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Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results.

Publication ,  Journal Article
Wu, Q; Mohan, R; Morris, M; Lauve, A; Schmidt-Ullrich, R
Published in: Int J Radiat Oncol Biol Phys
June 1, 2003

PURPOSE: This report describes the dosimetric analyses of a Phase I/II protocol, designed to examine the capabilities of an institutionally developed intensity-modulated radiotherapy (IMRT) system with respect to dose escalation. The protocol employed stringent dosimetric guidelines in the treatment of locally advanced head-and-neck squamous cell carcinomas (HNSCC) with radiotherapy alone using IMRT and the simultaneous integrated boost (SIB) technique. METHODS AND MATERIALS: The first 14 patients enrolled on the protocol were included in this analysis. Escalating doses of 68.1 Gy (6 patients), 70.8 Gy (6 patients), and 73.8 Gy (2 patients) were delivered to the gross tumor volume (GTV) in 30 fractions. Simultaneously, constant dose coverage was given to the subclinical disease and the electively treated nodal regions, which received 60 Gy and 54 Gy, respectively, in all three cohorts. Parotid glands were spared to the degree possible without compromising target coverage. The following indices are reported for the GTV: (1) dose to specified percent volumes (e.g., D(98) and D(2)); (2) homogeneity index defined as the ratio (D(2) - D(98))/D(prescription); (3) biologically equivalent uniform dose (EUD); and (4) an index of conformality, PITV, defined as the ratio of volume enclosed within the prescribed isodose surface to the target volume. Treatments were planned and delivered with nine 6-MV photon beams using the multileaf collimator (MLC) "sliding window" technique. RESULTS: Mean doses to 98% of GTV were 68.4 Gy, 70.5 Gy, and 70.8 Gy, and average GTV dose homogeneity was 6.7%, 7.6%, and 8.8% for the three cohorts. The average doses to the parotid gland proximal to and distant from GTV were 41.3 Gy and 25.7 Gy, respectively. Dose distributions measured in phantom showed good agreement with calculations. CONCLUSIONS: Treatment of locally advanced HNSCC using SIB-IMRT as described is feasible. Treatment planning and delivery are safer and more efficient than with conventional three-dimensional processes. Predicted dose distributions can be accurately delivered with excellent conformality using dynamic MLC. At least one of the parotid glands can be adequately spared. Patient follow-up continues and will allow eventual quantitative correlation of delivered dose distributions with clinical outcomes.

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Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

June 1, 2003

Volume

56

Issue

2

Start / End Page

573 / 585

Location

United States

Related Subject Headings

  • Radiotherapy, Conformal
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Humans
  • Head and Neck Neoplasms
  • Feasibility Studies
  • Cohort Studies
  • Carcinoma, Squamous Cell
  • 5105 Medical and biological physics
  • 3407 Theoretical and computational chemistry
 

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Wu, Q., Mohan, R., Morris, M., Lauve, A., & Schmidt-Ullrich, R. (2003). Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys, 56(2), 573–585. https://doi.org/10.1016/s0360-3016(02)04617-5
Wu, Qiuwen, Radhe Mohan, Monica Morris, Andrew Lauve, and Rupert Schmidt-Ullrich. “Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results.Int J Radiat Oncol Biol Phys 56, no. 2 (June 1, 2003): 573–85. https://doi.org/10.1016/s0360-3016(02)04617-5.
Wu Q, Mohan R, Morris M, Lauve A, Schmidt-Ullrich R. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):573–85.
Wu, Qiuwen, et al. “Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results.Int J Radiat Oncol Biol Phys, vol. 56, no. 2, June 2003, pp. 573–85. Pubmed, doi:10.1016/s0360-3016(02)04617-5.
Wu Q, Mohan R, Morris M, Lauve A, Schmidt-Ullrich R. Simultaneous integrated boost intensity-modulated radiotherapy for locally advanced head-and-neck squamous cell carcinomas. I: dosimetric results. Int J Radiat Oncol Biol Phys. 2003 Jun 1;56(2):573–585.
Journal cover image

Published In

Int J Radiat Oncol Biol Phys

DOI

ISSN

0360-3016

Publication Date

June 1, 2003

Volume

56

Issue

2

Start / End Page

573 / 585

Location

United States

Related Subject Headings

  • Radiotherapy, Conformal
  • Radiotherapy Dosage
  • Oncology & Carcinogenesis
  • Humans
  • Head and Neck Neoplasms
  • Feasibility Studies
  • Cohort Studies
  • Carcinoma, Squamous Cell
  • 5105 Medical and biological physics
  • 3407 Theoretical and computational chemistry