Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control

Neve, Wilfried De; Gersem, Werner De; Derycke, S.; Meerleer, Gert De; Moerman, Mieke; Bate, Marie-Thélèse; Duyse, B. Van; Vakaet, Luc; Deene, Yves De; Mersseman, B.; Waeter, Carlos De

doi:10.1016/s0167-8140(99)00019-5

Cited by 89 publications

(23 citation statements)

References 14 publications

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“…The feasibility of IMRT has been tested and confirmed in the treatment of prostate cancer [22], head and neck malignancies [4], and recurrent tumors after radiation therapy [5]. Experiences from Mallinckrodt Institute of Radiology have shown that tumor control is superior to the conventional beam arrangement and salivary glands were spared with subsequent improvement of quality of life [23].…”

Section: Discussionmentioning

confidence: 99%

“…Some efforts have been made to use threedimensional conformal radiation therapy (3DRT) [2] to preserve normal organ function while giving the tumor a tumoricidal dose. This goal may be possible with the development of an advanced form of 3DRT, called intensity-modulated radiation therapy (IMRT) [3][4][5][6]. IMRT is capable of generating complex 3D dose distributions to conform closely to the target volume even in tumors with concave features.…”

Section: Introductionmentioning

confidence: 99%

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Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

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SUMMARY We studied target volume coverage and normal tissue sparing of serial tomotherapy intensity modulated radiation therapy (IMRT) and fixed-field IMRT for nasopharyngeal carcinoma (NPC), as compared with those of conventional beam arrangements. Twelve patients with NPC (T2-4N1-3M0) at Mallinckrodt Institute of Radiology underwent computed tomography simulation. Images were then transferred to a virtual simulation workstation computer for target contouring. Target gross tumor volumes (GTV) were primary nasopharyngeal tumor (GTV NP ) with a prescription of 70 Gy, grossly enlarged cervical nodes (GTV LN ) with a prescription of 70 Gy, and the uninvolved cervical lymphatics [designated as the clinical tumor volume (CTV)] with a prescription of 60 Gy. Critical organs, including the parotid gland, spinal cord, brain stem, mandible, and pituitary gland, were also delineated. Conventional beam arrangements were designed following the guidelines of Intergroup (SWOG, RTOG, ECOG) NPC Study 0099 in which the dose was prescribed to the central axis and the target volumes were aimed to receive the prescribed dose ± 10%. Similar dosimetric criteria were used to assess the target volume coverage capability of IMRT. Serial tomotherapy IMRT was planned using a 0.86-cm wide multivane collimator, while a dynamic multileaf collimator system with five equally spaced fixed gantry angles was designated for fixed-beam IMRT. The fractional volume of each critical organ that received a certain predefined threshold dose was obtained from dose-volume histograms of each organ in either the three-dimensional or IMRT treatment planning computer systems. Statistical analysis (paired t-test) was used to examine statistical significance. We found that serial tomotherapy achieved similar target volume coverage as conventional techniques (97.8 ± 2.3% vs. 98.9 ± 1.3%). The static-field IMRT technique (five equally spaced fields) was inferior, with 92.1 ± 8.6% fractional GTV NP receiving 70 Gy ± 10% dose (P < 0.05). However, GTV LN coverage of 70 Gy was significantly better with both IMRT techniques (96.1 ± 3.2%, 87.7 ± 10.6%, and 42.2 ± 21% for tomotherapy, fixed-field IMRT, and conventional therapy, respectively). CTV coverage of 60 Gy was also significantly better with the IMRT techniques. Parotid gland sparing was quantified by evaluating the fractional volume of parotid gland receiving more than 30 Gy; 66.6 ± 15%, 48.3 ± 4%, and 93 ± 10% of the parotid volume received more than 30 Gy using tomotherapy, fixed-field IMRT, and conventional therapy, respectively (P < 0.05). Fixed-field IMRT technique had the best parotid-sparing effect despite less desirable target coverage. The pituitary gland, mandible, spinal cord, and brain stem were also better spared by both IMRT techniques. These encouraging dosimetric results substantiate the theoretical advantage of inverse-planning IMRT in the management of Publication of the International Union Against Cancer NPC. We showed that target coverage of the primary tumor was maintained and nodal coverage ...

