Is there a "mucosa-sparing" benefit of IMRT for head-and-neck cancer?

被引:52
作者
Sanguineti, Giuseppe
Endres, Eugene J.
Gunn, Brandon G.
Parker, Brent
机构
[1] Univ Texas, Med Branch, Dept Radiat Oncol, Galveston, TX 77555 USA
[2] Univ Texas, Med Branch, Dept Phys Med, Galveston, TX 77555 USA
来源
INTERNATIONAL JOURNAL OF RADIATION ONCOLOGY BIOLOGY PHYSICS | 2006年 / 66卷 / 03期
关键词
IMRT; acute mucositis; altered fractionation; MODULATED RADIATION-THERAPY; SQUAMOUS-CELL CARCINOMA; TARGET COVERAGE; ORAL MUCOSITIS; ONCOLOGY GROUP; UNITED-STATES; RADIOTHERAPY; FRACTIONATION; TRIAL; HYPERFRACTIONATION;
D O I
10.1016/j.ijrobp.2006.05.060
中图分类号
R73 [肿瘤学];
学科分类号
100214 ;
摘要
Purpose: To investigate whether intensity-modulated radiation therapy (IMRT) allows more mucosal sparing than standard three-field technique (3FT) radiotherapy for early oropharyngeal cancer. Methods and Materials: Whole-field IMRT plans were generated for 5 patients with early-stage oropharyngeal cancer according to Radiation Therapy Oncology Group 0022 (66 Gy/30 fractions/6 weeks) guidelines with and without a dose objective on the portion of mucosa not overlapping any PTV. 3FT plans were also generated for the same 5 patients with two fractionation schedules: conventional fractionation (CF) to 70 Gy/35 fractions/7 weeks and concomitant boost (CB) to 72 Gy/40 fractions/6 weeks. Cumulative dose volume histograms (DVHs) of the overall mucosal volume (as per in-house definition) from all trials were compared after transformation into the linear quadratic equivalent dose at 2 Gy per fraction with a time factor correction. Results: Compared with IMRT without dose objective on the mucosa, a 30-Gy maximum dose objective on the mucosa allows similar to 20% and similar to 12% mean absolute reduction in the percentage of mucosa volume exposed to a dose equivalent to 30 Gy (p < 0.01) and 70 Gy (p < 0.01) at 2 Gy in 3 and 7 weeks, respectively, without detrimental effect on the coverage of other regions of interest. Without mucosal dose objective, IMRT is associated with a larger amount of mucosa exposed to clinically relevant doses compared with both concomitant boost and conventional fractionation; however, if a dose objective is placed, the reverse is true, with up to similar to 30% reduction in the volume of the mucosa in the high-dose region compared with both concomitant boost and conventional fractionation (p < 0.01). Conclusions: Intensity-modulated radiation therapy can be potentially provide more mucosal sparing than traditional approaches. (c) 2006 Elsevier Inc.
引用
收藏
页码:931 / 938
页数:8
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