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. 2011 Jan;84(997):58-63.
doi: 10.1259/bjr/62332495. Epub 2010 Sep 21.

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

A M Chen  1 , W H Hall, B-Q Li, M Guiou, C Wright, M Mathai, A Dublin, J A Purdy
Affiliations

Intensity-modulated radiotherapy increases dose to the brachial plexus compared with conventional radiotherapy for head and neck cancer

A M Chen et al. Br J Radiol. 2011 Jan.

Abstract

Objective: The preferential use of intensity-modulated radiotherapy (IMRT) over conventional radiotherapy (CRT) in the treatment of head and neck cancer has raised concerns regarding dose to non-target tissue. The purpose of this study was to compare dose-volume characteristics with the brachial plexus between treatment plans generated by IMRT and CRT using several common treatment scenarios.

Method: The brachial plexus was delineated on radiation treatment planning CT scans from 10 patients undergoing IMRT for locally advanced head and neck cancer using a Radiation Therapy Oncology Group-endorsed atlas. No brachial plexus constraint was used. For each patient, a conventional three-field shrinking-field plan was generated and the dose-volume histogram (DVH) for the brachial plexus was compared with that of the IMRT plan.

Results: The mean irradiated volumes of the brachial plexus using the IMRT vs the CRT plan, respectively, were as follows: V50 (18±5 ml) vs (11±6 ml), p = 0.01; V60 (6±4 ml) vs (3±3 ml), p = 0.02; V66 (3±1 ml) vs (1±1 ml), p = 0.04, V70 (0±1 ml) vs (0±1 ml), p = 0.68. The maximum point dose to the brachial plexus was 68.9 Gy (range 62.3-78.7 Gy) and 66.1 Gy (range 60.2-75.6 Gy) for the IMRT and CRT plans, respectively (p = 0.01).

Conclusion: Dose to the brachial plexus is significantly increased among patients undergoing IMRT compared with CRT for head and neck cancer. Preliminary studies on brachial plexus-sparing IMRT are in progress.

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Figures

Figure 1
Figure 1
Case illustration: 50-year-old Asian male with T4N2 nasopharyngeal carcinoma who was treated to a total dose of 70 Gy in 35 fractions to gross disease. Axial images at the level of the thyroid notch demonstrating the increased dose to the brachial plexus (contoured in purple) for the intensity-modulated radiotherapy plan (a) compared with the conventional radiotherapy plan (b). Isodose lines are 72 Gy (grey), 70 Gy (red), 66 Gy (khaki), 60 Gy (green), 56 Gy (light blue) and 30 Gy (purple).
Figure 2
Figure 2
Coronal views demonstrating increased dose to the brachial plexus (contoured in purple) from the intensity-modulated radiotherapy plan (a) compared with the conventional radiotherapy plan (b) for the patient from Figure 1. Isodose lines are 72 Gy (grey), 70 Gy (red), 66 Gy (khaki), 60 Gy (green), 56 Gy (light blue), and 30 Gy (purple).
Figure 3
Figure 3
Sagittal views demonstrating increased dose to the brachial plexus (contoured in purple) from the intensity-modulated radiotherapy plan (a) compared with the radiotherapy plan (b) for the patient from Figure 1. Isodose lines are 72 Gy (grey), 70 Gy (red), 66 Gy (khaki), 60 Gy (green), 56 Gy (light blue) and 30 Gy (purple).
Figure 4
Figure 4
Dose-volume histograms of the brachial plexus from the intensity-modulated radiotherapy plan (solid line) and the conventional radiotherapy plan (dotted line) for the patient from Figure 1.
See this image and copyright information in PMC

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