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Cheng

Chao

Low

2001

Intl Journal of Cancer

125

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“…The intensity of the radiation beam can be modulated either to deliver uniform doses to decrease dosimetric "hot spots" in the normal tissues, as done in our study, or the photon fluence can be changed over time and space to increase dose conformality to the target tissue and decrease radiation to normal tissues [28,29]. 3D conformal techniques to deliver radiation can also be employed to improve the therapeutic ratio in the management of head and neck cancers [30,31].…”

Section: Discussionmentioning

confidence: 99%

Tissue/dose compensation to reduce toxicity from combined radiation and chemotherapy for advanced head and neck cancers

et al. 2001

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SUMMARY This study was undertaken to quantify the reduction in normal tissuecomplications resulting from the aggressive management of advanced head and neck cancers (AHNCs) utilizing tissue/dose compensation (TDC). Thirty-nine patients with AHNC were treated on an intensive chemotherapy ؉ radiation regimen. Eighteen of 39 patients were treated using TDC; the remaining 21 patients were radiated without TDC (NTDC). Acute and chronic toxicities, swallowing, speech function, and quality of life were assessed. The TDC group had a smaller radiation dose gradient across the entire treatment volume. Unscheduled treatment breaks were required in 11% of TDC patients as compared with 43% of the NTDC group (P ‫؍‬ 0.04). The TDC group had fewer Grade 3 or 4 acute and chronic toxicities and lower SOMA scores. At 3 months posttreatment, patients in the TDC group had better oral intake, lower pharyngeal residue, and better oropharyngeal swallowing efficiency and were able to swallow more bolus types. Patients in the TDC group also had better articulation. Use of TDC resulted in reduced treatmentrelated interruptions, decreased acute and chronic toxicities, and better speech and swallowing functions. Techniques to improve radiation dose conformality around the target tissues while decreasing the radiation dose to the normal tissues should be an integral part of aggressive combined modality therapy.

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“…The authors also concluded that inverse treatment planning and IMRT might be a tool for escalating the dose in high-risk regions. De Neve et al [12] hypothesized that in the nasopharynx, a tumor-free distance of 1-1.5 cm seems sufficient to spare an adjacent parotid gland. This statement is important in the ongoing discussion whether the parotid glands may be spared without achieving lower tumor control rates.…”

Section: Discussionmentioning

confidence: 99%

Inverse Treatment Planning and Stereotactic Intensity-Modulated Radiation Therapy (IMRT) of the Tumor and Lymph Node Levels for Nasopharyngeal Carcinomas

Münter

Debus

Hof

et al. 2002

Strahlentherapie und Onkologie

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IMRT allows the treatment of the target volumes with high doses combined with an excellent sparing of the organs at risk. The IMRT approach presented here makes the treatment of the whole target volume with a single-beam arrangement feasible and does not increase the treatment time compared to a split-beam IMRT technique. Treatment time was comparable to a conventional three-field technique combined with electrons. This IMRT technique can prevent over- or underdosage at field matchlines in the head and neck region and, moreover, is able to spare parotid glands and therefore better avoid xerostomia compared to conventional techniques.

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Clinical delivery of intensity modulated conformal radiotherapy for relapsed or second-primary head and neck cancer using a multileaf collimator with dynamic control

Cited by 89 publications

References 14 publications

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Comparison of intensity modulated radiation therapy (IMRT) treatment techniques for nasopharyngeal carcinoma

Tissue/dose compensation to reduce toxicity from combined radiation and chemotherapy for advanced head and neck cancers

Inverse Treatment Planning and Stereotactic Intensity-Modulated Radiation Therapy (IMRT) of the Tumor and Lymph Node Levels for Nasopharyngeal Carcinomas

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