Significant improvement in normal tissue sparing and target coverage for head and neck cancer by means of helical tomotherapy

Fiorino, Claudio; Dell’Oca, I.; Pierelli, A.; Broggi, S.; Martin, E. De; Muzio, N. Di; Longobardi, B.; Fazio, Ferruccio; Calandrino, R.

doi:10.1016/j.radonc.2006.02.009

Cited by 139 publications

(88 citation statements)

References 32 publications

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“…This is in agreement with the recommendations that strict

{normalD}^{max}

constraints are essential to maintain functionality of such critical organs 19 , 20 , 21 , 22 . However, Fig.…”

Section: Resultssupporting

confidence: 91%

“…However, a tighter control is not necessary because the probability of myelopathy vanishes for

D < 40 Gy

to the cord (18) . These observations may be considered as an indirect effect of the predominant

{normalD}^{max}

constraints on brainstems and spines, as common in head‐and‐neck cases 19 , 20 , 21 , 22 . Note that

{normalD}^{max}

thresholds lead to

V = 0 %

D \geq {normalD}^{max}

, resulting in narrower

{IQR}^{vol}

.…”

Section: Resultsmentioning

confidence: 99%

“…The first DVH falloff is attributed to an artifact of the patient geometry (for some cases, lower doses to significant portions of organs is common, but not for all). On the other hand, the turning point at

D = 40 Gy

is a direct result of maximum dose constraints for brainstem and spine, which are typically imposed in head‐and‐neck cancer cases 19 , 20 , 21 , 22 …”

Section: Resultsmentioning

confidence: 99%

“…For brainstem,

{normalD}^{con} = 50 Gy

and for spine,

{normalD}^{con} = 45 Gy

. This corresponds to maximum dose constraints that are usually imposed on all structures, often being the only constraint for brainstem or spine 19 , 20 , 21 , 22 . When

{normalV}_{110}

{normalV}_{50}

, or

{normalV}_{45}

are negligible

(\leq 2 %)

, we hypothesize them to be a consequence of maximum dose constraints, and otherwise

(> 2 %)

independent.…”

Section: Resultsmentioning

confidence: 99%

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On correlations in IMRT planning aims

Roy

Das

Nohadani

2016

J Applied Clin Med Phys

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The purpose was to study correlations amongst IMRT DVH evaluation points and how their relaxation impacts the overall plan. 100 head‐and‐neck cancer cases, using the Eclipse treatment planning system with the same protocol, are statistically analyzed for PTV, brainstem, and spinal cord. To measure variations amongst the plans, we use (i) interquartile range (IQR) of volume as a function of dose, (ii) interquartile range of dose as a function of volume, and (iii) dose falloff. To determine correlations for institutional and ICRU goals, conditional probabilities and medians are computed. We observe that most plans exceed the median PTV dose (average normalD50 = 104% prescribed dose). Furthermore, satisfying normalD50 reduced the probability of also satisfying normalD98, constituting a negative correlation of these goals. On the other hand, satisfying normalD50 increased the probability of satisfying normalD2, suggesting a positive correlation. A positive correlation is also observed between the PTV normalV105 and normalV110. Similarly, a positive correlation between the brainstem normalV45 and normalV50 is measured by an increase in the conditional median of normalV45, when normalV50 is violated. Despite the imposed institutional and international recommendations, significant variations amongst DVH points can occur. Even though DVH aims are evaluated independently, sizable correlations amongst them are possible, indicating that some goals cannot be satisfied concurrently, calling for unbiased plan criteria.PACS number(s): 87.55.dk, 87.53.Bn, 87.55.Qr, 87.55.de.

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“…This is in agreement with the recommendations that strict

{normalD}^{max}

constraints are essential to maintain functionality of such critical organs 19 , 20 , 21 , 22 . However, Fig.…”

Section: Resultssupporting

confidence: 91%

“…However, a tighter control is not necessary because the probability of myelopathy vanishes for

D < 40 Gy

to the cord (18) . These observations may be considered as an indirect effect of the predominant

{normalD}^{max}

constraints on brainstems and spines, as common in head‐and‐neck cases 19 , 20 , 21 , 22 . Note that

{normalD}^{max}

thresholds lead to

V = 0 %

D \geq {normalD}^{max}

, resulting in narrower

{IQR}^{vol}

.…”

Section: Resultsmentioning

confidence: 99%

D = 40 Gy

is a direct result of maximum dose constraints for brainstem and spine, which are typically imposed in head‐and‐neck cancer cases 19 , 20 , 21 , 22 …”

Section: Resultsmentioning

confidence: 99%

“…For brainstem,

{normalD}^{con} = 50 Gy

and for spine,

{normalD}^{con} = 45 Gy

. This corresponds to maximum dose constraints that are usually imposed on all structures, often being the only constraint for brainstem or spine 19 , 20 , 21 , 22 . When

{normalV}_{110}

{normalV}_{50}

, or

{normalV}_{45}

are negligible

(\leq 2 %)

, we hypothesize them to be a consequence of maximum dose constraints, and otherwise

(> 2 %)

independent.…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

On correlations in IMRT planning aims

Roy

Das

Nohadani

2016

J Applied Clin Med Phys

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“…12 Volumetricmodulated arc therapy, a form of rotational IMRT, and stereotactic RT, a form of highly focused irradiation using tridimensional tumor targeting, also offer advantages. 13 Arc therapy reduces IMRT delivery time from 20 minutes to fewer than 5 minutes, while optimizing dose homogeneity and normal tissue sparing, [14][15][16][17][18][19][20][21][22][23][24][25] including parotid gland sparing. 26 Stereotactic fractionated RT allows for the generation of x-ray beams from a single electronic source, which can be rotated or moved around a central focus.…”

Section: Chemoradiation Therapymentioning

confidence: 99%

Oral complications of cancer and cancer therapy

Epstein

Thariat

Bensadoun

et al. 2012

CA A Cancer J Clinicians

429

356

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Answer questions and earn CME/CNEOral complications resulting from cancer and cancer therapies cause acute and late toxicities that may be underreported, underrecognized, and undertreated. Recent advances in cancer treatment have led to changes in the incidence, nature, and severity of oral complications. As the number of survivors increases, it is becoming increasingly recognized that the aggressive management of oral toxicities is needed to ensure optimal long‐term oral health and general well‐being. Advances in care have had an impact on previously recognized oral complications and are leading to newly recognized adverse effects. Here, the authors briefly review advances in cancer therapy, including recent advances in surgery, oral care, radiation therapy, hematopoietic cell transplantation, and medical oncology; describe how these advances affect oral health; and discuss the frequent and/or severe oral health complications associated with cancer and cancer treatment and their effect upon long‐term health. Although some of the acute oral toxicities of cancer therapies may be reduced, they remain essentially unavoidable. The significant impact of long‐term complications requires increased awareness and recognition to promote prevention and appropriate intervention. It is therefore important for the primary oncologist to be aware of these complications so that appropriate measures can be implemented in a timely manner. Prevention and management is best provided via multidisciplinary health care teams, which must be integrated and communicate effectively in order to provide the best patient care in a coordinated manner at the appropriate time. CA Cancer J Clin 2012. © 2012 American Cancer Society.

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