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. 2010 Oct 15:5:93.
doi: 10.1186/1748-717X-5-93.

Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients

Marta Scorsetti  1 , Antonella Fogliata, Simona Castiglioni, Caterina Bressi, Mario Bignardi, Piera Navarria, Pietro Mancosu, Luca Cozzi, Sara Pentimalli, Filippo Alongi, Armando Santoro
Affiliations

Early clinical experience with volumetric modulated arc therapy in head and neck cancer patients

Marta Scorsetti et al. Radiat Oncol. .

Abstract

Background: To report about early clinical experience in radiation treatment of head and neck cancer of different sites and histology by volumetric modulated arcs with the RapidArc technology.

Methods: During 2009, 45 patients were treated at Istituto Clinico Humanitas with RapidArc (28 males and 17 females, median age 65 years). Of these, 78% received concomitant chemotherapy. Thirty-six patients were treated as exclusive curative intent (group A), three as postoperative curative intent (group B) and six with sinonasal tumours (group C). Dose prescription was at Planning Target Volumes (PTV) with simultaneous integrated boost: 54.45 Gy and 69.96 Gy in 33 fractions (group A); 54.45 Gy and 66 Gy in 33 fractions (group B) and 55 Gy in 25 fractions (group C).

Results: Concerning planning optimization strategies and constraints, as per PTV coverage, for all groups, D98% > 95% and V95% > 99%. As regards organs at risk, all planning objectives were respected, and this was correlated with observed acute toxicity rates. Only 28% of patients experienced G3 mucositis, 14% G3 dermitis 44% had G2 dysphagia. Nobody required feeding tubes to be placed during treatment. Acute toxicity is also related to chemotherapy. Two patients interrupted the course of radiotherapy because of a quick worsening of general clinical condition.

Conclusions: These preliminary results stated that volumetric modulated arc therapy in locally advanced head and neck cancers is feasible and effective, with acceptable toxicities.

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Figures

Figure 1
Figure 1
Dose distributions for two patients (upper row from Group A, lower row from Group C) for axial, coronal and sagittal views. CTV, PTV, and OARs are outlined.
Figure 2
Figure 2
First row: average (over all patients) DVH for CTV and PTV high dose, with 1SD as dotted lines. Second row: average (divided for groups A and B) DVH for CTV and PTV low dose, with 1SD as dotted lines.
Figure 3
Figure 3
Average DVHs for OARs, with 1SD as dotted lines, divided for Group A+B and Group C.
See this image and copyright information in PMC

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