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    Evaluation of larynx-sparing techniques with IMRT when treating the head and neck.

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    Authors
    Webster, Gareth J
    Rowbottom, Carl G
    Ho, Kean F
    Slevin, Nicholas J
    Mackay, Ranald I
    Affiliation
    North Western Medical Physics, Christie Hospital National Health Service Foundation Trust, Manchester, UK. Gareth.Webster@physics.cr.man.ac.uk
    Issue Date
    2008-10-01
    
    Metadata
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    Abstract
    PURPOSE: Concern exists that widespread implementation of whole-field intensity-modulated radiotherapy (IMRT) for the treatment of head-and-neck cancer has resulted in increased levels of dysphagia relative to those seen with conventional planning. Other investigators have suggested an alternative junctioned-IMRT (J-IMRT) method, which matches an IMRT plan to a centrally blocked neck field to restrict the laryngeal dose and reduce dysphagia. The effect on target coverage and sparing of organs at risk, including laryngeal sparing, in the optimization was evaluated and compared with that achieved using a J-IMRT technique. METHODS AND MATERIALS: A total of 13 oropharyngeal cancer whole-field IMRT plans were planned with and without including laryngeal sparing in the optimization. A comparison of the target coverage and sparing of organs at risk was made using the resulting dose-volume histograms and dose distribution. The nine plans with disease located superior to the level of the larynx were replanned using a series of J-IMRT techniques to compare the two laryngeal-sparing techniques. RESULTS: An average mean larynx dose of 29.1 Gy was achieved if disease did not extend to the level of the larynx, with 38.8 Gy for disease extending inferiorly and close to the larynx (reduced from 46.2 and 47.7 Gy, respectively, without laryngeal sparing). Additional laryngeal sparing could be achieved with J-IMRT (mean dose 24.4 Gy), although often at the expense of significantly reduced coverage of the target volume and with no improvement to other areas of the IMRT plan. CONCLUSION: The benefits of J-IMRT can be achieved with whole-field IMRT if laryngeal sparing is incorporated into the class solution. Inclusion of laryngeal sparing had no effect on other parameters in the plan.
    Citation
    Evaluation of larynx-sparing techniques with IMRT when treating the head and neck. 2008, 72 (2):617-22 Int. J. Radiat. Oncol. Biol. Phys.
    Journal
    International Journal of Radiation Oncology, Biology, Physics
    URI
    http://hdl.handle.net/10541/58687
    DOI
    10.1016/j.ijrobp.2008.06.1495
    PubMed ID
    18793966
    Type
    Article
    Language
    en
    ISSN
    0360-3016
    ae974a485f413a2113503eed53cd6c53
    10.1016/j.ijrobp.2008.06.1495
    Scopus Count
    Collections
    All Christie Publications
    Christie Medical Physics and Engineering Research
    Academic Department of Radiation Oncology - ADRO

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