Beam Path Toxicities to Non-target Structures During Intensity-modulated Radiation Therapy for Head and Neck Cancer

Overview

Journal Int J Radiat Oncol Biol Phys

Specialties Oncology
Radiology

Date 2008 May 6

PMID 18455324

Citations 61

Authors

David I Rosenthal

Mark S Chambers

Clifton D Fuller

Neal C S Rebueno

John Garcia

Merrill S Kies

William H Morrison

K Kian Ang

Adam S Garden

Affiliations

Soon will be listed here.

Abstract

Background: Intensity-modulated radiation therapy (IMRT) beams traverse nontarget normal structures not irradiated during three-dimensional conformal RT (3D-CRT) for head and neck cancer (HNC). This study estimates the doses and toxicities to nontarget structures during IMRT.

Materials And Methods: Oropharyngeal cancer IMRT and 3D-CRT cases were reviewed. Dose-volume histograms (DVH) were used to evaluate radiation dose to the lip, cochlea, brainstem, occipital scalp, and segments of the mandible. Toxicity rates were compared for 3D-CRT, IMRT alone, or IMRT with concurrent cisplatin. Descriptive statistics and exploratory recursive partitioning analysis were used to estimate dose "breakpoints" associated with observed toxicities.

Results: A total of 160 patients were evaluated for toxicity; 60 had detailed DVH evaluation and 15 had 3D-CRT plan comparison. Comparing IMRT with 3D-CRT, there was significant (p </= 0.002) nonparametric differential dose to all clinically significant structures of interest. Thirty percent of IMRT patients had headaches and 40% had occipital scalp alopecia. A total of 76% and 38% of patients treated with IMRT alone had nausea and vomiting, compared with 99% and 68%, respectively, of those with concurrent cisplatin. IMRT had a markedly distinct toxicity profile than 3D-CRT. In recursive partitioning analysis, National Cancer Institute's Common Toxicity Criteria adverse effects 3.0 nausea and vomiting, scalp alopecia and anterior mucositis were associated with reconstructed mean brainstem dose >36 Gy, occipital scalp dose >30 Gy, and anterior mandible dose >34 Gy, respectively.

Conclusions: Dose reduction to specified structures during IMRT implies an increased beam path dose to alternate nontarget structures that may result in clinical toxicities that were uncommon with previous, less conformal approaches. These findings have implications for IMRT treatment planning and research, toxicity assessment, and multidisciplinary patient management.

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References

Hoppe B, Stegman L, Zelefsky M, Rosenzweig K, Wolden S, Patel S . Treatment of nasal cavity and paranasal sinus cancer with modern radiotherapy techniques in the postoperative setting--the MSKCC experience. Int J Radiat Oncol Biol Phys. 2006; 67(3):691-702. DOI: 10.1016/j.ijrobp.2006.09.023. View

Meeks S, Paulino A, Pennington E, Simon J, Skwarchuk M, Buatti J . In vivo determination of extra-target doses received from serial tomotherapy. Radiother Oncol. 2002; 63(2):217-22. DOI: 10.1016/s0167-8140(02)00074-9. View

Alexander 3rd E, Siddon R, Loeffler J . The acute onset of nausea and vomiting following stereotactic radiosurgery: correlation with total dose to area postrema. Surg Neurol. 1989; 32(1):40-4. DOI: 10.1016/0090-3019(89)90033-5. View

Wilkens J, Alaly J, Zakarian K, Thorstad W, Deasy J . IMRT treatment planning based on prioritizing prescription goals. Phys Med Biol. 2007; 52(6):1675-92. DOI: 10.1088/0031-9155/52/6/009. View

Cooper J, Farnan N, Asbell S, Rotman M, MARCIAL V, Fu K . Recursive partitioning analysis of 2105 patients treated in Radiation Therapy Oncology Group studies of head and neck cancer. Cancer. 1996; 77(9):1905-11. DOI: 10.1002/(SICI)1097-0142(19960501)77:9<1905::AID-CNCR22>3.0.CO;2-2. View

Wang X, Zhang X, Dong L, Liu H, Gillin M, Ahamad A . Effectiveness of noncoplanar IMRT planning using a parallelized multiresolution beam angle optimization method for paranasal sinus carcinoma. Int J Radiat Oncol Biol Phys. 2005; 63(2):594-601. DOI: 10.1016/j.ijrobp.2005.06.006. View

