The Potential for Dose Dumping in Normal Tissues with IMRT for Pelvic and H&amp;N Cancers

Reddy, Nandanuri M. S.; Mazur, A; Sampath, Seshadri; Osian, Adrian; Sood, Brij; Ravi, A.; Nori, Dattatreyudu

doi:10.1016/j.meddos.2007.05.001

Cited by 10 publications

(14 citation statements)

References 27 publications

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“…Rectum was contoured in full, from rectosigmoid flexure to anorectal junction. 8,9 In the text, volumes on planning CT means the volumes on the treatment planning CT day, and treatment fraction means the treatment day. The Varian Eclipse treatment planning system ͑Varian Medical Systems, Palo Alto, CA͒ was used to generate 5-field IMRT plans with five gantry angles ͑250°, 315°, 45°, 110°, and 180°͒.…”

Section: Methodsmentioning

confidence: 99%

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image‐guided IMRTa)

et al. 2009

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Section: Methodsmentioning

confidence: 99%

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image‐guided IMRTa)

et al. 2009

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“…''Dose dumping'' behind the spinal cord is a known potential problem in head and neck IMRT [18], as the optimisation attempts to boost dose to PTVs while sparing the spinal cord itself. This can lead to a doughnut-style ring of high dose around the spared spinal cord and is particularly undesirable because of the risk that weight loss or set-up errors could cause the cord position to relax into the high-dose area.…”

Section: Treatment Planningmentioning

confidence: 99%

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

Chatterjee

Mott²,

Smyth³

et al. 2011

BJR

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Objective: Intensity-modulated radiotherapy (IMRT) is increasingly being used to treat head and neck cancer cases. Methods: We discuss the clinical challenges associated with the setting up of an image guided intensity modulated radiotherapy service for a subset of head and neck cancer patients, using a recently commissioned helical tomotherapy (HT) Hi Art (Tomotherapy Inc, WI) machine in this article. We also discuss the clinical aspects of the tomotherapy planning process, treatment and image guidance experiences for the first 10 head and neck cancer cases. The concepts of geographical miss along with tomotherapy-specific effects, including that of field width and megavoltage CT (MVCT) imaging strategy, have been highlighted using the first 10 head and neck cases treated. Results: There is a need for effective streamlining of all aspects of the service to ensure compliance with cancer waiting time targets. We discuss how patient toxicity audits are crucial to guide refinement of the newly set-up planning dose constraints. The advantages of intensity-modulated radiotherapy (IMRT) in head and neck cancer, in terms of target conformation, organ at risk sparing and associated improvement in quality of life, and the potential for dose escalation, have been well documented [1][2][3]. The development and commercial release of the helical tomotherapy (HT) Hi Art (Tomotherapy, Madison WI) system by Mackie et al [4] has introduced advanced helical IMRT delivery techniques and combined these with integrated onboard image guidance capabilities [5]. Recent adoption of this technology within the NHS by two centres (Cambridge and Newcastle), alongside existing provision within a private sector treatment centre (BUPA Cromwell Hospital, London), enables delivery of highly conformal image-guided IMRT in the UK.The physical characteristics of the HT system are described in detail elsewhere [4,5]; however, in basic terms, the system is a short waveguide 6 MV linac mounted on a spiral CT gantry system. Beam collimation is by a pneumatically controlled binary multileaf collimator (MLC), with each leaf projecting to 6.25 mm at isocentre, for three selectable field widths [6]. Owing to its continuous rotational delivery technique and rapid beam modulation throughout its full arc of travel, the HT system gives greater flexibility than conventional linear accelerator (linac)-based IMRT that provides intensity modulation at multiple fixed gantry angles. Planning comparisons between tomotherapy and rotational techniques using conventional linacs, volumetric arc therapy (VMAT) or intensity-modulated arc therapy (IMAT), have also been published [7,8]; however, there is ongoing debate as to the relative merits of each technique [9][10][11][12].The complexity of head and neck radiotherapy is due to the proximity of multiple organs at risk (OAR), including critical structures such as the brain stem and spinal cord and important functional organs such as the parotid glands, optic nerve, optic chiasm, larynx and mandible. The dose prescription ...

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“…2,6,7 This tight dose gradient allows an escalated tumoricidal dose to be delivered to the prostate while abutting or in close proximity to GI and GU structures. 3,9,10 IMRT has proven to lower rates of complications associated with normal tissue structures. 4,8,[11][12][13] Unlike 3-dimensional conformal radiotherapy, IMRT planning requires dose and volume objectives to be assigned to target tissues as well as critical structures.…”

Section: Introductionmentioning

confidence: 99%

“…7 This phenomenon has been coined "dose dumping" by some authors. 7,9 Dose dumping often occurs in nontarget tissues and can result in increased dose to normal tissues. 9 To reduce unwanted dose deposition in normal tissues, a series of tuning structures should be created.…”

Section: Introductionmentioning

confidence: 99%

“…7,9 Dose dumping often occurs in nontarget tissues and can result in increased dose to normal tissues. 9 To reduce unwanted dose deposition in normal tissues, a series of tuning structures should be created. These structures allow for the adjustment of dose by assigning objectives associated to them, thus guiding the IMRT algorithm to produce a desirable plan.…”

Section: Introductionmentioning

confidence: 99%

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Dosimetric comparison of intensity-modulated solutions for intact prostate cancer

Neill

2014

Medical Dosimetry

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The Potential for Dose Dumping in Normal Tissues with IMRT for Pelvic and H&N Cancers

Cited by 10 publications

References 27 publications

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image‐guided IMRTa)

Influence of volumes of prostate, rectum, and bladder on treatment planning CT on interfraction prostate shifts during ultrasound image‐guided IMRTa)

Clinical challenges in the implementation of a tomotherapy service for head and neck cancer patients in a regional UK radiotherapy centre

Dosimetric comparison of intensity-modulated solutions for intact prostate cancer

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