Simple Carotid-Sparing Intensity-Modulated Radiotherapy Technique and Preliminary Experience for T1-2 Glottic Cancer

David I. Rosenthal; Clifton D. Fuller; Jerry L. Barker; Bryan Mason; John A. Garcia; Jan S. Lewin; F. Christopher Holsinger; C. Richard Stasney; Steven J. Frank; David L. Schwartz; William H. Morrison; Adam S. Garden; K. Kian Ang

doi:10.1016/j.ijrobp.2009.04.061

Simple Carotid-Sparing Intensity-Modulated Radiotherapy Technique and Preliminary Experience for T1-2 Glottic Cancer

David I. Rosenthal, Clifton D. Fuller, Jerry L. Barker, Bryan Mason, John A. Garcia, Jan S. Lewin, F. Christopher Holsinger, C. Richard Stasney, Steven J. Frank, David L. Schwartz, William H. Morrison, Adam S. Garden, K. Kian Ang

Research output: Contribution to journal › Article › peer-review

77 Scopus citations

Abstract

Purpose: To investigate the dosimetry and feasibility of carotid-sparing intensity-modulated radiotherapy (IMRT) for early glottic cancer and to report preliminary clinical experience. Methods and Materials: Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) datasets from 6 T1-2 conventionally treated glottic cancer patients were used to create both conventional IMRT plans. We developed a simplified IMRT planning algorithm with three fields and limited segments. Conventional and IMRT plans were compared using generalized equivalent uniform dose and dose-volume parameters for in-field carotid arteries, target volumes, and organs at risk. We have treated 11 patients with this simplified IMRT technique. Results: Intensity-modulated radiotherapy consistently reduced radiation dose to the carotid arteries (p < 0.05) while maintaining the clinical target volume coverage. With conventional planning, median carotid V35, V50, and V63 were 100%, 100%, and 69.0%, respectively. With IMRT planning these decreased to 2%, 0%, and 0%, respectively (p < 0.01). Radiation planning and treatment times were similar for conventional radiotherapy and IMRT. Treatment results have been excellent thus far. Conclusions: Intensity-modulated radiotherapy significantly reduced unnecessary radiation dose to the carotid arteries compared with conventional lateral fields while maintaining clinical target volume coverage. Further experience and longer follow-up will be required to demonstrate outcomes for cancer control and carotid artery effects.

Original language	English (US)
Pages (from-to)	455-461
Number of pages	7
Journal	International Journal of Radiation Oncology Biology Physics
Volume	77
Issue number	2
DOIs	https://doi.org/10.1016/j.ijrobp.2009.04.061
State	Published - Jun 1 2010

Keywords

Glottic cancer
IMRT
Larynx
Radiotherapy

ASJC Scopus subject areas

Radiation
Oncology
Radiology Nuclear Medicine and imaging
Cancer Research

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10.1016/j.ijrobp.2009.04.061

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Rosenthal, D. I., Fuller, C. D., Barker, J. L., Mason, B., Garcia, J. A., Lewin, J. S., Holsinger, F. C., Stasney, C. R., Frank, S. J., Schwartz, D. L., Morrison, W. H., Garden, A. S., & Ang, K. K. (2010). Simple Carotid-Sparing Intensity-Modulated Radiotherapy Technique and Preliminary Experience for T1-2 Glottic Cancer. International Journal of Radiation Oncology Biology Physics, 77(2), 455-461. https://doi.org/10.1016/j.ijrobp.2009.04.061

Rosenthal, DI, Fuller, CD, Barker, JL, Mason, B, Garcia, JA, Lewin, JS, Holsinger, FC, Stasney, CR, Frank, SJ, Schwartz, DL, Morrison, WH, Garden, AS & Ang, KK 2010, 'Simple Carotid-Sparing Intensity-Modulated Radiotherapy Technique and Preliminary Experience for T1-2 Glottic Cancer', International Journal of Radiation Oncology Biology Physics, vol. 77, no. 2, pp. 455-461. https://doi.org/10.1016/j.ijrobp.2009.04.061

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abstract = "Purpose: To investigate the dosimetry and feasibility of carotid-sparing intensity-modulated radiotherapy (IMRT) for early glottic cancer and to report preliminary clinical experience. Methods and Materials: Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) datasets from 6 T1-2 conventionally treated glottic cancer patients were used to create both conventional IMRT plans. We developed a simplified IMRT planning algorithm with three fields and limited segments. Conventional and IMRT plans were compared using generalized equivalent uniform dose and dose-volume parameters for in-field carotid arteries, target volumes, and organs at risk. We have treated 11 patients with this simplified IMRT technique. Results: Intensity-modulated radiotherapy consistently reduced radiation dose to the carotid arteries (p < 0.05) while maintaining the clinical target volume coverage. With conventional planning, median carotid V35, V50, and V63 were 100%, 100%, and 69.0%, respectively. With IMRT planning these decreased to 2%, 0%, and 0%, respectively (p < 0.01). Radiation planning and treatment times were similar for conventional radiotherapy and IMRT. Treatment results have been excellent thus far. Conclusions: Intensity-modulated radiotherapy significantly reduced unnecessary radiation dose to the carotid arteries compared with conventional lateral fields while maintaining clinical target volume coverage. Further experience and longer follow-up will be required to demonstrate outcomes for cancer control and carotid artery effects.",

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AU - Fuller, Clifton D.

AU - Barker, Jerry L.

AU - Mason, Bryan

AU - Garcia, John A.

AU - Lewin, Jan S.

AU - Holsinger, F. Christopher

AU - Stasney, C. Richard

AU - Frank, Steven J.

AU - Schwartz, David L.

AU - Morrison, William H.

AU - Garden, Adam S.

AU - Ang, K. Kian

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AB - Purpose: To investigate the dosimetry and feasibility of carotid-sparing intensity-modulated radiotherapy (IMRT) for early glottic cancer and to report preliminary clinical experience. Methods and Materials: Digital Imaging and Communications in Medicine radiotherapy (DICOM-RT) datasets from 6 T1-2 conventionally treated glottic cancer patients were used to create both conventional IMRT plans. We developed a simplified IMRT planning algorithm with three fields and limited segments. Conventional and IMRT plans were compared using generalized equivalent uniform dose and dose-volume parameters for in-field carotid arteries, target volumes, and organs at risk. We have treated 11 patients with this simplified IMRT technique. Results: Intensity-modulated radiotherapy consistently reduced radiation dose to the carotid arteries (p < 0.05) while maintaining the clinical target volume coverage. With conventional planning, median carotid V35, V50, and V63 were 100%, 100%, and 69.0%, respectively. With IMRT planning these decreased to 2%, 0%, and 0%, respectively (p < 0.01). Radiation planning and treatment times were similar for conventional radiotherapy and IMRT. Treatment results have been excellent thus far. Conclusions: Intensity-modulated radiotherapy significantly reduced unnecessary radiation dose to the carotid arteries compared with conventional lateral fields while maintaining clinical target volume coverage. Further experience and longer follow-up will be required to demonstrate outcomes for cancer control and carotid artery effects.

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Simple Carotid-Sparing Intensity-Modulated Radiotherapy Technique and Preliminary Experience for T1-2 Glottic Cancer

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