Aoyama H, Westerly D, Rockwell Mackie T, Olivera G, Bentzen S, Patel R . Integral radiation dose to normal structures with conformal external beam radiation. Int J Radiat Oncol Biol Phys. 2006; 64(3):962-7. DOI: 10.1016/j.ijrobp.2005.11.005. View

Kris M, Hesketh P, Somerfield M, Feyer P, Clark-Snow R, Koeller J . American Society of Clinical Oncology guideline for antiemetics in oncology: update 2006. J Clin Oncol. 2006; 24(18):2932-47. DOI: 10.1200/JCO.2006.06.9591. View

Forastiere A, Goepfert H, Maor M, Pajak T, Weber R, Morrison W . Concurrent chemotherapy and radiotherapy for organ preservation in advanced laryngeal cancer. N Engl J Med. 2003; 349(22):2091-8. DOI: 10.1056/NEJMoa031317. View

10.

Li Y, Taylor J, Ten Haken R, Eisbruch A . The impact of dose on parotid salivary recovery in head and neck cancer patients treated with radiation therapy. Int J Radiat Oncol Biol Phys. 2006; 67(3):660-9. PMC: 2001308. DOI: 10.1016/j.ijrobp.2006.09.021. View

11.

Amdur R, Li J, Liu C, Hinerman R, Mendenhall W . Unnecessary laryngeal irradiation in the IMRT era. Head Neck. 2004; 26(3):257-63. DOI: 10.1002/hed.10379. View

12.

de Arruda F, Puri D, Zhung J, Narayana A, Wolden S, Hunt M . Intensity-modulated radiation therapy for the treatment of oropharyngeal carcinoma: the Memorial Sloan-Kettering Cancer Center experience. Int J Radiat Oncol Biol Phys. 2005; 64(2):363-73. DOI: 10.1016/j.ijrobp.2005.03.006. View

13.

Ling C, Yorke E, Fuks Z . From IMRT to IGRT: frontierland or neverland?. Radiother Oncol. 2006; 78(2):119-22. DOI: 10.1016/j.radonc.2005.12.005. View

14.

Hand D . Statistical methods in diagnosis. Stat Methods Med Res. 1992; 1(1):49-67. DOI: 10.1177/096228029200100104. View

15.

Garden A, Morrison W, Wong P, Tung S, Rosenthal D, Dong L . Disease-control rates following intensity-modulated radiation therapy for small primary oropharyngeal carcinoma. Int J Radiat Oncol Biol Phys. 2006; 67(2):438-44. PMC: 4125020. DOI: 10.1016/j.ijrobp.2006.08.078. View

16.

van Vulpen M, Field C, Raaijmakers C, Parliament M, Terhaard C, Mackenzie M . Comparing step-and-shoot IMRT with dynamic helical tomotherapy IMRT plans for head-and-neck cancer. Int J Radiat Oncol Biol Phys. 2005; 62(5):1535-9. DOI: 10.1016/j.ijrobp.2005.04.011. View

17.

Hall E . Cancer caused by x-rays--a random event?. Lancet Oncol. 2007; 8(5):369-70. DOI: 10.1016/S1470-2045(07)70113-4. View

18.

Feng M, Eisbruch A . Future issues in highly conformal radiotherapy for head and neck cancer. J Clin Oncol. 2007; 25(8):1009-13. DOI: 10.1200/JCO.2006.10.4638. View

19.

Sheng K, Molloy J, Read P . Intensity-modulated radiation therapy (IMRT) dosimetry of the head and neck: a comparison of treatment plans using linear accelerator-based IMRT and helical tomotherapy. Int J Radiat Oncol Biol Phys. 2006; 65(3):917-23. DOI: 10.1016/j.ijrobp.2006.02.038. View

20.

Fua T, Corry J, Milner A, Cramb J, Walsham S, Peters L . Intensity-modulated radiotherapy for nasopharyngeal carcinoma: clinical correlation of dose to the pharyngo-esophageal axis and dysphagia. Int J Radiat Oncol Biol Phys. 2007; 67(4):976-81. DOI: 10.1016/j.ijrobp.2006.10.028. View