Intensity modulated radiotherapy improves target coverage and parotid gland sparing when delivering total mucosal irradiation in patients with squamous cell carcinoma of head and neck of unknown primary site
Intensity modulated radiotherapy improves target coverage and parotid gland sparing when delivering total mucosal irradiation in patients with squamous cell carcinoma of head and neck of unknown primary site
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DOI：
10.1016/j.meddos.2007.01.002
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发表时间：
2007-09-01
影响因子：
1.2
通讯作者：
Nutting, Christopher M.
中科院分区：
文献类型：
--
作者：
Bhide, Shreerang;Clark, Catherine;Nutting, Christopher M.
原发部位隐匿的头颈部鳞状细胞癌是一个有争议的临床问题。传统的全粘膜照射（TMI）最大限度地提高了局部控制，但以口干为代价。调强放射治疗已被证明可以节省头部和癌症患者的唾液组织。本研究旨在研究调强放射治疗在该患者组中进行淋巴结和TMI以及保留腮腺的潜力。对6例患者进行常规放疗（CRT）和调强放疗计划，以治疗同侧（受累）术后颈部（PTV 1）和未手术的对侧颈部和粘膜轴（PTV 2）。在PTV 2中生成了包含和不包含鼻咽的计划。调强放射治疗计划提高靶区覆盖率和保留腮腺的潜力进行了研究。使用CRT和IMRT时，PTV 1的平均剂量无显著差异（分别为59.7和60.0，p = 0.5）。IMRT技术的PTV 1和PTV 2的最大剂量分别低于CRT（P = 0.008和P < 0.0001），IMRT的PTV 1和PTV 2的最小剂量分别显著高于CRT（P = 0.001和P = 0.001），说明IMRT的剂量均匀性更好。IMRT（23.21 +/- 0.7）的PTV 1对侧腮腺平均剂量显著低于CRT（50.5 +/- 5.8）（P < 0.0001）。在包含鼻咽和不包含鼻咽的计划之间腮腺剂量存在显著差异。调强放射治疗可改善PTV 1和PTV 2的剂量均匀性，并可保留腮腺。皇冠版权所有（C）2007由爱思唯尔公司出版。代表美国医学剂量学家协会。
Head and neck squamous cell carcinoma with occult primary site represents a controversial clinical problem. Conventional total mucosal irradiation (TMI) maximizes local control, but at the expense of xerostomia. IMRT has been shown to spare salivary tissue in head and cancer patients. This study has been performed to investigate the potential of IMRT to perform nodal and TMI and also allow parotid gland sparing in this patient group. Conventional radiotherapy (CRT) and IMRT plans were produced for six patients to treat the ipsilateral (involved) post-operative neck (PTV1) and the un-operated contralateral neck and mucosal axis (PTV2). Plans were produced with and without the inclusion of nasopharynx in the PTV2. The potential to improve target coverage and spare the parotid glands was investigated for the IMRT plans. There was no significant difference in the mean doses to the PTV1 using CRT and IMRT (59.7 and 60.0 respectively, p = 0.5). The maximum doses to PTV1 and PTV2 were lower for the IMRT technique as compared to CRT (P = 0.008 and P < 0.0001), respectively, and the minimum doses to PTV1 and PTV2 were significantly higher for IMRT as compared to CRT (P = 0.001 and P = 0.001), respectively, illustrating better dose homogeneity with IMRT. The mean dose to the parotid gland contralateral to PTV1 was significantly lower for IMRT (23.21 +/- 0.7) as compared to CRT (50.5 +/- 5.8) (P < 0.0001). There was a significant difference in parotid dose between plans with and without the inclusion of the nasopharynx. IMRT offers improved dose homogeneity in PTV1 and PTV2 and allows for parotid sparing. Crown Copyright (C) 2007 Published by Elsevier Inc. on behalf of American Association of Medical Dosimetrists.