Emphasizing Conformal Avoidance Versus Target Definition for IMRT Planning in Head-and-Neck Cancer

Paul M. Harari, Shiyu Song, Wolfgang A. Tome

Research output: Contribution to journalArticle

25 Citations (Scopus)

Abstract

Purpose: To describe a method for streamlining the process of elective nodal volume definition for head-and-neck (H&N) intensity-modulated radiotherapy (IMRT) planning. Methods and Materials: A total of 20 patients who had undergone curative-intent RT for H&N cancer underwent comprehensive treatment planning using three distinct, plan design techniques: conventional three-field design, target-defined IMRT (TD-IMRT), and conformal avoidance IMRT (CA-IMRT). For each patient, the conventional three-field design was created first, thereby providing the "outermost boundaries" for subsequent IMRT design. In brief, TD-IMRT involved physician contouring of the gross tumor volume, high- and low-risk clinical target volume, and normal tissue avoidance structures on consecutive 1.25-mm computed tomography images. CA-IMRT involved physician contouring of the gross tumor volume and normal tissue avoidance structures only. The overall physician time for each approach was monitored, and the resultant plans were rigorously compared. Results: The average physician working time for the design of the respective H&N treatment contours was 0.3 hour for the conventional three-field design plan, 2.7 hours for TD-IMRT, and 0.9 hour for CA-IMRT. Dosimetric analysis confirmed that the largest volume of tissue treated to an intermediate (50 Gy) and high (70 Gy) dose occurred with the conventional three-field design followed by CA-IMRT and then TD-IMRT. However, for the two IMRT approaches, comparable results were found in terms of salivary gland and spinal cord protection. Conclusion: CA-IMRT for H&N treatment offers an alternative to TD-IMRT. The overall time for physician contouring was substantially reduced (approximately threefold), yielding a more standardized elective nodal volume. Because of the complexity of H&N IMRT target design, CA-IMRT might ultimately prove a safer and more reliable method to export to general radiation oncology practitioners, particularly those with limited H&N caseload experience.

Original languageEnglish (US)
Pages (from-to)950-958
Number of pages9
JournalInternational Journal of Radiation Oncology Biology Physics
Volume77
Issue number3
DOIs
StatePublished - 2010
Externally publishedYes

Fingerprint

Intensity-Modulated Radiotherapy
avoidance
Head and Neck Neoplasms
planning
radiation therapy
cancer
physicians
Physicians
Tumor Burden
Radiation Oncology
tumors
streamlining
Salivary Glands
salivary glands
spinal cord
Spinal Cord
Neck
Therapeutics
Head
Tomography

Keywords

  • clinical target volume
  • conformal avoidance
  • CTV
  • gross tumor volume
  • GTV
  • Head-and-neck intensity-modulated radiotherapy
  • IMRT
  • target definition

ASJC Scopus subject areas

  • Oncology
  • Radiology Nuclear Medicine and imaging
  • Radiation
  • Cancer Research

Cite this

Emphasizing Conformal Avoidance Versus Target Definition for IMRT Planning in Head-and-Neck Cancer. / Harari, Paul M.; Song, Shiyu; Tome, Wolfgang A.

In: International Journal of Radiation Oncology Biology Physics, Vol. 77, No. 3, 2010, p. 950-958.

Research output: Contribution to journalArticle

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AB - Purpose: To describe a method for streamlining the process of elective nodal volume definition for head-and-neck (H&N) intensity-modulated radiotherapy (IMRT) planning. Methods and Materials: A total of 20 patients who had undergone curative-intent RT for H&N cancer underwent comprehensive treatment planning using three distinct, plan design techniques: conventional three-field design, target-defined IMRT (TD-IMRT), and conformal avoidance IMRT (CA-IMRT). For each patient, the conventional three-field design was created first, thereby providing the "outermost boundaries" for subsequent IMRT design. In brief, TD-IMRT involved physician contouring of the gross tumor volume, high- and low-risk clinical target volume, and normal tissue avoidance structures on consecutive 1.25-mm computed tomography images. CA-IMRT involved physician contouring of the gross tumor volume and normal tissue avoidance structures only. The overall physician time for each approach was monitored, and the resultant plans were rigorously compared. Results: The average physician working time for the design of the respective H&N treatment contours was 0.3 hour for the conventional three-field design plan, 2.7 hours for TD-IMRT, and 0.9 hour for CA-IMRT. Dosimetric analysis confirmed that the largest volume of tissue treated to an intermediate (50 Gy) and high (70 Gy) dose occurred with the conventional three-field design followed by CA-IMRT and then TD-IMRT. However, for the two IMRT approaches, comparable results were found in terms of salivary gland and spinal cord protection. Conclusion: CA-IMRT for H&N treatment offers an alternative to TD-IMRT. The overall time for physician contouring was substantially reduced (approximately threefold), yielding a more standardized elective nodal volume. Because of the complexity of H&N IMRT target design, CA-IMRT might ultimately prove a safer and more reliable method to export to general radiation oncology practitioners, particularly those with limited H&N caseload experience.

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