Dental radiation dosimetric maps from intensity‐modulated radiation therapy planning for head and neck cancers

Abstract

Background The purpose of this study was to create dental radiation maps to calculate the mean dose to individual teeth, maxilla and mandible using intensity‐modulated radiation therapy (IMRT). Methods Eighteen common clinical settings were chosen. Radiation plans were extracted, and each tooth was contoured at its junction with the gingiva and labeled based on the Universal/American numbering system. Results All patients were treated with prescribed doses of 50–70 Gy in 1.66–2 Gy/fraction. Patients receiving mean doses >50 Gy to the teeth, mandible, and maxilla included those with advanced tumors of the oral cavity and gross lymphadenopathy of level 1b. Conclusion We believe this to be the first study generating dosimetric maps of estimated doses to each tooth and each third of the mandible and the maxilla for common examples of head and neck cancer faced by radiation oncologists. Adoption of these dental maps may help improve clinical workflow efficiency.

Dosimetric Comparison between Volumetric Modulated Arc Therapy (VMAT) and Intensity-Modulated Radiotherapy (IMRT) for Dental Structures of Head and Neck Cancer Patients

“…In addition, compared with other tumor locations, more energy can be devoted to protecting other OAR, such as the parotid glands, which can help reduce the incidence of radiation-related caries. Finally, when level Ib was included in the PTV, the radiation dose delivered to mandibular teeth, especially the mandibular molars, was significantly higher than PTV excluding level Ib, consistent with a study by Polce et al [ 31 ]. Furthermore, the radiation dose delivered to mandibular molars reaches or approaches 60 Gy using these two radiotherapy techniques.…”

Dental Evaluation Prior to Cancer Therapy

“…For patients undergoing high dose HNRT, the advent of Intensity Modulated Radiation Therapy (IMRT) has allowed for continued high dose delivery to the tumor bed while reducing the radiation to the adjacent tissues [ 66 – 68 ]. This has resulted in some reduction of the oral toxicities induced by HNRT [ 28 , 69 ].…”

“…This has resulted in some reduction of the oral toxicities induced by HNRT [ 28 , 69 ]. Polce et al had further explored using the IMRT radiation plans to estimate the radiation dose to each tooth or selected area of interest so that decision making during treatment planning can be more precise [ 66 ]. Other local measures include fabrication of intra-oral stents to be worn during HNRT treatment sessions to decrease radiation scatter in patients with heavily restored dentition, to displace the tongue or to position the oral structures away from the epicenter where the radiation dose is at the highest [ 70 , 71 ].…”

Over 300 Radiation Caries Papers: Reflections From the Rearview Mirror

“…This could guide the selection of dosimetric parameters utilized in the oncologic setting. Dosimetric dental maps have contributed to assessing the prediction of doses in individual teeth and helped improve clinical workflow efficiency [ 30 ]. Therefore, radiation oncologists should recognize the challenges faced by dental oncologists in HNC patients adapting their radiation fields to minimize dental and salivary glands exposure [ 29 ].…”