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

Dabaja, Bouthaina S.; Salehpour, Mohammad; Rosen, Isaac I.; Tung, S.; Morrison, William H.; Ang, K. Kian; Garden, Adam S.

doi:10.1016/j.ijrobp.2005.03.069

Cited by 77 publications

(62 citation statements)

References 11 publications

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“…Some investigators have proposed a split-field technique matched to a superior IMRT field as a means of minimising dose to critical structures within the low neck (e.g. larynx, oesophagus) [12,13]. We believe that the use of this technique probably would not have changed our study findings since the brachial plexus emerges anatomically from C5-6, which would lie superiorly to the match line.…”

Section: Discussionmentioning

confidence: 89%

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Chen

Wh²,

Bq³

et al. 2011

BJR

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Objective: The preferential use of intensity-modulated radiotherapy (IMRT) over conventional radiotherapy (CRT) in the treatment of head and neck cancer has raised concerns regarding dose to non-target tissue. The purpose of this study was to compare dose-volume characteristics with the brachial plexus between treatment plans generated by IMRT and CRT using several common treatment scenarios. Method: The brachial plexus was delineated on radiation treatment planning CT scans from 10 patients undergoing IMRT for locally advanced head and neck cancer using a Radiation Therapy Oncology Group-endorsed atlas. No brachial plexus constraint was used. For each patient, a conventional three-field shrinking-field plan was generated and the dose-volume histogram (DVH) for the brachial plexus was compared with that of the IMRT plan. Results: The mean irradiated volumes of the brachial plexus using the IMRT vs the CRT plan, respectively, were as follows: V50 (18¡5 ml) vs (11¡6 ml), p50.01; V60 (6¡4 ml) vs (3¡3 ml), p50.02; V66 (3¡1 ml) vs (1¡1 ml), p50.04, V70 (0¡1 ml) vs (0¡1 ml), p50.68. The maximum point dose to the brachial plexus was 68.9 Gy (range 62.3-78.7 Gy) and 66.1 Gy (range 60.2-75.6 Gy) for the IMRT and CRT plans, respectively (p50.01). Conclusion: Dose to the brachial plexus is significantly increased among patients undergoing IMRT compared with CRT for head and neck cancer. Preliminary studies on brachial plexus-sparing IMRT are in progress.

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Section: Discussionmentioning

confidence: 89%

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Chen

Wh²,

Bq³

et al. 2011

BJR

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“…We were however, often able to obtain dose distributions to the parotid gland that potentially can minimize the risk of severe xerostomia. We continue to treat the vast majority of our oropharynx patients with a split-beam technique 20 . Newer planning systems allow us to model the entire treatment in a single plan allowing us more flexibility in choice of fractionation, as well as combining the lower neck isodoses with the IMRT component of the treatment to minimize problems at the junctions.…”

Section: Discussionmentioning

confidence: 99%

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma

Garden

Morrison

Wong

et al. 2007

International Journal of Radiation Oncology*Biology*Physics

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130

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“…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: Discussionmentioning

confidence: 93%

“…The use of IMRT has been shown to unnecessarily distribute higher dose of radiation to the larynx when the larynx sparing is not attempted as part of the IMRT treatment planning [5,9,10].…”

Section: Discussionmentioning

confidence: 99%

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

Lin

Hwang

et al. 2012

Medical Dosimetry

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

Cited by 77 publications

References 11 publications

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma

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

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