures, most significant predictor was esophageal mean doses (48±17 Gy in patients with, vs 27±12 in patients without strictures, p=0.004). Normal tissue complication probabilities (NTCPs) increased moderately with mean doses without any threshold. For increased VF-based aspirations or worsened VF summary scores, TD50 and TD25 were 63Gy and 56Gy for PC, and 56Gy and 39Gy for GSL, respectively. For both PC and GSL, patient-reported swallowing TDs were substantially higher than VF-based TDs. Conclusions Swallowing organs mean doses correlated significantly with long-term worsening of swallowing. Different methods assessing dysphagia resulted in different NTCPs, and none demonstrated a threshold.

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“…A number of groups have explored techniques to reduce dose to the larynx and pharyngeal musculature, including a matched low anterior neck field (4,16,17), IMRT (10,18), brachytherapy (19), or a CyberKnife (Accuray, Sunnyvale, CA) boost (19) while maintaining adequate target coverage. Some have suggested using split-field IMRT with a matched low anterior neck field in patients with nasopharyngeal and oropharyngeal primaries, whereas an extended whole-field IMRT plan is preferred for other head-and-neck primary lesions and gross nodal disease at the match line (20).…”

Section: Discussionmentioning

confidence: 99%

Dosimetric Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

Caudell

Schaner

Desmond

et al. 2010

International Journal of Radiation Oncology*Biology*Physics

195

175

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Evaluation of Larynx-Sparing Techniques With IMRT When Treating the Head and Neck

Cited by 22 publications

References 12 publications

Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

Larynx-sparing techniques using intensity-modulated radiation therapy for oropharyngeal cancer

Chemo-IMRT of Oropharyngeal Cancer Aiming to Reduce Dysphagia: Swallowing Organs Late Complication Probabilities and Dosimetric Correlates

Dosimetric Factors Associated With Long-Term Dysphagia After Definitive Radiotherapy for Squamous Cell Carcinoma of the Head and Neck

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