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dc.contributor.authorWebster, Gareth J
dc.contributor.authorRowbottom, Carl G
dc.contributor.authorHo, Kean F
dc.contributor.authorSlevin, Nicholas J
dc.contributor.authorMackay, Ranald I
dc.date.accessioned2009-04-01T23:13:00Z
dc.date.available2009-04-01T23:13:00Z
dc.date.issued2008-10-01
dc.identifier.citationEvaluation of larynx-sparing techniques with IMRT when treating the head and neck. 2008, 72 (2):617-22 Int. J. Radiat. Oncol. Biol. Phys.en
dc.identifier.issn0360-3016
dc.identifier.pmid18793966
dc.identifier.doi10.1016/j.ijrobp.2008.06.1495
dc.identifier.urihttp://hdl.handle.net/10541/58687
dc.description.abstractPURPOSE: 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.
dc.language.isoenen
dc.subjectDysphagiaen
dc.subjectHead and Neck Canceren
dc.subjectOropharyngeal Cancers
dc.subject.meshDeglutition Disorders
dc.subject.meshHead and Neck Neoplasms
dc.subject.meshHumans
dc.subject.meshLarynx
dc.subject.meshOropharyngeal Neoplasms
dc.subject.meshRadiation Injuries
dc.subject.meshRadiotherapy Dosage
dc.subject.meshRadiotherapy Planning, Computer-Assisted
dc.subject.meshRadiotherapy, Intensity-Modulated
dc.titleEvaluation of larynx-sparing techniques with IMRT when treating the head and neck.en
dc.typeArticleen
dc.contributor.departmentNorth Western Medical Physics, Christie Hospital National Health Service Foundation Trust, Manchester, UK. Gareth.Webster@physics.cr.man.ac.uken
dc.identifier.journalInternational Journal of Radiation Oncology, Biology, Physicsen
html.description.abstractPURPOSE: 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.


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