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. 2010 Jun 1;77(2):455-61.
doi: 10.1016/j.ijrobp.2009.04.061. Epub 2009 Aug 11.

Simple carotid-sparing intensity-modulated radiotherapy technique and preliminary experience for T1-2 glottic cancer

David I Rosenthal  1 , Clifton D Fuller, Jerry L Barker Jr, Bryan Mason, John A Garcia, Jan S Lewin, F Christopher Holsinger, C Richard Stasney, Steven J Frank, David L Schwartz, William H Morrison, Adam S Garden, K Kian Ang
Affiliations

Simple carotid-sparing intensity-modulated radiotherapy technique and preliminary experience for T1-2 glottic cancer

David I Rosenthal et al. Int J Radiat Oncol Biol Phys. .

Abstract

Purpose: To investigate the dosimetry and feasibility of carotid-sparing intensity-modulated radiotherapy (IMRT) for early glottic cancer and to report preliminary clinical experience.

Methods and materials: Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) datasets from 6 T1-2 conventionally treated glottic cancer patients were used to create both conventional IMRT plans. We developed a simplified IMRT planning algorithm with three fields and limited segments. Conventional and IMRT plans were compared using generalized equivalent uniform dose and dose-volume parameters for in-field carotid arteries, target volumes, and organs at risk. We have treated 11 patients with this simplified IMRT technique.

Results: Intensity-modulated radiotherapy consistently reduced radiation dose to the carotid arteries (p < 0.05) while maintaining the clinical target volume coverage. With conventional planning, median carotid V35, V50, and V63 were 100%, 100%, and 69.0%, respectively. With IMRT planning these decreased to 2%, 0%, and 0%, respectively (p < 0.01). Radiation planning and treatment times were similar for conventional radiotherapy and IMRT. Treatment results have been excellent thus far.

Conclusions: Intensity-modulated radiotherapy significantly reduced unnecessary radiation dose to the carotid arteries compared with conventional lateral fields while maintaining clinical target volume coverage. Further experience and longer follow-up will be required to demonstrate outcomes for cancer control and carotid artery effects.

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Conflict of interest statement

Conflict of interest: none.

Figures

Fig. 1
Fig. 1
Composite carotid artery dose–volume histogram (n = 6) showing mean (solid line) and 95% confidence interval (shaded region) for virtual plans (red = intensity-modulated radiotherapy, blue = opposed laterals).
Fig. 2
Fig. 2
Stereotypic isodose plans for (a) lateral field setup and (b) intensity-modulated radiotherapy.
Fig. 3
Fig. 3
Pre- (a), during (b), and post–intensity-modulated radiotherapy (c) laryngoscopic examination, showing development and resolution of circular mucositis, in a distribution similar to the expected isodose volumes.
See this image and copyright information in PMC

References

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